HIPAA

1
HIPAA

• The Health Insurance Portability And
  Accountability Act of 1996

2
HIPAA History and Objectives

• Improve the efficiency of the health care system.
• Reduce the overall cost of health care and
  therefore the federal governments future
  liability.
• Protect the Privacy and Security of Individuals
  health care information by setting Standards
  and requirements.
• Standardize and automate increased enabling of
  fraud and abuse monitoring and enforcement.
• Eliminate pervasive Medicare fraud and abuse.

3
HIPAA Major Rules

• Transaction Code Sets
• Standard code sets are required for selected
  data elements in more than one of the electronic
  transaction standards. Electronic transaction
  include transactions using ANY media, even when
  information is physically moved from one location
  to another using diskette, tape or CD media.
• 2. Privacy Rule
• Defines who is authorized to access
  information. It is the right of individuals to
  keep information about themselves from being
  disclosed.
• Security Rule
• The ability to control access and protect
  information from accidental or intentional
  disclosure to unauthorized persons and from
  alteration, destruction or loss. This is the
  implementation of the Privacy Rules.

4
Protected Health InformationPHI

• Any information that identifies individual or
  gives a reasonable basis in identifying the
  individual must be protected.
• Covers all forms of information.
• Covers names, telephone numbers, fax numbers,
  e-mail addresses, social security numbers,
  photographs, geographical identifier smaller than
  state and any date element such as birth date or
  service discharge date.

5
The Individuals Rights

• Right to access, inspect and get a copy of their
  own information.
• Right to request amendment or correction of
  information.
• Right to have written notice of information
  practices and receive accounting of disclosures.

6
HIPAA Rules and Guidelines

• Transaction and Code Sets
• Fully effective October 16, 2003.
• Privacy Standards for Individually Identifiable
  health Information
• Fully effective April 14, 2003
• Security Standards
• Fully effective date for compliance
  enforcement Fall 2004

7
Who must comply with HIPAA?

• All direct and indirect providers of health care
  services and supplies
• direct providers like hospitals
• indirect providers like laboratories
• vendors
• any entity transmitting health information
  in electronic form.

8
Who is not required to follow HIPPA Rules?

• Life Insurance Programs
• Worker Compensation Programs
• Property casualty insurance programs
• Disability insurance programs
• Other non-health insurance programs

9
Federal Civil Criminal Penalties for Violation
of Patients Right to Privacy.

• Civil Monetary Penalties non-criminal
  violations, including disclosures made in error-
  not intent to violate.
• 100 per violation up to 25,000 per
  year/standard/individual.
• Criminal Penalties knowingly violating.
• Up to 50,000 1 year imprisonment for
  obtaining or disclosing PHI.
• Up to 100,000 up to 5 years imprisonment for
  obtaining or disclosing PHI under false
  pretenses.
• Up to 250,000 10 years imprisonment for
  obtaining PHI with the intent to sell, transfer,
  or use for commercial advantage, personal gain,
  or malicious harm.

10
Who Polices HIPAA ?

• Office of Civil Rights of the Department of
  Health Human Services.
• Covered Entities provide records and compliance
  reports.
• Any person may file a complaint with the
  Department of Health Human Services.
• Whistleblower provisions.

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WHO ARE THE HIPAA WHISTLEBLOWERS?
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Your Patient Relations

• Patients are your whistle blowers

13
Provide Notice of Policies Procedures in
Patient Privacy

• To anyone who asks for it
• Read or pickup at office
• Accessible on Web sites
• Health plans provide notice at enrollment or
  notice of availability
• First Treatment Service with individuals written
  acknowledgement of receipt
• Consent and acknowledgement on one form
• Email notice of Policy and Procedures

14
Reasonable Safeguards

• Speak quietly
• Avoid using patient names in public hallways and
  elevators and posting signs to remind employees
  to protect patient
• Lock or isolate patient records in file cabinets
  or records rooms
• Passwords on computer systems

15
Concerns of HIPAA Investigators

• Incidental disclosures
• Handling in office records or computer screens
• Faxing of records
• Loss of control
• Transfer of records via email / computer
  encription
• Covered Entitiy ignoring HIPAA compliance
  standards

16
Release of Information ROI

• Within the patient provider relationship,
  health professionals have a legal, ethical and
  moral obligation to protect confidential
  information

17
What is Confidential?

• Is there a professional patient provider
  relationship?
• Was the information exchanged within this
  relationship?
• Is the information needed to diagnose or treat
  the patient?

18
What is Not Confidential?

• Patient name
• Address
• DOB
• Insurer
• Next of Kin
• Not confidential but private!

19
Need to Know

• Users may be authorized to see the record
• Should have a clear need to know to have access

20
Record Ownership

• Provider owns the record whatever physical form
  its kept in
• Record is maintained for benefit of patient
• Documents service and standard of care
• Patient owns the information has right to
  control its flow
• Those who violate this right may be held liable
  to the patient

21
Personal and Impersonal Use

• Confidentiality belongs to the person not to
  the information
• Personal Uses which depend on individual
  identity, such as patient care, insurance claims
  and legal action
• Impersonal uses which are independent to
  personal identity program evaluation ,
  statistical report and/or research

22
Valid Authorization

• Requests in writing
• Addressed to provider
• Specific name, address and DOB
• Specifies information requested
• Specific dates of service
• Indicates reason information is needed
• Date event or condition of expiration
• Signed by patient or legal representative
  relationship
• WHEN IN DOUBTlt DONT GIVE IT OUT, seek advice

23
Valid Release Process

• Locate documents/chart
• Match the signature for validation
• Calculate charges
• Make copy
• Add cover letter, stress confidentiality/ Return
  receipt if necessary
• Mail and log it

24
Telephone and Fax (ROI)

• Discouraged but may be necessary
• Caller name and number
• Reason information is needed
• Information requested
• Special authorizations

25
Telephone and Fax (ROI)

• Call backs
• Fax with cover sheet with confidentiality
  statement
• Call and confirm that fax is attended
• Document request and release in log and patient
  chart

26
Releases

• Patient
• Attorney
• Failure to release may result in legal action
• Subpoena

27
Caution

• Be alert!
• Information may be released in unanticipated ways
• Be cautious who can see computer screens ,
  schedules , copiers, fax machines and who may
  over hear your conversations

28
What DO You Think?

• One patient overhearing patient health
  information laden conversation in an adjoining
  room between doctor and patient.

29
Answer

• we dont need to rebuild our offices only to
  create a private , soundproof room, reports the
  Department of Health and Human Services Office
  of Civil Rights (December 2003)
• Figure out in your office what reasonable
  safeguards
• Keep Your Staff AWARE!!

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Scenario

• A patient overhears the receptionist and
  technician making unkind comments about the waist
  measurement of another patient

31
Answer

• This is not incidental disclosure. Even if
  individuals were making kind or flattering
  comments about a patients waistline, it would
  still be inappropriate disclosure
• Gwen Hughes, Care Communications, Chicago Ill.

32
Scenario

• A bartender overhears an office assistant telling
  another assistant about the famous actor that she
  had as a patient

33
Answer

• This is an inappropriate disclosure. Personal
  discussions of patients should not take place in
  or especially out of the office.
• Gwen Hughes, Care Communications, Chicago Ill.

34
5 Step CHECK LIST

• Notice of Privacy Policies and Procedures
  available
• Make sure patients can assert their privacy
  rights
• Keep staff trained (Part time and Full time and
  NEW STAFF)
• Encourage ongoing awareness and possible
  Incidental Disclosure events
• Protect the handling of your records

35
True Professionals Are And Should Be Held
Accountable For Their Actions C. Bruce
36
Ten Commandments of HIPAA

1. Thou shalt accurately capture, code and bill for
   services.
2. Thou shalt honor the Privacy Security of all
   patient information that is ethically, morally,
   and legally required of every workforce member as
   a part of their job description as a condition
   of employment/service.

37
Ten Commandments of HIPAA

• Thou shalt treat all patient information, in any
  form, as PHI.
• Thou shalt access use patient information on a
  need to know basis only idle curiosity is a
  sin and illegal.
• Thou shalt not discuss patients unless it is
  necessary for treatment, payment, or the
  operation of the organization otherwise it is
  gossip and wrong.

38
Ten Commandments of HIPAA

1. Thou shalt not disclose individually identifiable
   patient information as it is is a crime,
   punishable by civil and criminal penalties.
2. Thou shalt discuss patient information only in a
   private setting.
3. Thou shalt not share user IDs, passwords,
   combinations, etc.

39
Ten Commandments of HIPAA

1. Thou shalt keep paper patient records out of
   sight of unauthorized persons, including
   workforce members.
2. Thou shalt report something or someones actions
   that look questionable, as if it seems wrong it
   probably is. Most compliance is common sense.

40
What does this mean to me as a Vision Care
Technology Student at SCC?

• All patient information is private and not to be
  discussed outside of a classroom situation.
• Disposal of surgery schedules will follow my
  clinical guidelines for disposal.
• Transferring any patient information will not be
  done.