HIPAA is now changing the way health care is insured, documented, compensated, communicated, and policed. In addition to our HIPAA-ready MedLedger™ software, HDS participates with national and regional policy making groups and government regulators in an earnest effort to stay ahead of the 'HIPAA curve.' Get answers to some common HIPAA questions below.

Who's responsible for HIPAA compliance?
Some key points about HIPAA
What is HDS doing about HIPAA?
What makes an electronic claim "HIPAA-Compliant"?
Why do some payers pay claims that aren’t “perfect” and some don’t?
We’re moving from paper to electronic claims. What do we need in order to get a claim to a payer without it rejecting?
MedLedger™—Powerful technology for HIPAA
Edifecs Certification: Excellence Squared.

Who's Responsible for HIPAA Compliance?
Make no mistake, the responsibility for HIPAA compliance rests squarely on the shoulders of providers. To be HIPAA compliant, a provider must address several areas with respect to the HIPAA Transactions, Code Sets and Privacy regulations. One of the most important things a provider must have is a trusted relationship with a knowledgeable vendor. However, it is a crucial mistake to assume that your vendor will take care of everything for you. The truth is, the vendor has no legal responsibility to assure your practice is compliant and because HIPAA is so broad in scope, any software application — in and of itself — can’t provide a solution. Because Health Data Services provides clearinghouse services (among other services), HIPAA classifies us as a covered entity, as is a provider. We have a duty to our clients to remain abreast of and comply with HIPAA within the context of a clearinghouse as well as other relevant regulations.
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Some Key Points About HIPAA:

• HIPAA is not going away
• HIPAA is constantly evolving
• HIPAA compliance is a moving target
• HIPAA compliance requires a trusted provider-vendor relationship to reduce cost and create value

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What is HDS Doing About HIPAA?
At HDS, we educate our clients. We provide you with expertise and tools to make HIPAA compliance easier. Our MedLedger™ software provides all HIPAA data fields and meets or exceeds all security and privacy requirements. Additionally, HDS participates with national and regional policy making groups and government regulators in order to provide our clients with accurate and timely information.
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What makes an Electronic Claim “HIPAA Compliant”?
This is one of the most misunderstood sections of the HIPAA regulations. A HIPAA compliant claim is hard to define because the definition is open to interpretation and the regulations are ambiguous. To explain it in simple terms, a HIPAA compliant claim (known in HIPAA parlance as a “standard transaction”) is one that meets the criteria contained in the HIPAA law and meets the data requirements of the individual payer you’re sending the claim to. While it’s true that payers cannot reject a “compliant claim”, the payers have great latitude to define what a complaint claim is. The most important point is: payers can and will demand data specifically to meet their needs. Each and every payer has payer specific “edits” which must be present in order for the claim to be accepted by them as “compliant” and these requirements are constantly changing.
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Why do some payers pay claims that aren’t “perfect” and some don’t?
This is one of the most hotly contested parts of HIPAA Transactions. Some payers have adopted an “all or nothing” 100% compliance stance — meaning that all of the data has to be 100% accurate, including the correct ICD-9 code, the correct CPT code, the correct zip code, etc., and be sent in the proper HIPAA format before a payer will even consider paying the claim. Other payers accept “less than 100%” compliant claims. This makes it almost impossible for a provider to send electronic claims without vendor assistance. HDS provides these services.
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We’re moving from paper to electronic claims. What do we need in order to get a claim to a payer without it rejecting?
In order for your practice to submit HIPAA compliant claims and minimize rejections, you need to go through several steps:

A provider is responsible for:

1. Knowing what information a specific payer requires in order to pay a claim.
2. Gather that information from the patient or other sources.
3. Knowing the correct codes for the encounter.

A provider needs the expertise of HDS to:

1. Provide software that contains all HIPAA data fields.
2. Provide claim editing to output the data in HIPAA format, thus minimizing rejections.
3. Ensure secure claims output to the payer.
4. Access detailed information with regard to the claim status after it’s entered the system. With MedLedger™, your office has the ability to track any claim to determine its latest status.

MedLedger™—Powerful Technology For HIPAA
Health Data Services developed MedLedger™ — from the ground up — to generate HIPAA compliant electronic claims. Many of our competitors are trying to patch their existing software with new "add-ons" to comply with HIPAA datasets — a risky proposition. MedLedger™ meets HIPAA’s proposed transaction set, and meets or exceeds security and approved privacy standards — with no add-ons.MedLedger™ provides HIPAA data sets for Professional and Institutional transactions.
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Claredi and Edifecs HIPAA Certification
To make good on its commitment to excellence, HDS has taken an additional, voluntary quality-assurance step. In 2002, HDS began HIPAA certification testing with nationally-recognized authority for independent HIPAA transaction certification, Claredi. HDS earned Claredi certification for the 837 Professional and Institutional claims. Claredi. In 2003, HDS began certification with another recognized authority, Edifecs, with whom we have also earned certification. Many vendors are not making this voluntary commitment, but HDS believes in leaving nothing to chance when it comes to quality-assurance for our clients. The result is that HDS produces clean, HIPAA compliant claims.

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