Title I: Healthcare Access, Portability and Renewability

Title I of HIPAA addresses health insurance policies within the confines of a person’s employment. Under Title I, HIPAA sets guidelines for what an employer can and cannot do with an employee’s healthcare plan as provided by the employer. Specifically, Title I protects health insurance coverage for employees and their dependents by making healthcare plans available to those who have either lost their job or those who are in the process of switching employers.

Title I protects employees by modifying and improving the Consolidated Omnibus Reconciliation Act of 1985 (COBRA). Title I of HIPAA has extended healthcare benefits already offered by COBRA, including extending the duration of benefits of disabled persons eligible for COBRA from 18 to 36 months. Title I also allowed dependents of a person covered under COBRA to continue to receive the same healthcare coverage as they did when that person was employed with health benefits.

Title I also addresses how health insurance companies treat patients with pre-existing conditions. Before HIPAA, a person with a pre-existing condition may have had trouble finding a healthcare plan that covers their medical expenses because commercial insurance companies would consider them too risky to cover. Under Title I, insurance companies are limited in the number of restrictions they can put into place in their healthcare plans for people with pre-existing conditions.

For medical billing and coding professionals, Title I is important because it ensures that more people are eligible for health insurance. Because of the laws set forth in Title I, you will process claims that involve patients covered by COBRA or those with pre-existing conditions that still receive coverage owing to this act.

Title I of HIPAA addresses health insurance policies within the confines of a person’s employment. Under Title I, HIPAA sets guidelines for what an employer can and cannot do with an employee’s healthcare plan as provided by the employer. Specifically, Title I protects health insurance coverage for employees and their dependents by making healthcare plans available to those who have either lost their job or those who are in the process of switching employers.

Title I protects employees by modifying and improving the Consolidated Omnibus Reconciliation Act of 1985 (COBRA). Title I of HIPAA has extended healthcare benefits already offered by COBRA, including extending the duration of benefits of disabled persons eligible for COBRA from 18 to 36 months. Title I also allowed dependents of a person covered under COBRA to continue to receive the same healthcare coverage as they did when that person was employed with health benefits.

Title I also addresses how health insurance companies treat patients with pre-existing conditions. Before HIPAA, a person with a pre-existing condition may have had trouble finding a healthcare plan that covers their medical expenses because commercial insurance companies would consider them too risky to cover. Under Title I, insurance companies are limited in the number of restrictions they can put into place in their healthcare plans for people with pre-existing conditions.

For medical billing and coding professionals, Title I is important because it ensures that more people are eligible for health insurance. Because of the laws set forth in Title I, you will process claims that involve patients covered by COBRA or those with pre-existing conditions that still receive coverage owing to this act.

Title II: Preventing Medical Healthcare Fraud and Abuse, Administrative Simplification and Medical Liability Reform

Title II addresses many more concerns relevant to the medical billing and coding field, namely, security and privacy requirements for handling a patient’s medical records and methods to simplify the billing and processing of claims. In addition, it establishes guidelines for electronic record-keeping and electronic transactions between parties in the healthcare system.

Title II also stipulates how healthcare providers and insurance companies should avoid fraudulent activity. The law puts the Officer of the Inspector General (OIG) of the Department of Health and Human Services (DHHS) in charge of investigating and if necessary, prosecuting those who commit fraud. Your responsibilities as a medical billing specialist will be discussed in the next section of this lesson.

The Privacy Rule

Title II expands security and privacy measures within the healthcare system with the creation of the Privacy Rule and the Security Rule. The Privacy Rule addresses how insurance companies and providers can handle patient information by regulating how they disclose the information to each other and to other entities that may require medical data. Under the Privacy Rule, medical billing and coding specialists must be careful not to share a patient’s Protected Health Information (PHI) with parties that aren’t covered entities (providers, insurance companies, etc.) as stipulated by Title II. A patient’s PHI includes the following data:

- The patient’s medical record, including present and past medical conditions or illnesses and treatments received for them

- The location and type of healthcare provider wherein the patient received care

- Any and all fees paid by the patient or a patient’s insurance company to cover healthcare expenses rendered by a provider

The Security Rule

The Security Rule, on the other hand, establishes the rules for protecting a person’s information and also explains how those rules can be enforced if necessary. The security rule explains how covered entities must collaborate to protect patient medical information. Part of this collaboration involves the creation of computerized physician order entry (CPOE) systems and electronic healthcare records (EHRs) that medical billing and coding specialists use every day to file and process claims. The Security Rule also requires that any technologies developed by covered entities to facilitate their administrative work must be secure and up to standards established by HIPAA.

Title II also creates unique identifiers for providers, employers, and patients in an attempt to optimize communication between entities in the healthcare system and universalize the billing process. This is done in accordance with the Electronic Data Interchange (EDI) Rule set forth in Title II. The unique identifiers created for the EDI are either individual numbers or code sets assigned to covered entities for the use of EDI.