...How HIPAA Violations Affect the Medical Billing Process HCR/220 October 7, 2012 How HIPAA Violations Affect the Medical Billing Process In this paper we will discuss how HIPAA violations affect the medical billing process and why HIV and AIDS information is more sensitive than other types of health conditions. We will also examine the social, legal, and ethical ramifications of improper information disclosure. In 1996 on August 21, the Health Insurance Portability and Accountability Act (HIPAA) was enacted by the Federal Government and signed into law by President Bill Clinton (HIPAA – The Health Insurance Portability and Accountability Act, 2011). According to “Health Insurance Portability and Accountability Act” (2012), “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 electric billing and other processes, and requires the protection and confidential handling of protected health information” (What is HIPAA?). The main reason HIPAA was enacted was to protect patient’s personal health information regardless of its severity. Their personal health information is just that, theirs! For that reason, among many other, it is very important to know that a patient’s personal health information is not to be shared with any unauthorized...
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...HCR 220 Week 9 Final Project How HIPAA Violations Affect the Medical Billing Process To Buy This material Click below link http://www.uoptutors.com/HCR-220/HCR-220-Week-9-Final-Project-How-HIPAA-Violations-Affect-the-Medical-Billing-Process Part One: Resources:Appendix A, Appendix C, and Table 8.3 on pp. 258–259 of Medical Insurance Refer toTable 8.3 on pp. 258–259 of your text to complete the CMS-1500 form, located in Appendix C, according to the following case study: A 67-year-old Medicare patient presents to the office, exhibiting symptoms of HIV infection. After detailed examination, symptoms are determined to be advanced AIDS with manifestation of Kaposi’s sarcoma and other opportunistic infections. Name: James Brown Account Number: 080811 Insurer: Medicare Policy Number: 1098765 ID number: 12345678910 DOB: 02/01/1940 Gender: Male Insured: James Brown Address: 1600 Pennsylvania Ave. Wash. D.C. 60000 Marital Status: Widowed Patient’s Employer: Retired Nature of Condition: HIV, AIDS, Kaposi’s sarcoma Date of Illness: 06/01/2007 Referring Physician: Thomas Glassman, M.D. Physician ID: 1080808080 Federal Tax ID: 5551116679 Dates of Service: 06/01/2007, 06/15/2007, 07/07/2007, 08/01/2007 Procedure: Detailed examination, screening blood panel, pathology services Patient Signature Include ICD (categories only), CPT, HCPCS, and insurance information. If you believe there is insufficient information provided to fill a required field with data...
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...How HIPPAA Violations Affect the Medical Billing Process, Part Two Amber Padgett HCR/220 October 19, 2014 Felecia Pettit-Wallace The purpose of this paper is to relate to ways that the Health Insurance Portability and Accountability Act (HIPAA) violations may affect the medical billing process. While researching, the findings conclude that confidentiality of health information was adopted centuries ago. The findings of the research show that although, HIPAA laws have been put into place to protect the privacy and confidential heath information of patients; HIPAA laws are sometimes violated. The medical billing coders are sometimes careless when handling confidential information; however medical health records should be protected adequately. The coder that violates the HIPAA laws concerning the confidentiality and privacy of patient health information can suffer serious ramifications. The ramifications of these violations could result in serious penalties such as disciplinary actions by the employer, monetary fines, and jail time, or both. HIPAA violations ranks number one among the complaints received by the Office of Civil Rights each year. Humans take pleasure in the right to privacy in every aspect of life. The right of protecting the confidentiality and privacy of identifiable personal health information takes first priority and is greatly cherished among most. The Hippocratic Oath, dating back centuries required physicians to keep medical information concerning...
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...How HIPAA Violations Affect the Medical Billing Process Rebecca Clements HCA 220 University of Phoenix (Axia) October 3, 2010 Monica Tucker Abstract HIPAA mandates privacy rules and regulations regarding patient’s protected health information. This includes diagnoses, information regarding sexuality and history of drug use. HIPAA applies to all diagnoses, because of the social stigmas placed upon certain types of diagnosis; history has shown society to be more sensitive when it comes to HIV and AIDS disclosures. Inappropriate disclosure of information can create social, legal and ethical ramifications. How has the medical industry improved upon confidentialities and disclosure with HIV and AIDS patients. How HIPAA Violations Affect the Medical Billing Process References Dickens, B., & Cook, R. (05/08/2000). Law and ethics in conflict over confidentiality? Retrieved from http://papers.ssrn.com/sol3/papers.cfm?abstract_id=946463 Myers, J., Friednan, T., Berhwani, K., & Henning, K. (2008, May). Ethics in Public Health Research: Privacy and Public Health at Risk: Public Health Confidentiality in the Digital Age. American Journal of Public Health, 98(5), 793-801. doi:10.2105/AJPH.2006.107706 Richards, E. (1999). HIV: Testing, Screening, and Confidentiality - An American Perspective. Retrieved from http://biotech.law.lsu.edu/cphl/articles/american-hiv.htm UNAIDS, U. (2007, June 27). Confidentiality and Security of HIV...
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...Business Ethics in a Hospital Setting Darlene V Nickerson Columbia Southern University Abstract Business ethics in a hospital setting includes a review of many areas. Ethical considerations include the areas of patient care, nursing ethics, physician ethics, patient privacy, and medical billing practices. This paper will touch on ethical concerns for each of these topics. Keywords: hospitals, ethics, patient care, nursing, physicians Business Ethics in a Hospital Setting When beginning a discussion of business ethics in a hospital setting it is important to take a broad approach. Because a hospital is a business and also a treatment facility, the ethical concerns must be considered not only for areas such as billing and privacy but also for ethics related to the appropriate care of patients, nursing ethics, and physician ethics. The ethics of the treatment methods employed based on the patient’s condition must also be considered. Ethics and Patient Care I believe that when discussing the ethical implications of patient care it is helpful to review a real-world scenario. One highly publicized case involved Terri Schiavo and her husband’s fight to stop her tube feedings as there was no hope for her recovery (VandeKieft, 2005). One reason for the high visibility of this case in the media occurred because the patient's husband and the patient's family disagreed on the diagnosis (VandeKieft, 2005). Terri suffered a cardiac arrest due to severe hypokalemia (low potassium...
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...year. It is a rising threat, with national health care spending rising to $2.7 trillion and expenses continuing to outpace inflation. The saddest element of this situation is that recent cases have shown that medical professionals are more willing to risk patient harm in pursuit of successfully executing their schemes. Health Care fraud is in the jurisdiction of the FBI. They are the primary agency responsible for investigating these types of cases, and also for exposing them. They are responsible for the federal and private insurance programs. As the Chief Medical Officer of a large Obstetrics Health Care Center, I am sadden and extremely angry to learn that these types of fraudulent activities are associated with my facility. As I investigate and learn more about the situation, I will also be exploring other topics as listed below. 1. Evaluate how the Healthcare Qui Tam affects health care organizations. 2. Provide four (4) examples of Qui Tam cases that exist in a variety of health care organizations. 3. Devise a procedure for admission into a health care facility that upholds the law about the required number of Medicare and Medicaid referrals. 4. Recommend a corporate integrity program that will mitigate incidents of fraud and assess how the recommendation will...
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...How HIPAA Violations Affect the Medical Billing Process Kathleen Davis HCR/220 7/22/2012 Lydia Cavieux HIPPA HIV and AIDS Keywords: HIV, AIDS, HIPPA One of the most sensitive of all disease is HIV and AIDS. These diseases keep many people from receiving treatment due to the fear of breach of confidentiality. This fear directly affects their health, because they do not receive the treatment they so desperately need. If any organization or doctor’s office breaches a patient confidentiality they could face civil or criminal penalties. HIPPA does not separate HIV/AIDS, but an individual is still protected under set guidelines. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) attempts to address some of the barriers to healthcare coverage and related job mobility impediments facing people with HIV as well as other vulnerable populations. HIPAA has three main goals. The first is to provide persons with group coverage new protections from discriminatory treatment. The second is to enable small groups (such as businesses with a small number of employees) to obtain and keep health insurance coverage more easily. The third is to give persons losing/leaving group coverage new options for obtaining individual coverage. This law provides several protections important to people with HIV/AIDS. The first is it limits (but does not wholly eliminate) the use of pre-existing condition exclusions. HIPPA also allows a patient to be aware of who will receive...
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...and abuse in health insurance and health care delivery, to promote the use of medical savings accounts, to improve access to long-term care services and coverage, to simplify the administration of health insurance, and for other purposes. HIPAA Colloquial acronym(s) Enacted by the 104th United States Congress Citations Public Law Stat. Pub.L. 104–191 110 Stat. 1936 [1] [2] Legislative history [3] • • • • • • • • • Introduced in the House as H.R. 3103 [4] by Bill Archer (D-TX) on March 18, 1996 [5] Committee consideration by: House Ways and Means Passed the House on March 28, 1996 (267–151 Passed the Senate on April 23, 1996 (100-0 [6] ) [7] ) [8] ) and by the Senate on , in lieu of S. 1028 Reported by the joint conference committee on July 31, 1996; agreed to by the House on August 1, 1996 (421–2 [9] August 2, 1996 (98–0 ) Signed into law by President Bill Clinton on August 21, 1996 e v t [10] The Health Insurance Portability and Accountability Act of 1996 (HIPAA; Pub.L. 104–191 [1], 110 Stat. 1936 [2] , enacted August 21, 1996) was enacted by the United States Congress and signed by President Bill Clinton in 1996. It has been known as the Kennedy–Kassebaum Act or Kassebaum-Kennedy Act after two of its leading sponsors.[11] Title I of HIPAA protects health insurance coverage for workers and their families when they change or lose their jobs. Title II of HIPAA, known as the Administrative...
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...they can in person without the use of an EHR. According to the Journal of American Medicine Association, “the role of telemedicine in medical practice is yet to be defined. Even now, it ranges from simple teleconference (a means of communication) to remote surgery (a new modality).” (JAMA, 1995) The EHR (Electronic Health Record) is an electronic record of a patient’s health information that can be generated by one or more departments in the health care delivery system. The health record includes patient address, phone numbers, religion, ethnicity, history and physical, lab tests, lab results and progress notes of their medical information over a period of time. “The EHR has the ability to generate a complete record of a clinical patient encounter-as well as supporting other care-related activities directly or indirectly via interface- including evidence-based decision support, quality management, and outcomes reporting.” (HIMSS, 2009) The EHR main goals should be to help guide the health professional to better provide quality services to patients with the goal of providing interactive alerts to the health professional to update medication profiles, physician orders and diagnostics all at once, which cannot be done with a paper charting system. The computer based medical record secures real-time information while sharing and evaluating medical information for patient delivery services and...
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...The 5W’s behind recent healthcare reform initiatives and how they have, are or can impact the delivery of healthcare and HIM professionals. There have been many controversies over healthcare reform ideas and all the issues that may or may not arise affecting everything from the delivery and costs to the patients, HIM and surrounding professionals roles, and the politicians and the different ideas they stand behind. Examples of some of the most influential and recent initiatives are HIPAA (Health Insurance Portability and Accountability Act)enforced in 1996 and ARRA (American Recovery and Reinvestment Act) and its revision HITECH(Health Information Technology for Economic and Clinical Act) of 2009 Each of these reforms have impacted the delivery of healthcare and therefore everyone in the U.S and especially with each reform new challenges, changes, benefits and/or problems for the HIM professionals and their roles and all they consist of. An HIM professional can work in many environments, including from home, private offices, doctors offices, nursing homes, hospitals and anywhere else that healthcare and/or PHI and/or EHR are handled. The HIM profession not only exists physically in numerous healthcare places but can work in numerous areas in the field such as medical billing and coding, a secretary, in any health area as a clerk, with many electronic systems such as HHS, MPI, HER, RIS and so many more and as the medical world changes so does the roles, jobs and duties of an HIM...
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...History and Future Of Medical Coding and Billing John F. McMahon BU480, Central Methodist University Abstract Medical coding and billing affects everyone during their lifetime and yet the regulations of medical coding and billing are extremely complex. Examining the history, evaluation, and effect of new regulations and their cost shed light on an already complex industry. We will review government regulations, technological advancements, and requirements that providers will face in the near future. We will examine our current systems and how they evolved through time and what they may be in the future. We have reviewed articles from the Medical Billing and Coding Association, the Department of Human and Health Services as well as the Office of the Inspector General. We will review the different types of insurance, how they each affect the process of medical coding and billing and then see what the future will be. Finally we will review what steps we have taken that has allowed a government to be so involved in our healthcare decisions. Thesis Statement Medical Coding and Billing has evolved to a point that it affects everyone at one time or another during their lifetime and has only led to complex rules and regulations that you almost need a degree to understand. From times that Physicians bartered for their services to the government telling them what to charge and insurance companies...
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...Fundamentals of Law for Health Informatics and Information Management Second Edition Check Your Understanding Chapter Answers CHAPTER 1 Check Your Understanding 1.1 1. A hybrid record is refers to record that is totally electronic. False 2. An electronic health record can be managed across more than one healthcare organization. True 3. Confidentiality refers to the right to be left alone. False 4. HITECH widens the scope of privacy and security protections under HIPAA. True 5. Privileged communication is a legal concept designed to protect the communication between two parties. True Check Your Understanding 1.2 1. Ownership of a health record generated by a doctor on a patient belongs to the patient. False 2. A custodian of records is responsible for certifying that a record is what it purports to be. True 3. When a patient refuses treatment he or she is exercising the ethical principle of beneficence. False 4. In a malpractice case, a professional code of ethics may be used as a benchmark for what should be acceptable practice by a healthcare professional. True 5. The ethical principle of nonmaleficence refers to making sure rules are fairly and consistently applied to all. False CHAPTER 2 Check Your Understanding 2.1 1. Private law defines rights and duties between individuals and the government. False 2. Statutes are enacted by legislative bodies. True 3. Administrative law is created by court...
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...Sunshine State Medical Billing Service Legal Issues in Business BUSI 561-D05 LUO 12/16/2011 This paper explores the legal challenges faced when forming and operating the Sunshine State Medical Billing Service. The legal issues surrounding the business will be analyzed using a business law perspective, as well as a Christian worldview. This legal business plan was prepared by Karri-Marie Baskin, Suzanne Ludikhuize, Renada Manning, Susan Schaeffer, and Dixie Wallace. Executive Summary Sunshine State Medical Billing Service’s physical location is in Tampa, Florida. Because the billing company utilizes the internet, it is able to provide services to many doctor’s offices across the United States. Sunshine State Medical Billing Service selected the Tampa site for several reasons: Low corporate and unemployment taxes, no individual income tax, large hiring base and new business incentive programs. http://www.tampaedc.com/site-selection/business-incentive.aspx; http://money.usnew.com/money/business-economy/small-business/articles/2009/01/06 Sunshine State Medical Billing Service offers the best streamlined billing service via the latest technology in the nation. Our clients are licensed doctors, who choose to use an outside billing company to act as their agent to bill and collect fees due them for services rendered. While there is a growing trend of medical billing services being offered as a home business, our clients can be assured that all of our employees are...
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...will evaluate how the Healthcare Qui Tam affects health care organizations while providing (4) examples of Qui Tam cases that exist in a variety of health care organizations. Other responsibilities discussed, are devising a procedure for admission into a health care facility that upholds the law about the required number of Medicare and Medicaid referrals; the ability to recommend a corporate integrity program that will mitigate incidents of fraud and assess how the recommendation will impact issues of reproduction and birth. The know how to devise a plan to protect patient information that complies with all necessary laws. Evaluate how the Healthcare Qui Tam affects health care organizations. The Healthcare Qui Tam affects health care organizations in that well over more than 450 hospitals across the country were the subject of Medicare fraud investigations. Whether or not Medicare violations are found, the costs of responding to an investigation can be significant. Westchester Medical Center of New York, being investigated for possible health care fraud and violations of anti-kickback laws, received a subpoena for extensive records in some thirty-seven categories going back to 1997. Millions of dollars may be spent in legal fees and other costs associated with the investigation (e.g., hiring or reassigning staff to assist with compiling requested data) (Degnan & Scoggin, 2007). According to Degnan & Scoggin (2007), where violations are found, the...
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...ram4577X_ch03.qxd 4/16/04 11:50 Page 37 Legal and Ethical Issues in Medical Practice, Including HIPAA AREAS OF COMPETENCE 2003 Role Delineation Study CLINICAL Fundamental Principles ɀ Apply principles of aseptic technique and infection control ɀ Comply with quality assurance practices Patient Care ɀ Coordinate patient care information with other health-care providers GENERAL Legal Concepts ɀ Perform within legal and ethical boundaries ɀ Prepare and maintain medical records ɀ Document accurately ɀ Follow employer’s established policies dealing with the health-care contract ɀ Implement and maintain federal and state health-care legislation and regulations ɀ Comply with established risk management and safety procedures ɀ Recognize professional credentialing criteria CHAPTER OUTLINE ɀ ɀ ɀ ɀ Medical Law and Ethics OSHA Regulations Quality Control and Assurance Code of Ethics ɀ HIPAA ɀ Confidentiality Issues and Mandatory Disclosure OBJECTIVES After completing Chapter 3, you will be able to: 3.1 Define ethics, bioethics, and law. 3.2 Discuss the measures a medical practice must take to avoid malpractice claims. 3.3 Describe OSHA requirements for a medical office. KEY TERMS abandonment agent arbitration assault authorization battery bioethics breach of contract civil law contract crime criminal law defamation disclosure durable power of attorney electronic transaction record ethics expressed contract felony fraud ...
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