Health Care Technology Solutions

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PDM
Health Care Technology Solutions
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www.pdmsolutions.us
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Agenda
Academy of Medicine of Cincinnati Delivering
Quality Patient Care Within the New HIPAA
Guidelines

• Introduction
• Defining Quality Patient Care
• HIPAA
• ADAPT-ing to HIPAA
• Questions Answers

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Orientation
HOW We Do It

• PDMs Focus
• Healthcare Regulatory Compliance,
• Information Systems,
• Law,
• Project Management, and
• Electronic Data Management
• for HIPAA compliance.

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Just Think!
FACT 1
National health expenditures are projected to
reach 2.6 trillion dollars by the year 2010!
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Just Think!
FACT 2
Prescription Drugs are the fastest rising
component of personal health expenditures.
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Just Think!
FACT 3
Medical care information is now about 20 above
the overall inflation rate.
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Just Think!
FACT 4
Personal consumption expenditure data for 1999
reveals that Americans spent 15 cents of every
dollar on health care!
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QUALITY
Just Think!
How would you define Quality Patient Care?
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HIPAA
Health Insurance Portability Accountability
Act HIPAA
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HIPAA
The Health Insurance Portability Accountability
Act (HIPAA) impacts the classification and
handling of
Personal Health Information or Medical Records
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HIPAA
The Health Insurance Portability Accountability
Act (HIPAA)
Personal Health Information

• Patient Identification Bracelet
• Insurance Card
• Dictation (PreTranscription)
• Financial Records
• Test Results
• Celebrity News Regarding Health
• Data on Computer Monitors

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HIPAA
The Health Insurance Portability Accountability
Act (HIPAA)
General Information Becomes Protected Health
Information If Linked To The Following

• Patients Name
• Patients Social Security Number
• Patients Drivers License Number
• Telephone or Fax Number
• Patients Address

• E-mail Address or URL
• Patient Identification Number
• Health Insurance Plan ID Number
• Finger, Voice Print or Biometric ID
• Photographs

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HIPAA
The Health Insurance Portability Accountability
Act (HIPAA)
mandates
HOW to secure and store Protected Health
Information
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HIPAA
The Health Insurance Portability Accountability
Act (HIPAA) mandates
Standards for sending and receiving electronic
data Privacy and Security Protection for patient
data Establishes uniform healthcare identifiers
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HIPAA
Do you KNOW what is expected of YOU?
ADMINISTRATIVE SIMPLIFICATION
WHAT?
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HIPAA
Part 1 You must develop and implement STANDARD
PROCESSES for electronic transactions
Part 2 You must develop and implement PRIVACY
SECURITY procedures to ensure confidentiality and
prevent the misuse of patient information.
ADMINISTRATIVE SIMPLIFICATION
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HIPAA
Part 1 You must develop and implement STANDARD
PROCESSES for electronic transactions
HIPAA requires any practice that electronically
sends and receives certain transactions must do
so in a standard format.
ADMINISTRATIVE SIMPLIFICATION
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HIPAA
REQUIREMENT FOR STANDARD TRANSACTIONS
In use by October 16, 2002!
A one year extension is available from HHS, If
an application is filed by October 16, 2002.
Are YOU in COMPLIANCE?
ADMINISTRATIVE SIMPLIFICATION
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HIPAA
Standard Transactions
In use by October 16, 2002 or one year extension
filed!
NO EXTENSION ????
You MAY be excluded from MEDICARE Payments!!!
ADMINISTRATIVE SIMPLIFICATION
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HIPAA
HIPAA Standard Electronic Transactions

• Claims or Equivalent Encounters (837)
• Remittance and Payment Advice (835)
• Claim Status (276/277)
• Enrollment Un-enrollment in Health Plan (834)
• Premium Payment
• Eligibility Inquiry and Response (270/271)
• Referral Certification Authorization (278)
• Coordination of Benefits (837)
• First Report of Injury (148)
• Claim Attachments (275)

ADMINISTRATIVE SIMPLIFICATION
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HIPAA
HIPAA Uniform Code Sets

• Drug Codes NDC (may be changed back to J
  codes in hospitals)

• Other Service Codes HCPCS (no more local codes)

• Diagnosis Codes ICD-9-CM

• Physician Services Codes CPT-4

• Inpatient Service Codes ICD-9-CM

• Procedure Codes CPT-4

• Dental Codes CDT

ADMINISTRATIVE SIMPLIFICATION
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HIPAA
HIPAA National Identifiers

• EMPLOYER (Effective May 13, 2002)

• INDIVIDUAL (On Hold)

• HEALTH PLAN

• PROVIDER

ADMINISTRATIVE SIMPLIFICATION
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HIPAA
Part 2 You must develop and implement PRIVACY
SECURITY procedures to ensure confidentiality
and prevent the misuse of patient information.
HIPAA requires, for a covered practice, all
CONFIDENTIAL information (electronic and paper)
must be protected.
ADMINISTRATIVE SIMPLIFICATION
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HIPAA
REQUIREMENT FOR PRIVACY SECURITY STANDARDS
Privacy compliance required by April 14, 2003!
SECURITY requirements are not finalized!
ADMINISTRATIVE SIMPLIFICATION
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HIPAA
REQUIREMENT FOR PRIVACY OF ALL PATIENT INFORMATION
You must limit the availability and use of
CONFIDENTIAL data!
Data is considered PHI Protected Health
Information
ADMINISTRATIVE SIMPLIFICATION
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HIPAA
REQUIREMENT SECURITY STANDARDS
Although SECURITY requirements are not finalized,
Security will be required for the SYSTEMS used to
physically and electronically limit access to
confidential information.
ADMINISTRATIVE SIMPLIFICATION
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HIPAA
REMEMBER
PRIVACY refers to WHAT must be kept Confidential.
SECURITY refers to HOW it is to be kept
Confidential.
ADMINISTRATIVE SIMPLIFICATION
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HIPAA
ADMINISTRATIVE SIMPLIFICATION
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HIPAA
What you should do to prepare
A D A P T
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HIPAA
ccept CCOUNTABILITY
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for Implementation
A D A P T
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HIPAA
efine and OCUMENT
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Policies and Procedures
A D A P T
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HIPAA
A
UDIT
and Take Corrective Action
A D A P T
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HIPAA
P
HI (Protected Health Information)
Privacy Security
A D A P T
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HIPAA
T
ECHNOLOGY
For Administrative Simplification
A D A P T
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HIPAA
A D A P T
Delivering Quality Patient Care Within the New
HIPAA Guidelines requires
Accountability for Implementation Document
Policies Procedures Audit and Take Corrective
Action Protected Health Information Privacy
Security Technology for Administrative
Simplification
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Change Management
HIPAA
What you should do to prepare
Take time to understand the basics of HIPAA
Conduct an initial practice audit
ADMINISTRATIVE SIMPLIFICATION
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Change Management
HIPAA
What you should do to prepare
Evaluate current policies and practices
Revise policies and practices as needed
ADMINISTRATIVE SIMPLIFICATION
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Change Management
HIPAA
What you should do to prepare
Develop and adopt new processes for use
Create documentation to support process changes
ADMINISTRATIVE SIMPLIFICATION
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Change Management
HIPAA
What you should do to prepare
Execute a FINAL AUDIT to ensure practice is HIPAA
compliant
Monitor processes and practice to ensure HIPAA
compliance is maintained and loss is eliminated
ADMINISTRATIVE SIMPLIFICATION
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Change Management
HIPAA
HEALTH PRACTICE RISK CONSIDERATIONS

• DECISION MAKING
• The structure and authority within a practice
  must ensure compliance.

ADMINISTRATIVE SIMPLIFICATION
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HIPAA
Adapt to HIPAA!
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QUESTIONS ANSWERS
PDM
Health Care Technology Solutions
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Your Partner in HIPAA Compliance Theresa A.
Hood [phone] www.pdmsolutions.us
PDM
Health Care Technology Solutions