Federal law designed to limit exclusions for preexisting conditions, prohibit discrimination against employees and dependents based on their health status, guarantee that health insurance is available to small employers, and guarantee renewability of insurance to all employers regardless of size. However, people must go through the Consolidated Omnibus Budget Reconciliation Act program before using HIPAA. HIPAA allows portability in that it provides continuing insurance coverage when a person changes employment. It also simplifies administrative aspects of electronic health care transactions; mandates standard transaction code sets used by providers, plans, payers, and employers; and orders security, privacy, and confidentiality of patients’ health information via electronic transmission. HIPAA requires use of national identification systems for health care patients, providers, payers or plans, and employers. This act is also known as K2, Kennedy-Kasselbaum Bill, Kennedy-Kassenbaum Bill , and Public law 104-191 .

Code system for procedures that is used when billing Medicare patients in skilled nursing facilities, home health agencies, inpatient rehabilitation facilities, and swing bed facilities in rural hospitals. HIPPS codes are alphanumerical codes of five digits: The first three are derived from the resource utilization group (RUG), and the last two represent a modifier code for the specific assessment. This code is put in Form Locator 44 on the UB-04 Medicare claim form. Any patient coded in one of the top 26 RUGs is a skilled patient.

Entity that provides for or arranges for the provision of care and contracts on a prepaid capitated risk basis to provide a comprehensive set of services. This may involve state or federal programs such as Medicaid or Medicare beneficiaries. HIOs contract with providers on a discounted fee-for-service or a capitated basis to provide medical services.

Provides professional training and certification for those responsible for planning, selecting, implementing, and managing electronic health records (EHRs) and other health information technology (HIT). See Certified Professional in Electronic Health Records (CPEHR) and Certified Professional in Health Information Technology (CPHIT) . Website: www.HealthITCertification.com

Standard protocols and encoding rules published for developers to apply in the health industry. These were created by the Accredited Standards Committee X12 (ASC X12), a committee formed by American National Standards Institute (ANSI). HL7 sets some of the electronic standards for exchange of clinical and administrative information in health care applications (see Box H-1 ).Box H-1HEALTH LEVEL SEVEN FORMAT OF DATE AND TIME OF BIRTHTo determine the date and time of a patient’s birth date (e.g., for a neonate, for whom the age in hours might be relevant), the time of the birth, using military time, can be recorded with the birth date. From this, the age can be generated from the date of birth (DOB). Baby Jane was born on March 24, 2007, at 8:26 am .When the required HL7 format is YYYY MMDDHHMM, Baby Jane’s date and time of birth will be entered for transmission as: 200703240826YYYYMMDDHHMM200703240826YearMonthDayHourMinute

Founded in 1987, a nonprofit, American National Standards Institute (ANSI)-accredited standards developing organization dedicated to providing a comprehensive framework and related standards for the exchange, integration, sharing, and retrieval of electronic health information that supports clinical practice and the management, delivery, and evaluation of health services.

Ability to obtain, interpret, and understand basic medical information and health services and the capability to use the data and services to improve health.

Act developed by the National Association of Insurance Commissioners (NAIC) and used by most states as a model for legislation of health maintenance organizations (HMOs). This act mandates that HMOs have a certificate of authority to carry out their business in the state and they must provide the state with detailed financial and qualifying data.