...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 of the principles and practice include: * Regulations...
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...simplification requirements of HIPAA? • Electronic transactions and code sets standards requirements • Privacy requirements • Security requirements • National identifier requirements 2. Name 3 factors used to determine whether you need to comply with HIPAA. a. Whether the health plan is self-insured or fully insured b. Whether the plan sponsor receives PHI or SHI c. How the plan sponsor utilizes SHI. 3. What are the three categories of entities affected by HIPAA Medical Privacy Regulations? • Health Care Providers: Any provider of medical or other health services, or supplies, who transmits any health information in electronic form in connection with a transaction for which standard requirements have been adopted. • Health Plans: Any individual or group plan that provides or pays the cost of health care. • Health Care Clearinghouses: A public or private entity that transforms health care transactions from one format to another. 4. What would Business Associates of covered entities consist of as it pertains to HIPAA’s regulation? HIPAA defines a business associate as an individual or corporate "person" that: • performs on behalf of the covered entity any function or activity involving the use or disclosure of protected health information (PHI); and • is not a member of the covered entity's workforce. 5. Who is covered by the Privacy Rule in HIPAA? Give some examples. • Health care providers who transmit any health information electronically...
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...Health Insurance Portability and Accountability Act Compliance Guide US Department of Health and Human Services Information Security Program Health Insurance Portability and Accountability Act (HIPAA) Compliance Guide September 14, 2005 Page i Health Insurance Portability and Accountability Act Compliance Guide US Department of Health and Human Services Table of Contents Table of Contents .......................................................................................... i Preface.........................................................................................................iii Document Change History ............................................................................iv 1. Introduction ....................................................................................... 1 1.1 1.2 1.3 1.4 2. 2.1 Purpose ........................................................................................... 1 Background...................................................................................... 1 Scope.............................................................................................. 2 Document Organization ..................................................................... 4 HIPAA Administrative Simplification Requirements ........................... 5 General Overview ............................................................................. 5 2.1.1 HIPAA Administrative Simplification Goals and Objectives ............. 5...
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...Administrative Ethics Paper Alyssa Jane Marie Cunningham HCS/335 January 16, 2011 Sonja Allen Administrative Ethics Paper When developing an effective strategy and rewards compensation plan one must produce a policy that executes the plan successfully. The Affirmative Action and Equal Employment Opportunity (EEO) laws allows the human resources professionals to hire the high qualified staff by selecting the right candidates for interviews, and giving the best job offers without discriminating against any candidates. Affirmative Action prevents discrimination among race, creed, religion, and sex. According to State of South Carolina (2009), “Affirmative action is an effort to develop a systematic approach to eliminate the current and lingering effects of prior discrimination. It is a race and sex conscious effort to achieve equal employment opportunity for all race sex groups in a workforce” (p. 1). According to the United States Department of Labor (2009), “The Equal Employment Opportunity (EEO) prohibits specific types of job discrimination in certain workplaces. EEOC is an independent federal agency that promotes equal opportunity in employment through administrative and judicial enforcement of the federal civil rights laws and through education and technical assistance. EEOC protects applicants and employees of many private employers, state and local governments, educational institutions, employment agencies...
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...Administrative Ethics Paper Shannon Carpenter HCS/335 February 16, 2015 Administrative Ethics Paper When developing an effective strategy and rewards compensation plan one must produce a policy that executes the plan successfully. The Affirmative Action and Equal Employment Opportunity (EEO) laws allows the human resources professionals to hire the high qualified staff by selecting the right candidates for interviews, and giving the best job offers without discriminating against any candidates. Affirmative Action prevents discrimination among race, creed, religion, and sex. According to State of South Carolina (2009), “Affirmative action is an effort to develop a systematic approach to eliminate the current and lingering effects of prior discrimination. It is a race and sex conscious effort to achieve equal employment opportunity for all race sex groups in a workforce” (p. 1). According to the United States Department of Labor (2009), “The Equal Employment Opportunity (EEO) prohibits specific types of job discrimination in certain workplaces. EEOC is an independent federal agency that promotes equal opportunity in employment through administrative and judicial enforcement of the federal civil rights laws and through education and technical assistance. EEOC protects applicants and employees of many private employers, state and local governments, educational institutions, employment agencies, and labor organizations...
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...The Step’s Within the HIPAA Laws Page 1 The Step’s Within the HIPAA Laws Shannon Michael HCS/230 10/20/2014 Ann Maleta The Step’s Within the HIPAA Laws Page 2 Introduction The Health Insurance Portability and Accountability Act of 1996, which is known as HIPAA. The Federal legislation created this national standard to help protect the privacy of patients’ and there medical information. It was put in place to ensure greater accountability and to simplify the administrative function with the health care industry. Its purpose is to provider better healthcare continuity for the patients. There are several steps to the Privacy Rule and Compliance I will share a few with you. There must be Someone in Charge With the Privacy Rule someone needs to be assigned the responsibility to implement the rule. This person’s job is to get all the other steps in a line to implement the guild line that is done. For a small practice the doctor or office manager can take care of this duty. It the long run it will start out as a full-time job for a few weeks only and part-time job thereafter. The Duties of the Privacy Officer The privacy officer in place has a lot of things to do and to keep in place. First of all they have to track all of the steps that it takes to comply with the HIPAA Rule. This would be things like keeping files locked up in the file whether it is the cabinets or the door to the room locked. This keeps the records out of reach to others...
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...Health Insurance Portability and Accountability Act 1 Health Insurance Portability and Accountability Act Health Insurance Portability and Accountability Act of 1996 Other short title(s) Long title Kassebaum-Kennedy Act, Kennedy-Kassebaum Act An Act To amend the Internal Revenue Code of 1986 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 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...
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...Administrative ethical issues occur in health care today such as patient privacy, confidentiality or HIPAA. It is best to resolve this type of issue because patient privacy in health care is very important. These policies are designed to protect the rights of patients by making sure personal information of the patient is not disclosed in any way. Protecting a patient’s privacy by way of disclosing personal information and is not to be released without personal formal consent. Also, of employees discussing patient information on the job to people with no knowledge of the patient or even off the job. Many health care organizations enforce privacy policies such as HIPAA and confidentiality although all employees do not abide by such policies. It is being found that more frequently that people from these health care organizations are breaking these policies and their must be changes to provide patients with protection. Administrative ethical issues of the HIPAA Policy within health care organizations must make necessary changes to appropriately protect the rights of patients. The issue at hand is that of health care organizations properly protecting the rights of their patients. The article that will be discussed in this paper is that of OCR issues proposed Modifications to HIPAA Privacy and Security settings (Frank Irving, 2004). The population that is affected by it most has been impacted by such ethical issues brought upon by employees of health care organizations. The population most...
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...Administrative Ethics Paper By William Keyser HCS/335 4-26-11 Susan Morgan When developing an effective strategy and rewards compensation plan one must produce a policy that executes the plan successfully. The Affirmative Action and Equal Employment Opportunity (EEO) laws allows the human resources professionals to hire the high qualified staff by selecting the right candidates for interviews, and giving the best job offers without discriminating against any candidates. Affirmative Action prevents discrimination among race, creed, religion, and sex. According to State of South Carolina (2009), “Affirmative action is an effort to develop a systematic approach to eliminate the current and lingering effects of prior discrimination. It is a race and sex conscious effort to achieve equal employment opportunity for all race sex groups in a workforce. Then with the Equal Employment Opportunity (EEO) it prohibits specific types of job discrimination in certain workplaces, and they are a independent federal...
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... HSM Law Profile Paper HIPAA LEGAL SUMMARY The use of Information technology now allows human service organizations to more efficiently keep track of high priority information on clients, costs, and regulations. Years ago this information was kept by hand in ledgers. Nowadays client numbers, costs, and regulations have increased astronomically. As such information technology is the only way to keep track. There are a plethora of IT solutions for human service organizations. Out of the box solutions typically contain applications that record physician orders and keep track of claims and medical record information. Modern day regulation sets are complex and the need to keep track of these is extremely important. A good example of a large and complex regulation set is the Health Insurance Portability and Accountability act (HIPAA) which was put into law in 1996 by president, Bill Clinton. HIPAA has multiple facets. However the most important is that it sets rules on how to properly communicate medical data. Individuals, groups, or organizations that need to transfer medical data must do so according to HIPAA rules. As such administrators of health service organizations as well as IT professionals must understand the rules (Information Technology Association of America, 2004). The two most important components of HIPAA are simplification and privacy. Simplification means that the underlying HIPAA system must be based on one computer language...
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...A Literature Review “Privacy and Health Information Technology” Deborah Jones Dr. Udoh Udom Health Information Systems HAS 520 12/06/10 Introduction The increased use of health information technology (Health IT) is a common element of privacy of medical information. Proponents hope that the increased use of health IT will improve health outcomes for individual patients by facilitating the delivery of evidence-based care and reducing medical errors. Additionally, proponents hope that increasing information sharing among providers will better coordinate care within and across health care settings. Health IT facilitates the creation of a comprehensive health record that can move with an individual over his or her lifetime, in contrast to the fragmented records that exist today. Further, health IT is promoted as a critical tool for improving population health by allowing for the more efficient gathering of data regarding the effectiveness of certain treatments. Finally, health IT is also expected to help decrease health costs by reducing the duplication of services and the delivery of unnecessary or inappropriate care. This paper examines some of the “gaps” in privacy protections that arise out of the current federal health privacy standard, the Health Insurance Portability and Accountability (HIPAA) Privacy Rule, the main federal law which governs the use and disclosure of health information. Additionally, it puts forth a range of possible solutions, accompanied by...
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...Introduction: No matter what industry the organization fits in, IT Compliance plays an essential role of operations. It will cover both internal policies, federal regulations ,ethical practices, standards. Privacy is Fundamental to good health care. The HIPAA privacy rule is essential to patient care and public health and safety. Its very important to protect against disclosure of sensitive health information. Its critical to recognize that the lack of health privacy can lead to Individual health care and endanger public health and safety. Additional mesasures could enhance the effectivenss of the HIPAA privacy rule. Before the privacy rule with effect in April 2003, the inadequate health professional and patient outreach , awareness have...
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...HIPAA Privacy – Safe Guarding and Securing Patient Data HIPAA Privacy – Safe Guarding and Securing Patient Data Robert N. Reges DeVry University/ HSM 410 Professor Anthony LaBonte 12 December 2010 Abstract According to section 1.07 of the APA Publication Manual [ (Ame01) ], “An abstract is a brief, comprehensive summary of the contents of the article; it allows readers to survey the contents of an article quickly, and like a title, it enables abstracting and information services to index and retrieve articles” (p. 12). . HIPAA Privacy – Safe Guarding and Securing Patient Data It has been said time and time again that life was much less complicated at the turn of the 20th Century and this saying could not be truer when it comes to medicine. At the turn of the 1900’s there was a personal bond between the provider and the patient, between the provider and the community, and between citizens in the community. In small towns across the nation there was less of a sense of privacy & individualism and more emphasis on helping your neighbor; because of this medical privacy was not a concern. You cannot help your neighbor if you are not aware of their issues. If we fast forward to the year 2010 times have changed significantly; with the advent of technology the American culture has changed. Personal information is no longer just stored on paper in the doctor’s office, patient information is stored in vast computer banks and sold like stocks and bonds on...
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...A Critical Regulatory Issue in Health Care A Critical Regulatory Issue in Health Care Congress grants agencies the ability to create regulations to promote and carry out public policy (Fremgen, 2012). A critical health care regulatory issue in today’s world is The Privacy and Security Rule. The Privacy Rule, 45 CFR (Code of Federal Regulations) Part 160 and Subparts A and E of Part 164 govern the privacy of individually identifiable health information and the security of electronic individually identifiable health information. CFR 45 Part 160 is otherwise known as the Health Insurance Portability and Accountability Act (HIPAA) (U.S. Department of Health and Human Services, 2012). HIPAA enacted in 1996, outlines the conditions protected health information (PHI) may be used or released by covered entities or individuals. The Office for Civil Rights (OCR) of the Department of Health and Human Services (HHS) enforces the HIPAA Privacy Rule. The Privacy Rule, modified in 2002 and 2003, set standards for protecting the integrity and confidentiality of PHIs covered entities must follow. Medical organizations and their employees have a legal and ethical responsibility to protect patients’ medical privacy at all times. Health care facilities and employees who fail to implement effective privacy rules and regulations are subject to fines, accreditation problems, and possible suits from affected individuals. Facilities and government agencies are liable to HHS for fines but also the...
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...Administrative Ethics Paper When creating effective strategy and rewards compensation programs one must ensure that the policy established executes the plan well. The EEO or Equal Employment Opportunity and Affirmative Action laws give authorization for Human Resources representative to hire the best-qualified staff by selecting the finest candidates for interviews, and make a job offer without discriminating against any candidates. Affirmative Action assists in elevating discrimination among race, creed, religion, and sex. Based off the State of South Carolina (2009), “Affirmative action is an effort to create a logical approach to remove the current and lingering effects of prior discrimination. This is an ethnic and sex conscious effort to achieve equal employment opportunities for every person regardless of race and sex group in a workforce” (p.1). The United States Department of Labor (2009), reports “The Equal Employment Opportunity forbids specific kinds of job discrimination in certain workplaces. EEOC also known as the Equal Employment Opportunity Commission is an independent federal organization that promotes equal opportunity jobs through administrative and at times judicial enforcement of civil rights laws and technical help. The EEOC division helps protect applicants and some employees of private employers to include state and local governments, education institutions, and labor organizations (p 2.). The HR Guide, (2009) references Disparate Treatment in...
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