The national security exception in the Health Insurance Portability and Accountability Act (HIPAA), passed in 1996, was one of the crucial milestones in healthcare legislation in the US. This healthcare reform focuses on broad categories of change, such as a rise in the number of individuals with health insurance and the number of healthcare professionals available to the general public. It introduced three unique identifiers related to health insurance. These are EIN, HPID, and NPI. The National Health Plan Identifier, or HPID, was created to provide a standardized manner to designate insurance coverage in electronic payments (Santoso et al., 2018). The NPI, or National Provider Identifier, was also mandated in all routine HIPAA transactions. However, it is no longer utilized owing to security issues (Santoso et al., 2018). For tax reasons, an EIN is used to identify a legal entity.
HIPAA Title I protects health insurance in case employees and their families change or leave employment. It also regulates the availability and scope of corporate health plans as well as some individual health insurance policies, as well as the problem of the so-called job lock. Title II provides civil and criminal consequences for fraud and abuse in the healthcare system (Department of Health Care Services, 2021). These include mainly upcoding (when practitioners report treatments or services at a greater degree than what can be verified), downloading (the data necessary for diagnosis is excluded in its entirety), and unbundling (payments that have been split down and charged separately in order to increase the amount that can be refunded) (Santoso et al., 2018).
Title III provides medical expense account criteria and standardizes the amount that can be saved per individual (Department of Health Care Services, 2021). Title IV defines rules for group health plans, specifies health plan conditions, and modifies coverage criteria (Department of Health Care Services, 2021). It also assesses the Consolidated Budget Reconciliation Act (COBRA), which ensures that health coverage is maintained after retirement. The company’s life insurance coverage is governed under Title V (Department of Health Care Services, 2021). The interest distribution rule of the financial institution is likewise abolished, as well as amending the provisions of the law relating to people who renounce their citizenship or permanent residency status in the United States.
Department of Health Care Services (2021, 23 March). “HIPAA Title Information“.
Santoso, B., Hendrartini, J., Rianto, B. U. D., & Trisnantoro, L. (2018). System for detection of national healthcare insurance fraud based on computer application. Public Health of Indonesia, 4(2), 46-56.