...Accountability Act of 1996 (HIPAA). As such, the HHS rolled out a new audit initiative to assess compliance across the nation with the privacy and security standards for protected health information This paper focus on how the audit program of HIPPA works, what the covered entity can do to prepare for the audit, and what happens once the audit is complete. Introduction Ever since implementation of the HIPAA privacy and security standards, entities have been required to establish and maintain a variety of compliance mechanisms, including written policies and procedures, training of responsible workforce members, business associate agreements, relevant notices to patients or plan participants, and health plan document amendments. Until now, most compliance actions have been complaint-driven investigations arising from alleged violations of the HIPAA privacy or security standards (Arant, 2011). Pursuant to the HITECH Act, a more robust enforcement program was created to make a more ???? The U.S. Department of Health & Human Services' Office for Civil Rights (OCR) administers HIPAA (including the HITECH amendments) by investigating complaints, enforcing rights, promulgating regulations, developing policy and providing technical assistance and public education. Since the enactment of HITECH in 2009, OCR has assumed another function: compliance audits. HITECH requires periodic audits to ensure that covered entities and business associates are complying with the HIPAA privacy and security...
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...Section 1 State the overview of HIPAA Privacy Rules The HIPAA Privacy Rule is designed to safeguard protected health information (PHI). The Rule is a set of national standards that mandates medical practices that conduct electronic transactions to protect individuals’ medical records and their personal health information. Implementing the HIPAA privacy requirements sets boundaries on the use and disclosure of health records, imparts individuals more control over their health information, and holds health care providers and their business associates accountable for establishing appropriate safeguards to protect the confidentiality of health information. The rule requires: • Medical practices to provide a Notice of Privacy Practices that describes patients’ privacy rights and how their personal health information may be used or disclosed. • Clear and enforceable policies and procedures,which address how the medical practice will comply with the Privacy Rule. • Designation of a privacy official who will be chiefly responsible for developing and implementing the policies and procedures with respect to the privacy compliance. • Adoption of a formal business associate contract, that assures a medical practice and its business partners that are hold liable for protecting the privacy of personal health information. • Development of administrative procedures, physical safeguards, and technical safeguards to assure the security of personal health information stored and...
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...coverage can differ hugely between companies, individual, and plans, The biller needs to make sure each patient’s coverage in order to create the bill correctly. This also goes for prescriptions, some insurance companies do not allow for certain types or prefer generics. 3 Check in patients- Patient check-in and check-out are pretty much straight-at the desk task. When the comes in, First time patients will be asked to fill out paper forms or confirm the information the doctor has on file. The patient should be asked to verify ID and provide an insureance card. Some providers will receive a copy of the check in. 4 Check out Patient- When the patient is checked out, the medical report from that patient’s visit is sent to the medical coder, who will decode and translate the information into a report. This report, which also includes...
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...more prevalent healthcare information technology has played a “pivotal role in improving healthcare quality, cost, effectiveness, and efficiency,” (Srinivasan, 2013). However, the use of healthcare information technology has brought up concerns about privacy and protection of patient health information. In 1996, the Health Information Privacy and Accountability Act also known as HIPAA was passed. This was the first federal law regulating the privacy of health information. HIPAA was “designed primarily to modernize the flow of health information” (Solove, 2013). While at this time medical records were still in paper form, it was clear that health records would become digital in the future. (Solove, 2013). In the early years of HIPAA there was much confusion and no civil enforcement actions were taken. The Department of Health and Human Services (HHS) proposed a privacy regulation that was finalized in 2000. The Privacy Rule “governs personal health information, which is any ‘individually identifiable health information’ a broad definition including paper records.” (Solove, 2013). The HIPAA Security Rule, established in...
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...Why Healthcare Must Embrace Cloud Computing Regulatory compliance for the healthcare industry is a hot-button issue. The overriding compliance requirements that this industry faces are dictated by the Health Insurance Portability and Accountability Act (HIPAA), enacted by Congress in 1996. HIPAA was designed to protect the privacy of patients’ medical records and restrict who has access to them. Regulatory compliance for the healthcare industry is a hot-button issue. The overriding compliance requirements that this industry faces are dictated by the Health Insurance Portability and Accountability Act (HIPAA), enacted by Congress in 1996. HIPAA was designed to protect the privacy of patients’ medical records and restrict who has access to them. The latest HIPAA standards surrounding the security and privacy of patient data makes many in the healthcare industry understandably cautious about adopting new technologies. In the past, healthcare companies preferred to keep any electronic data concerning business operations and patient care behind a secure firewall. Now, HIPAA omnibus and the American Recovery and Reinvestment Act (ARRA) requirements stipulate everyone in the healthcare industry begin migrating patient records and other data to cloud computing. Essentially, by 2015, all medical professionals with access to patient records must utilize electronic medical and health records (EMR and EHR), or face penalties. A recent study by the firm MarketsandMarkets indicates that...
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...Administrative Ethics Paper Heather Simmons HCS/335 September 19, 2011 Claudia Haywood Administrative Ethics Paper Health care organizations are responsible for the privacy and proper handling of people’s personal medical and financial information. The Health Insurance Portability and Accountability Act (HIPAA) has been set into place to set the standards to organizations on how to handle patient information and how to deal with any situation that may arise to the best interest of the patient and the organization. There are situations that will arise, and the organization must be prepared to handle it. An instance may arise when the U.S Department of Health and Human Services (HHS) may have to get involved. The HHS is an organization designed to help enforce the HIPAA rules and regulations and make sure organizations are in compliance with HIPAA. Recently, a major health care organization in Massachusetts, The General Hospital Corporation and Massachusetts General Organization Inc. (Mass General), settled to pay the U.S. Government $1,000,000 because of a HIPAA violation. Documents containing protected health information (PHI) were lost and never recovered from an employee losing a folder containing 192 patient’s records. The employee took the records from the hospital and while riding the subway returning back to work, the employee left the records on the train. The investigation of the missing records was started from a patient discovering their record was lost and...
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...HIPAA- How To Avoid Data Breach? How do data breaches occur? • we suspect our information system has been • targeted and patient information exposed. After one a laptop and other portable device is lost or stolen. • We did a rapid assessment to mitigation of damage and is and define scope of the incident we discovered following facts: – – – – data are not encrypted laptop are not protected by password Information of patients are exposed. No log file exist What are consequences of these breaches ? A data security breach can have devastating consequences for healthcare organizations as well as patients or clients What are our strategies to prevent theses breaches • We must be in compliance with the final HIPAA Omnibus Rule through following : – Administrative safeguards – Physical safeguards – Technical safeguards What is HIPAA? • HIPAA: Health Insurance Portability and Accountability Act • It was passed by Congress in 1996 • broadly applicable to the health care industry • intended to address security for both electronic and physical patient records • standardizing electronic exchange of administrative & financial data in health care system • It includes requirements for: • Transfer and continuation of health insurance coverage • Reducing healthcare fraud and waste – The protection and confidential handling of protected health information (PHI) What is a breach? – A breach is an impermissible use or disclosure that compromises the security or privacy of PHI and poses...
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...Research Study Review Lauren Jones May 17, 2014 ENGL305 Lisa Burkart-Chalmers Article Summary This article discusses the idea of being in compliance with HIPAA transaction standards is reducing the cost of submitting health care claims. At the beginning of 2006, Bob Brown reported that there was little evidence that the administrative simplification provisions of HIPAA had produced any savings in health care costs. However, a new research report indicates that the standards for electronic transactions may be responsible for savings of over $1 billion. (Brown, 2006) Bob Brown relied on the research that he did a few months before to compare his findings about health care claims and saving money on costs of the claims that were being processed at the time of this article. He analyzed both time frames and nearly 25 million claims. He also pulled data from America’s Health Insurance Plan’s (AHIP) Center for Policy and Research for his research too. Although he didn’t look at too many resources, the couple that he used were solid references. Thesis Statement The author did his research about being in compliance with HIPAA transaction standards leads to a reduced cost when a health care claim is submitted. He convinced his audience and backed up his data with interesting facts. Strengths and Limitations The author did a good job with his research but it was limited. He used information that he already had and added to it. He did look to a couple other researches...
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...HIPAA COW Risk Analysis & Risk Management Toolkit Networking Group Guide for the HIPAA COW Risk Analysis & Risk Management Toolkit Disclaimers This Guide and the HIPAA COW Risk Analysis & Risk Management Toolkit (Toolkit) documents are Copyright by the HIPAA Collaborative of Wisconsin (“HIPAA COW”). They may be freely redistributed in their entirety provided that this copyright notice is not removed. When information from this document is used, HIPAA COW shall be referenced as a resource. They may not be sold for profit or used in commercial documents without the written permission of the copyright holder. This Guide and the Toolkit documents are provided “as is” without any express or implied warranty. This Guide and the Toolkit documents are for educational purposes only and do not constitute legal advice. If you require legal advice, you should consult with an attorney. Unless otherwise noted, HIPAA COW has not addressed all state pre-emption issues related to this Guide and the Toolkit documents. Therefore, these documents may need to be modified in order to comply with Wisconsin/State law. The Toolkit provides an example HIPAA Security Risk Assessment and documents to support completing a Risk Analysis and Risk Mitigation Implementation Plan. While it covers a broad spectrum of the requirements under the HIPAA Security Rule and HITECH, it may not cover all measures needed to secure your patients’ electronic protected health information (ePHI). It...
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...false, fraudulent or fictitious and made for a monetary benefit. The false claim is established when an individual is in possession of a property or money used by the government with the intention to defraud the government (Boese, 2005). It must also be established that the ‘false claim’ was made with actual knowledge. False certification of receipt of property without attempting to confirm the truth of the information provided is also an element that constitutes false claim. Three Broad Objectives of HIPAA Privacy Standards HIPAA privacy standards aims to achieve the following three important objectives: i) Administrative Safeguards HIPAA privacy rules designed procedures and policies regarding the administrative procedures of the act; how will the act be complied with. ii) Physical Safeguards HIPAA privacy rules were designed to control physical access to guard against inappropriate access to personal healthcare information. iii) Technical Safeguards HIPAA privacy rules control access to computer systems and facilitate enclosed entities to protect interactions involving PHI transmitted electronically over open networks from being intercepted by anyone other than the intended recipient. 10 specific Designated Health Services (DHS) for which referrals by physicians who have financial relationships with the entity providing the DHS are prohibited under Stark II Laws As mentioned by Satiani (2006), following are the prohibited categories under Stark II: ...
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...access to our data. Not only general demographic data such as full name, home address, phone number, and date of birth but also extremely sensitive medical information such as diagnosis and medication prescribed. Even though the convenience of digital records accessible to care providers via the web can expedite service, security and privacy have to be considered and maintained. An organizational policy is required to provide guidance, direction and responsibilities to ensure compliance with all Health Insurance Portability and Accountability Act (HIPAA) requirements. HIPAA is the acronym that was passed by Congress in 1996. (Health, n.d.) Purpose: To promulgate organizational policy, procedures, and program management for web security. This policy defines the technical controls and security configurations users and information technology (IT) administrators are required to implement in order to ensure the confidentiality, integrity, and availability of the data environment in accordance with HIPAA does the following: Provides the ability to transfer and continue health insurance coverage for millions of American workers and their families when they change or lose their jobs; Reduces health care fraud and abuse; Mandates industry-wide standards for health care information on electronic billing and other processes; and Requires the protection and confidential handling of protected health information (Health, n.d.) With the multitude of threats that plague an organizations’...
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...PADMA ARYAL padmaaryal@gmail.com 646-701-4780 PROFILE | | Dynamic Business Analyst with over 6 years of professional experience in Software Development Lifecycle (SDLC) and business reengineering process, offering extensive experience in healthcare domain. Areas of expertise include HIPAA compliance ANSI X12 4010 to 5010 and ICD 9 to ICD 10, EDI transactions and Claims Adjudication process. Experience with FACETS and NASCO configuration, coordination of benefits (COB), Medicare and Medicaid programs; strong interpersonal communication, writing, presentation and collaboration skills. QUALIFICATIONS SUMMARY | | * Proven track record of delivering cost-effective, high performance technology solutions to meet the constantly changing business needs. * Demonstrated experience in gathering requirements and developing detailed functional specifications through JAD sessions, interviews, observation, and on site meetings with SME, business users & development teams. * Adept at writing business requirement documents (BRD), functional requirement documents (FRD), system requirement specifications (SRS), system design specifications (SDS) and other project related documents. * Expertise in conducting gap analysis, SWOT analysis, risk analysis, root-cause analysis and change management assessment. * Proficient in business process reengineering and Software Development Life Cycle (SDLC), including analysis, design, development, testing,...
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...Why Healthcare Must Embrace Cloud Computing Regulatory compliance for the healthcare industry is a hot-button issue. The overriding compliance requirements that this industry faces are dictated by the Health Insurance Portability and Accountability Act (HIPAA), enacted by Congress in 1996. HIPAA was designed to protect the privacy of patients’ medical records and restrict who has access to them. Regulatory compliance for the healthcare industry is a hot-button issue. The overriding compliance requirements that this industry faces are dictated by the Health Insurance Portability and Accountability Act (HIPAA), enacted by Congress in 1996. HIPAA was designed to protect the privacy of patients’ medical records and restrict who has access to them. The latest HIPAA standards surrounding the security and privacy of patient data makes many in the healthcare industry understandably cautious about adopting new technologies. In the past, healthcare companies preferred to keep any electronic data concerning business operations and patient care behind a secure firewall. Now, HIPAA omnibus and the American Recovery and Reinvestment Act (ARRA) requirements stipulate everyone in the healthcare industry begin migrating patient records and other data to cloud computing. Essentially, by 2015, all medical professionals with access to patient records must utilize electronic medical and health records (EMR and EHR), or face penalties. A recent study by the firm MarketsandMarkets indicates that...
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...Name: Sunil Kumar Buttagandla Student Id: 10000126442 Course name: CMP 630 Network Security Audit & Forensics Professor Name: Dr. Nigel Basta Title: Week1- Assignment2 In the table below, identify compliance laws that are applicable to a large public health care organization. In the second column, include a description of each law. In the third column, justify your rationale for including the law by indicating why it applies to a large public health care organization Answer: Compliance Law | Description of the Compliance Law | Rationale for Including this Law | Title1 Health Care Access, Portability, and Renewability | offers protection of health insurance coverage without regard to pre-existing conditions | offers protection of health insurance coverage without regard to pre-existing conditions | Title II Preventing Health Care Fraud and Abuse,Administrative Simplification; | provides requirements for the privacy and security of health information | | Privacy Rule | •Provide information to patients about their privacy rights and how the information can be used.•Adopt clear privacy procedures.•Train employees on privacy procedures.•Designate someone to be responsible for overseeing that privacy procedures are adopted and followed. | It regulates the use and disclosure of PHI by covered entities. A covered entity, for example, includes health care providers, health plans, and health care clearinghouses | Security Rule | IT contains three broad safeguards...
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...ocedures that define the principles of secure information system use and the responsibility of users to follow them. Security awareness articles, posters, and bulletins should be periodically created and distributed throughout the corporation to educate employees about new and existing threats to security and how to cope with them. All employees are responsible for promptly reporting to their management and Information Systems (IS) management any suspected insecure conditions or security violations they encounter. All employees must be made aware of their security responsibilities on their first day of employment as part of the newhire orientation program. All employees must comply with IS security policies by signing a compliance agreement that is retained in their personnel file. IS Security policies and procedures must remain current and readily available (e.g., via the intranet site) for Information System users to review and understand them. Information Systems (IS) management must ensure that the terms and conditions of authorized system access are clearly communicated to potential users of those systems before access is granted. A formal process must exist to document that appropriate management was aware of and approved all access and privileges granted to corporate system users. Justification: Organizational security awareness is an essential part of the corporate security posture. Information is one of the most valuable assets owned by...
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