...Jennifer Sanchez MOD 160 Night Class M.B&C Chapter 2: Compliance, Privacy, Fraud, and Abuse in Insurance Billing 1. Define compliance. 2. Name the two provisions of the Health Insurance Portability and Accountability Act (HIPAA) that relate most to health care. 3. Explain the difference between Titles I insurance Reform and Title II Administrative Simplification. 4. Describe the Privacy Rule under HIPAA. 5. Define protected health information (PHI). 6. Identify the difference between disclosure and use of PHI. 7. Illustrate the difference between privileged and nonprivileged information. 8. Explain patient rights under HIPAA. 9. Explain responsibilities of the health care organization to protect patient rights under HIPAA. 10. State the guidelines for HIPAA privacy compliance. 11. List the three major categories of security safeguards under HIPAA. 12. Define the provisions of the HITECH Act. 13. List the civil and criminal penalties of noncompliance with HIPAA regulations. 14. Identify the difference between fraud and abuse. 15. Identify the Federal and State laws that regulate health care fraud and abuse. 16. List the various fraud and abuse audit programs 17. Describer the basic components of an effective compliance program. Compliance Defined * All regulations, recommendations, and expectations of regulating agencies must be met to be in compliance. * The professional elements...
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...Administrative Ethics- HIPAA HCS/335- Health Care Ethics and Social Responsibility Ruth Bundy September 26, 2011 The Health Insurance Portability and Accountability Act, or HIPAA was introduced to the House of Representative in 1996. HIPAA was a huge piece of legislation that was intended to fix many aspects of health care and health insurance, and includes sections that ensure portability of health insurance, simplify the administration of health insurance coverage, and standardize electronic transactions between health care providers and insurance companies. This is also the law that sets up Medical Savings Accounts and requires insurers to cover patients with pre-existing conditions. The section of HIPAA that concerns dentistry is the Privacy Rule; it addresses patient privacy issues and regulates how private health information is used and disclosed. This private health information includes the personal medical records and any other individually identifiable health information, either written or oral that is created or received by a health care provider. This includes information about the patient's past, present, or future health or physical condition and any payment information. In this paper I will describe the issues and impacts on the population it affects most: what argument or facts are used in the article to support the proposed solution. Explain the legal and ethic issues reported for the administrative issue, the managerial responsibilities related to administrative...
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...Diane Hotaling HT1000 Week 3 assignment 3/18/2014 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...
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...The acronym HIPAA stands for the Health Insurance Portability and Accountability Act. HIPAA was enacted by congress August 21, 1996 and signed by President Bill Clinton the same year. It had required the Secretary of Health and Human Services (HSS) to propose standards protecting the privacy of individually identifiable health information within a year by August 21, 1997 (Summary of the HIPAA Privacy Rule, n.d.). The overall purpose of HIPAA is to improve the portability and continuity of health insurance coverage in group and individual markets. HIPAA has changed lives in many ways for patients, doctors and medical offices. As a patient it has helped to make them feel more secure with not only their health insurance, but also their personal information. Doctors have had to adjust their offices in many ways in order to comply with HIPAA. Medical offices have had to make changes in how they perform everyday tasks, including the medical offices use of electronic records (Summary of the HIPAA Privacy Rule, n.d.). Effect on Patients HIPAA has made a great impact on the privacy of patient’s personal information. As patient’s it is important to know our rights. Patient’s now have a specific place to file a complaint and there is recourse if a medical practice violates the patient’s privacy. HIPAA has helped patient’s rest a bit easier knowing that their protected health information (PHI) is now protected under HIPAA law. It has also given patient’s more rights when it comes...
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...information was accessible to employers in some cases, and also to people issuing loans to these individuals. Patients reveal intimate details in confidence to their health care providers, which were normally stored in locked file cabinets, and on shelves in medical records department, now records are stored in data files and may be seen by hundreds of strangers in health service, insurance companies and any organization affiliated with health service. HIPPA Privacy Rule made it possible for all patients to see, copy and request to amend their own medical records. It provides federal protection for patient’s health information. With the Privacy Rule patients must be notify about who their medical information is disclosed to. Patients can also find out who access their medical records for the prior six years. Under the HIPPA Privacy Rule only minimum information should be disclosed to accomplish the intended purpose and a complaint can be filed if there is a violation of privacy. The Privacy Rule only applies to health plans, health care clearinghouses, and to any health care provider who transmits health information in electronic form in connection with transactions for which the Secretary of Health and Human Services has adopted standards under HIPAA. The Health Insurance Portability and Accountability Act of 1996, was enacted on August 21, 1996. Sections 261 through 264 of HIPAA require the Secretary of Health and Human Services to publicize standards for the electronic exchange...
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...educational requirements in regard to information security. Likewise, the address will recognize the laws and how they shape policy in healthcare. Legislative and Legal Systems As a rule, shadow charts should contain copies of information from a patient’s primary chart. In some cases, the shadow chart may contain original information meant for the patient’s primary records. This causes the patient health record to be incomplete or at least not up to date. The need for seamless and routine reconciliation is clearly present. As with all patient health records, appropriate authorization is critical with shadow charts. Authorizations should be granted to appropriate staff, as well as identical release of information procedure followed by the H.I.M. Department. IT Staff and Security The Information Technology staff is to have entry orientation on information security, followed by documented annual reeducation. Along with all education should be the reminder of the legal and facility ramification of policy violation. Standard security work place practices should be in place to help safeguard patient information. IT security Practices Firewall | Encryption of data | Appropriate staff access | Anti-spyware | Secured workstations | No sharing of passwords | Legal Issues of Privacy In discussion of the Montana Code 41-1-402, it is noted subsections 2a-2d refers to consenting of minors for medical treatment. In addition of a minor consenting for treatment, there is...
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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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...Patient Confidentiality and HIPAA HCIS/ 245 May 2, 2014 Patient Confidentiality and HIPAA HIPAA is the abbreviation for the federal Health Insurance Portability and Accountability Act of 1996. The goal of the law set in place by HIPAA is to allow people to maintain health insurance, provide protection of health care information through confidentiality and security, and to help control administrative cost in the health industry [ (John J. Dreyzehner) ]. There are many different title sections to HIPAA. These sections are Title I- Health Insurance Reform, Title II- HIPAA Administrative Simplification, Title III- HIPAA Tax Related Health Provisions, Title IV- Application and Enforcement of Group Health Plan Requirements, and Title V- Revenue Offsets [ (HIPPA Title Information, 2013) ]. National standards have been established by the HIPAA Privacy Rule, it protects patient medical records and health information (The Privacy Rule). These standards apply to health plans, health care clearinghouses, and providers that use electronic information systems to conduct health care transactions (The Privacy Rule). Appropriate safeguards are demanded by the Privacy Rule. These safeguards protect the privacy of health information that may be personal, and it sets limits and conditions on the use and disclosures of information without the consent of the patient (The Privacy Rule). Patients also have rights over their health information provided under the Privacy Rule. Patients...
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...Introduction In today’s time, healthcare is constantly evolving. “Computer-based patient records, videoconferencing, electronic mail, and telehealth are just a few of the practices that have become common in the delivery of care” (Schmidt, 2005). The focus of this paper is intended to educate the importance of HIPAA in the healthcare system. Background HIPAA is the acronym for Health Insurance Portability and Accountability Act. It was originally known as the Kennedy-Kassebaum Bill (HIPAA, 2012). The law was passed in 1996. The main rules of HIPAA are Privacy, Transaction and Code Sets, Security, and Identifiers (HIPAA-Background, 2006). Even though the law was originally passed in 1996, it was revised many times over the years, in which it...
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...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 their patients a secret. However, in today’s society medical health information is maintained by more than the physician and patient. Personal health information is retained in paper records...
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...The healthcare industry is considered a trillion-dollar industry, growing rapidly with technology and employing millions of healthcare workers in numerous fields. “On August 21, 1996, the U.S. Congress passed the Health Insurance Portability and Accountability Act (HIPAA). The primary goals of the act are to improve the portability and continuity of health-care coverage in group and individual markets; to combat waste, fraud, and abuse in health-care insurance and health-care delivery;” (Ramutkowski & Pugh p.50) Being aware and familiar with the Health Insurance Portability Act not only benefits the patient but also protects the employee from falling into such a situation as this Nurse did. This paper will discuss the article’s issue and its effects, how the article uses current facts about healthcare and the issue addressed, the managerial responsibilities related to administrative ethical issues, and any proposed solutions. The article “Staff Nurse Faces Jail Time for HIPAA Violations” took place in 2008 years after the HIPAA law was enacted. “What had begun as routine file maintenance ended in arrest and possible jail time for a licensed practical nurse who shared medical information with her spouse.” (Latner p.1) Mrs. A had been employed at this physician’s office for over 4 years when the incident occurred. Her husband Mr. A was pending a lawsuit from a current auto accident which would put a strain on their family financially. Mrs. A (RN) decides to take measures...
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...Running Head: Confidence in Confidentiality Ashley Cox Confidence in Confidentiality HCS 335 October 3, 2011 An interesting article about medical confidentiality for patients strikes the attention of many more patients in the waiting room of Doctor Zains office. The article was in a column of the poplar waiting room magazine called, Counselor”. The magazine is said to be for the addiction type professionals. The article that seemed to get the most attention from patients is called “Confidence in Confidentiality. The article talks about the privacy act for patients which is known as HIPPA, confidentiality regulations, and also briefly talks about different types of patient confidentiality situation. Confidential information is a main concern among patients; it is their medical information which is at stake here in their minds, but is that all that is at stake? The confidentiality privacy act is known as HIPAA, which is the Health Insurance Portability and Accountability Act of 1996. This act was passed by congress to improve portability and continuity of health insurance coverage in the group and individual markets, to combat waste, fraud, and abuse in health insurance and health care delivery, to reduce costs and the administrative burdens of health care by improving efficiency and effectiveness of the health care system by standardizing the interchange of electronic data for specified administrative and financial transactions, To ensure...
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...each year. There are five elements pertaining to the establishment of a false claim under the False Claims Act; 1) a claim for property or money is made; 2) the claim is against or to a department or agency of the United States; 3) the claim was false, fictitious or fraudulent; 4) the organization, or persons representing the organization, must have known at the time that claim was false, fictitious or fraudulent; and 5) the false, fictitious or fraudulent claim was material.2 Qui Tam. When an individual (relator) brings a lawsuit against an organization claiming violation of the False Claims Act, this is considered a “qui tam” action. A relator’s knowledge, used to bring about a qui tam suit, “must not be public knowledge but information that would not otherwise be available without the qui tam suit.”1 The relator, often referred to as a “whistleblower”, receives a portion of any settlement amount dictated by the results of a qui tam suit. This incentive was established by the False Claims Act and encourages individuals to assist the government in identification of fraud.1 HIPAA Privacy Standards To encourage the establishment of an electronic information system for all health-related information, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) intended to establish standards for the electronic transmission of certain health information. Entities “covered” under HIPAA include healthcare providers, health plans, and healthcare clearinghouses, and any...
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...External Environment and Government Policy Health Information Systems/HSA 520/ / Introduction Health care providers have a long tradition of safeguarding private health information, but the protection of patient rights has recently been at the forefront of this discussion. The old system of storing private patient information in locked filing cabinets is no longer practical because modern technology allows for the rapid transmission of medical information electronically. However, along with this ease of sharing come new concerns regarding the confidentiality and protection of patient information. Body 1. Discuss the impacts of a breach to healthcare information systems, especially the financial and privacy impacts. The global economic crisis of today has put a lot of risk in the healthcare industry at an accelerated pace. The most important financial and privacy risks in the healthcare industry include compliance with government mandates such as Healthcare Insurance Portability and Accountability Act (HIPAA), the federal False Claims Act and Medicare/Medicaid regulation – along with data privacy and employee misconduct or fraud. Each of these factors has grown in significance and will become more severe in the coming years. On average, companies lost seven percent of revenue to fraud in 2008, according to the Association of Certified Fraud Examiners (ACFE) 2008 Report to the Nation on Occupational Fraud and Abuse. In healthcare, the median...
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... Definition: Healthcare industry is being faced by a major threat that is misuse of patient health information. To protect the patient and their families during their job transition or the unemployment period and to protect the patient health information from being misused the U.S Congress ratified HIPAA i.e. Health Insurance Portability and Accountability Act. HIPAA protects patients and their families in times of their unemployment by providing them with Health Insurance at that particular time. (Wikipedia, 2011) The area of study this research addresses is the health care industry and the processes within. Healthcare industry is one industry that is always successfully operational because human being is exposed to the threat of illness every second. Since health care industry is always operational, the competition within the industry is extremely high. The competition is not only about who provides the best services, but it is also about who provides the best protection to the patients in terms of managing their information as well as protecting them in times of need. The subject under consideration is to study the health department of Gary Job Corps Center and develop a procedure that is compliant with HIPAA. The procedure in focus will be the management of patient health information and its security maintenance in compliance with HIPAA. The proposed solution will be given in consideration of the basic statutes and laws stated in Health...
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