Physical Therapy Documentation and HPIAA Standards

HIPAA stands for Health Insurance Portability and Accountability Act which was endorsed by the U.S. Congress in 1995. It provides regulation for the use and/or disclosure of the health information of an individual. HIPAA affects the health care industry directly and indirectly. As a health care provider, it is important to know if HIPAA is applicable to you.

Not all health care providers are covered by HIPAA. You will not be covered by HIPAA if all your physical therapy documentation and transactions are all conducted without using electronic transmission – this means using paper, telephone or fax from a dedicated machine and not from a computer.

In this day and age, seldom would you find a private practitioner that does not use the computer or electronic transmission to handle their physical therapy documentation and business activities. It is best that the health care provider be aware of the HIPAA standards.

When you transmit physical therapy documentation containing health information of a patient in electronic form like insurance claims for care provided, HIPAA transactions and code set standards need to be met.

This means that the HIPAA sets the boundaries for the use and disclosure of the physical therapy documentation a private practitioner have in reference to the health information of a patient. This give patients control on how their health information be used. Privacy and security of health information is given emphasis by HIPAA. It will hold accountable the violators when they disclose personal health information with the consent of the individual. However for the benefit of the public and for national interest, disclosure of physical therapy documentation of the health information can be made without the concerned individual’s consent.

For Medicare claims, a HIPAA-covered private practice should submit physical therapy documentation of their claims electronically following HIPAA standard format. This provision applies only to Medicare claims. Physical therapy documentation in paper of claims can still be submitted to other health plans although most health plans prefer the more cost-effective and efficient electronic transmission.

A private practitioner may continue doing physical therapy documentation and transactions on paper but considerations have to be made on how doing that would impact adversely the Medicare payments. By law, Medicare is prohibited from paying paper claims effective October 16, 2003. Exceptions are made under certain circumstances and small providers. They can still submit claims using paper physical therapy documentation.

As a private practitioner, one has to consider the inefficiencies of handling paper physical therapy documentation. The significant benefits of electronic physical therapy documentation are obvious particularly when it comes to Medicare payments. By law, paper claims are paid after 28 days after receiving the claim. Electronic claims can be paid after 14 days.


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