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HIPPA-Health Insurance Portability and Accountability Act

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Harshit Trivedi
Harshit Trivedi

This document provides an overview of the Health Insurance Portability and Accountability Act (HIPAA). It discusses the objectives of HIPAA, which are to improve portability and continuity of health insurance, prevent healthcare fraud and abuse, and simplify administration of health insurance. It outlines the key areas covered by HIPAA: insurance portability, fraud enforcement, and administrative simplification. The document also discusses HIPAA regulations around protected health information, privacy laws, audits of access to medical records, and penalties for non-compliance.

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HIPAA-Health Insurance Portability and Accountability Act BY- HARSHIT TRIVEDI
Objective An Act to improve the Internal portability and continuity of health insurance coverage in the group and individual markets, to prevent 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. HIPPA initiative was taken to regain the public trust in health care so Health care institutions and providers have worked to make sharing of medical information easier to help facilitate care and payment.
Areas under HIPAA 1. Insurance portability or the ability to move to another employer and be certain that your insurance will not be denied 2. Fraud enforcement and accountability 3. Administrative simplification
Portability Portability ensures that as people move from one health plan to another they will have continuity of coverage and will not be denied coverage under pre-existing clauses. Accountability In accordance with HIPAA, accountability means an increase in the governments fraud enforcement authority.
HIPAA Privacy LAW HIPAA is Federal Law and compliance is mandatory. Patient information must be protected through conscious effort at all times no matter where you are! The ONLY exception is when information is shared in order to provide care, treatment and payment for services.
Consequences of NOT Protecting Patient Confidentiality There are both civil and criminal penalties associated with NOT following the HIPAA guidelines about releasing patient information. The penalties vary based on if the information was inadvertently or deliberately released, as well as the type of information released. Penalties and fines may be up to $250,000 and ten years imprisonment.
Electronic Data Exchange and Record Electronic Data Exchange defines the format of electronic transfers of information between providers and payers to carry out financial or administrative activities related to health care. Information includes coding, billing, and insurance verification. EHR, EPR (electronic patient record) and EMR (electronic medical record) all are falling under this category.
Protected Health Information (PHI) Protected Health Information (PHI) is a new term that will be used with increasing frequency in facilities where you work. PHI includes information by which the identity of a client can be determined with reasonable accuracy and speed either directly or by reference to other publicly available information. The patient now has the right to direct when, why, and to whom PHI may be released. For instance, in the past, aggregated patient information may have been collected for research, quality improvement, or other purposes. Even though the patients name would be omitted, the patient may still be identifiable through specific data including date of procedure, type of procedure, gender, or any number of other details. The new bill allows patients much more control over PHI.
PHI includes items in the record, such as: Encounter/visit documentation Lab results Appointment dates/times Invoices Radiology films and reports Histories and physicals, etc.
Using and Sharing Information Most likely, all the personal information that you use and share in your daily duties is covered under HIPAA for treatment purposes.These include: Discussing diagnosis and treatment with other nurses and physicians. Performing diagnostic tests and providing this information to other providers. Providing laboratory samples or imaging tests to those who perform diagnostics on them. Referring a patient to another provider or facility, and discussing the treatment and/or diagnosis. Telephone prescription information to a pharmacy.
Requests for Access to Records Each facility will determine the specific policies but the following will be routine: Clear identification that the person requesting the medical record is either the patient or has the correct authorization to view the record. Only the parts of the record included in the authorization can be viewed. The patient may request changes to the record and the facility and parties involved must respond to the request within a preset time frame. Note that this does not imply that the record must be changed, only that the patients request has a response. Clear guidelines exist as to which staff members may have access to records and for what reasons.
Allowed Disclosure HIPAA allows disclosure of PHI to spouses, parents, legal guardians, and others involved in a patients care without obtaining the patients formal, written permission. If you are in a patient room and need to discuss their care or treatment when others are present, simply ask the patient if there is any objection.
Audit of Computer Access Audits may be conducted on a regular basis to identify inappropriate access to medical record information. Audits may be conducted on all records for patients who are hospital employees, medical staff, admitted under an alias or recognized as high profile. Random samples of records may be audited on a regular basis. This procedure is outlined in hospital policy and is overseen by the Privacy Officer.
Common glitches When leaving his/her computer, an employee didnt lock or log off the computer; another employee then utilized it to look up her own family members. Theft (or loss) of a computer, laptop. A technology-related situation which results in a significant adverse effect on people, process, technology, facilities If something like this happens, report the incident to the Privacy Officer.
Current Status of HIPAA Existing policies effective The current policies are adequate Favored by hospitals and patients Fair and just treatment of patients, medical professions, and criminal justice personnel Still in need of implementation in some departments
HIPAA and INDIA There is no act like HIPAA has been enacted in India due to lack of intervention of IT and ITES in Indian health care industry. There is forum running in India to bring act like HIPAA in India The common people are not quite concerned with HIPAA in India but there are lot of benefits which can be revealed by implementing HIPAA to the booming Indian IT Industry and Health care services. Right now some clients hesitate to contract with Indian service providers companies so this setback can be removed
THANKYOU
For further information http://www.hipaa.com/ U.S. Department of Health & Human Services- http://www.hhs.gov/ http://www.hipaa-india.com/

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HIPPA-Health Insurance Portability and Accountability Act

  • 2. Objective An Act to improve the Internal portability and continuity of health insurance coverage in the group and individual markets, to prevent 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. HIPPA initiative was taken to regain the public trust in health care so Health care institutions and providers have worked to make sharing of medical information easier to help facilitate care and payment.
  • 3. Areas under HIPAA 1. Insurance portability or the ability to move to another employer and be certain that your insurance will not be denied 2. Fraud enforcement and accountability 3. Administrative simplification
  • 4. Portability Portability ensures that as people move from one health plan to another they will have continuity of coverage and will not be denied coverage under pre-existing clauses. Accountability In accordance with HIPAA, accountability means an increase in the governments fraud enforcement authority.
  • 5. HIPAA Privacy LAW HIPAA is Federal Law and compliance is mandatory. Patient information must be protected through conscious effort at all times no matter where you are! The ONLY exception is when information is shared in order to provide care, treatment and payment for services.
  • 6. Consequences of NOT Protecting Patient Confidentiality There are both civil and criminal penalties associated with NOT following the HIPAA guidelines about releasing patient information. The penalties vary based on if the information was inadvertently or deliberately released, as well as the type of information released. Penalties and fines may be up to $250,000 and ten years imprisonment.
  • 7. Electronic Data Exchange and Record Electronic Data Exchange defines the format of electronic transfers of information between providers and payers to carry out financial or administrative activities related to health care. Information includes coding, billing, and insurance verification. EHR, EPR (electronic patient record) and EMR (electronic medical record) all are falling under this category.
  • 8. Protected Health Information (PHI) Protected Health Information (PHI) is a new term that will be used with increasing frequency in facilities where you work. PHI includes information by which the identity of a client can be determined with reasonable accuracy and speed either directly or by reference to other publicly available information. The patient now has the right to direct when, why, and to whom PHI may be released. For instance, in the past, aggregated patient information may have been collected for research, quality improvement, or other purposes. Even though the patients name would be omitted, the patient may still be identifiable through specific data including date of procedure, type of procedure, gender, or any number of other details. The new bill allows patients much more control over PHI.
  • 9. PHI includes items in the record, such as: Encounter/visit documentation Lab results Appointment dates/times Invoices Radiology films and reports Histories and physicals, etc.
  • 10. Using and Sharing Information Most likely, all the personal information that you use and share in your daily duties is covered under HIPAA for treatment purposes.These include: Discussing diagnosis and treatment with other nurses and physicians. Performing diagnostic tests and providing this information to other providers. Providing laboratory samples or imaging tests to those who perform diagnostics on them. Referring a patient to another provider or facility, and discussing the treatment and/or diagnosis. Telephone prescription information to a pharmacy.
  • 11. Requests for Access to Records Each facility will determine the specific policies but the following will be routine: Clear identification that the person requesting the medical record is either the patient or has the correct authorization to view the record. Only the parts of the record included in the authorization can be viewed. The patient may request changes to the record and the facility and parties involved must respond to the request within a preset time frame. Note that this does not imply that the record must be changed, only that the patients request has a response. Clear guidelines exist as to which staff members may have access to records and for what reasons.
  • 12. Allowed Disclosure HIPAA allows disclosure of PHI to spouses, parents, legal guardians, and others involved in a patients care without obtaining the patients formal, written permission. If you are in a patient room and need to discuss their care or treatment when others are present, simply ask the patient if there is any objection.
  • 13. Audit of Computer Access Audits may be conducted on a regular basis to identify inappropriate access to medical record information. Audits may be conducted on all records for patients who are hospital employees, medical staff, admitted under an alias or recognized as high profile. Random samples of records may be audited on a regular basis. This procedure is outlined in hospital policy and is overseen by the Privacy Officer.
  • 14. Common glitches When leaving his/her computer, an employee didnt lock or log off the computer; another employee then utilized it to look up her own family members. Theft (or loss) of a computer, laptop. A technology-related situation which results in a significant adverse effect on people, process, technology, facilities If something like this happens, report the incident to the Privacy Officer.
  • 15. Current Status of HIPAA Existing policies effective The current policies are adequate Favored by hospitals and patients Fair and just treatment of patients, medical professions, and criminal justice personnel Still in need of implementation in some departments
  • 16. HIPAA and INDIA There is no act like HIPAA has been enacted in India due to lack of intervention of IT and ITES in Indian health care industry. There is forum running in India to bring act like HIPAA in India The common people are not quite concerned with HIPAA in India but there are lot of benefits which can be revealed by implementing HIPAA to the booming Indian IT Industry and Health care services. Right now some clients hesitate to contract with Indian service providers companies so this setback can be removed
  • 18. For further information http://www.hipaa.com/ U.S. Department of Health & Human Services- http://www.hhs.gov/ http://www.hipaa-india.com/