Explain the HIPAA Transaction and Code sets standard rules. Explain why it is important to know the differences between the code sets when submitting electronic claims.
Describe one factor, per HIPAA regulations, that you should consider when transmitting health insurance claims electronically.

Question:Explain the HIPAA Transaction and Code sets standard rules.

The HIPAA transactions and code set standards are rules to standardize the electronic exchange of patient-identifiable, health-related information. They are based on electronic data interchange (EDI) standards, which allow the electronic exchange of information from computer to computer without human involvement.

Question: Explain why it is important to know the difference between the codes sets when submitting electronic claims.

It is important because the codes show what the patient is seen for and what the doctor does during the procedure or office visit. If the coder puts in the wrong code set, the patient could be misdiagnosed to their insurer or charged unfairly. Each visit, procedure, lab test, etc has their own code set to abide by.

Question: Describe one factor, per HIPAA regulations, that you should consider when transmitting health insurance claims electronically.

HIPPA policy has some strict rules on account of which the medical records of a patient are secured. When transmitting health insurance claims electronically, healthcare organizations should implement secure electronic access to health data and remain in compliance with privacy regulations set by HHS.

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