Q

How to find HIPAA transaction code sets and HITECH resources

Complying with HIPAA and the new HITECH regulations is no small matter, and that's where HIPAA transaction code sets and HITECH resources for compliance can help. Learn where to find these resources in this expert response.

Do you have a recommendation for a good HITECH and/or HIPAA security audit resource(s)? I am particularly interested in code sets, transaction codes and HIPAA assessments.
There are a ton of great resources out there concerning transaction codes and code sets. The best resources come directly from the Department of Health and Human Services (HHS). For transactions, HHS also provides a great definition of what transactions are:

"Transactions are electronics exchanges involving the transfer of health care information between two parties for specific purposes, such as a health care provider submitting medical claims to a health plan for payment."

HIPAA mandates that, if covered entities engage in electronic transactions (and really, how many don't?), they must adhere to certain standards that HHS outlines.

Related to transactions are code sets. According to HHS, code sets are:

"Under HIPAA, a "code set" is any set of codes used for encoding data elements, such as tables of terms, medical concepts, medical diagnosis codes, or medical procedure codes. Medical data code sets used in the health care industry include coding systems for diseases, impairments, other health-related problems, and their manifestations; causes of injury, disease, impairment, or other health-related problems; actions taken to prevent, diagnose, treat, or manage diseases, injuries, and impairments; and any substances, equipment, supplies, or other items used to perform these actions."

HHS provides resources on code sets in their FAQ.

In addition to the HHS resources, there are two other great sites you should check out. The first, provided by the American Medical Association (AMA), covers HIPAA in general and has a specific section on Transactions and Code Sets.

Finally the American Academy of Family Physicians has a great article that covers HIPAA, including some great high-level advice on dealing with the regulation, as well as how to transition an organization to HIPAA compliance.

As for HIPAA assessments, there are several good resources also provided by HHS. One resource gives extensive information on safeguards, policies and risk management. Another resource has a great high-level outline of what to expect as part of being audited (.PDF). Finally, HIPAA auditors, as a general rule, use the Medicaid guidelines (.PDF) provided by the Office of the Inspector General of Health and Human Services.

For more information:

  • Check out these key elements of a HIPAA compliance checklist.
  • Also learn more about creating a HIPAA compliance employee training program.
  • This was first published in August 2009

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