Independent Nurses that transmit Protected Health Information (PHI) are considered Covered Entities under HIPAA.  As such, the HIPAA Privacy & Security Rules apply to the Independent Nurses' practice.  In addition, Wisconsin State Statute 146.8 applies.

Independent Nurses that do not transmit PHI are not Covered Entities.  While the HIPAA Privacy and Security Policies and Procedures are not required, Wisconsin State Statute 146.8 applies.

Independent Nurses submitting claims electronically are Covered Entities.  This includes both claims directly submitted by a Nurse as well as those submitted by a billing service.

On May 1, 2010, the Wisconsin Medicaid program requires all Independent Nurses to establish a ForwardHealth portal to receive remittance information.  This information contains PHI.  As long as Independent Nurses only receive PHI and don't use this Portal to transmit, they are not HIPAA Covered Entities.

Independent Nurses choosing to use the ForwardHealth Portal to submit information that contains PHI, become Covered Entities.  The HIPAA Privacy and Security Rules/Requirements apply to Nurses submitting PHI through the ForwardHealth Portal

Prior Authorizations contain PHI.  Independent Nurses submitting Prior Authorizations via the ForwardHealth Portal are called the Prior Authorization Liaison.  Liaisons are required to be HIPAA compliant.

New Nurse Packet

This packet contains basic information to assist the nurse in getting started with HIPAA.  If HIPAA applies, the nurse must have Policies and Procedures in place.  The nurse may write his/her own policies or purchase these documents.  The HIPPA Policy and Procedures Manuals specific to Independent Nurses are available through PHP and can be ordered by completing the HIPAA Manual Order Form and mailing it with your check to the address on the form.

This New Nurse Packet is available for the cost of postage and contains:

Application for a National Provider Identifier (NPI)

Introduction to the Health Information Portability & Accountability Act (HIPAA)

Information on the American Recovery & Reimbursement Act (ARRA)

Determination of Covered Entity Status

Independent Nurse Privacy Notice & Acknowledgement

Business Associate Agreement (2005 version)

Wisconsin State Statute 146.8

Contact Fran at meyerf@sbcglobal.net to get the New Nurse Packet.  Please include your name, address, and phone number in your e-mail.

Regulations governing Business Associate Agreements were to have changed in early 2010.  However, as of April 15, 2010, the Final Rule for Business Associate Agreements has not been published.  While there is a February 17 2010 enforcement date for the change, it won't be enforced until 30 days after the Final Rule is publiched in the Federal Register.  It is anticipated that the Secretary of Health & Human Services will publish a sample Business Associate Agreement that could be used by any Covered Entity.  PHP will continue to monitor for progress with this Rule/Document.