Privacy Rules: The privacy rule is a standard rule that addresses the use and disclosure of individual healthcare information. Your job as a health care organization is to implement, enforce, and protect the individual private information. They are important because it the organization responsibility to understand and control how the individual health information is well protected, while allowing the flow of health information needed to provide and promote high quality health care and to protect the public's health and well being.
The regulations require providers to make a reasonable effort to disclose only that information which is necessary for securing payment and conducting standard health care operations such as audits and data collection. Security Rules: The security rule is created to protect the privacy of individual health information, while allowing covered healthcare organization to adopt new technologies to improve the quality and efficiency of patient care.
The rule is designed to be flexible and scalable so a covered entity can implement policies, procedures, and technologies that are appropriate for the organization particular size, structure, and risks to individuals. The rule is national standards rule established to protect individuals’ electronic personal health information that is created, received, used, or maintained by the organization. Standardized transaction code sets rules (TCS): The TCS rule is created as a standard use of electronic transaction format.
It is important because it is a set standard formats that helps ensure that claims, health care enrollment, health care payment, refer certification and authorization for health care are uniformed. It impacts staff duties and the organization by keeping the transaction organized and allows the process of a claim easier to manage. U. S. Department of Health and Human Services. (2003, April 3). U. s. department of health.
From the Chief Compliance Officer (CCO) perspective on HIPAA, contemplate the three basic areas which HIT professionals must be most Part concerned with are: I (1) Privacy Rules (2) Security Rules, and (3) Standardized transaction code sets Write a paragraph on each of the 3 critical areas of HIPAA for a training session of your staff. Explain what they are, why they are important and how they impact staff duties and the organization. Department HIPAA Inventory Form Health Information Management Services: a. Critical Issue: maintains records for all inpatient, same-day surgery and outpatient services.
The information is protected by the HIPAA regulation and copies may be released upon the patient’s written consent. b. Information use: Records handling and access control - Allow only authorized personnel to extract information by copy/paste, restricted access to PHI to ensure integrity of information and minimize the risk of compromising confidentiality. For example, automate handling to quickly secure permission of the Chief to approve the physical removal of patient health records from the treating facility.
Communication and Information sharing- Preserve confidentiality of patient information by preventing its communication to unauthorized persons. Also, enforce persistent information access and use policies with care partners that safeguard the use and disclosure of PHI. For example, this support compliance activities without changing the way users work. Personal training and education - Display alerts and messages that reinforce the training employees have already received in maintaining the confidentiality of patient information.
Record Access and Auditing - A detailed logs and audit trails of protected health information access and demonstrate compliance with record privacy and confidentiality standards. For example, information is reported in a format that can be easily stored, viewed, and imported into other organization systems. Record Retention: documents must be maintained for 6 years, depending on your states rules. Fill out the HIPAA inventory form (see row 2, column #3) for your organization or a health care hospital.
Fill out the attached HIPAA inventory form for your organization. List the various departments from where you have retrieved Leading experts in HIPAA data. Indicate how the implementation agree that the data will be used. How Part first step toward HIPAA does each Health Care II compliance is to Inventory the Department (Health organization’s data Information Management Services, Clinical Nursing, Accounts Receivable or Credit) use the patient data of the facility? What specific information do they need and use in Clinical Nursing Services: their department?
Why is a. Critical Issue: The challenges facing nurses today, because of the information the a numerous of regulatory and administrative requirements such as labors, department uses delivery requirements, and the lack of adequate nursing staff to facilitate important to protect? care planning, and patient care and safety. b. Information use: Improve patient safety- documentation solutions improve patient safety by helping to reduce medication errors, identify at-risk patients, and to facilitate timely and shared information.
Improve performance - regulatory compliance and quality improvement initiatives mean constantly raising the bar. It shouldn’t be such a burden for the clinical staff to manage quality and clinical outcomes with tools that allow organizations to cost-effectively implement rapid and sustainable clinical quality improvements and quality of care using continuous feedback. Improve care efficiency - allow nurses to better manage their workload to facilitate care planning and focus on making the right care decisions, all of which provide more time to interact with patients and their families.
Credit Department: a. Critical Issue: payments include disclosures to consumer reporting, a privacy rule permits uses and disclosures by the organization or its affiliates as required by the Fair Credit Reporting Act. b. Information use: The disclosures are limited to the following PHI about the individual name and address; date of birth; social security number; payment history; and account number. The organization may perform this payment activity directly, or may carry out this function through a third party, such as a collection agency, under a business associate arrangement.
Misconceptions – An unpaid medical bill is treated as any other debt that goes unpaid. HIPPA protects how your personal medical information is handled, but it does not separate your medical expense responsibilities from your credit. Medical Billing - HIPPA does prohibit certain patient information from being released, it does not protect patients who do not pay their medical bills. For example, if you have a past due or overdue medical bill, the doctor or hospital does have the right to report this to the credit bureaus.
Minimum Information - an unpaid medical bill is considered a debt collection situation, under HIPPA health care providers can hire a debt collection agency to collect the debt on their behalf. When your medical expense is turned over to a collection agency, the health care provider is also allowed to supply the debt collection agency with some of your personal information, which is the minimum amount of information necessary for the debt collector to try to collect the debt.
Credit Report and Credit score - When your medical expense is turned over to a collection agency, the health care provider is also allowed to supply the debt collection agency with some of your personal information. Health care providers or the debt collectors hired may be able to obtain information that reveals you have the ability to pay outstanding medical expenses. For example, if you are applying for free medical care or discounted medical rates, a health care provider also has the right to pull your credit report.
Operational Activities and HIPAA TPO is treatment, payment and health care operations. CCO is correct under HIPAA regulations, because with a written consent from the patient they have the authorization to provide other entity health information about the patient. Treatment (T) – is the provision, coordination, or management of health care and related services among health care providers or by the third party consultation between health care providers regarding a patient, or the referral of a patient from one health care provider to another.
For example, my family doctor would refer me to another clinic for a blood test because they don’t provide that type of services. In a modern US hospital, the individual responsible for assembling a HIPAA implementation team Part generally holds the title Chief III Compliance Officer, with the Chief Information Officer (CIO) in the primary role of electronic communication, and all data compliance.
The CCO assures the CIO and HIMS Director that they may in fact release private health information (PHI) for TPO with a written authorization. What is TPO and why is the CCO correct under HIPAA? Payment (P) - the various activities of health care providers to obtain payment or be reimbursed for their services and of a health plan to obtain premiums, to fulfill their coverage responsibilities and provide benefits under the plan, and to obtain or provide reimbursement for the provision of health care.
For example, my insurance with Anthem Blue Cross required a $25 co-pay for the office visit; this is required payment during my visit to the doctor’s office. Operations (O) - are administrative, financial, legal, and quality improvement activities of a health care organization that are necessary to run its business and to support the core functions of treatment and payment.
The organization also conducting quality assessment and improvement its activities relating to improving health or reducing health care costs, and case management and care coordination. Also other activities such as conducting or arranging for medical review, legal, and auditing services, including fraud and abuse detection and compliance programs, and business management activities, including those related to implementing and complying with the Privacy Rule. U. S. Department of Health and Human Services.