Archive for April 2010
Administrative Simplification is special provision which was included in Health Insurance Portability and Accountability Act of 1996 (HIPAA) to make it more efficient and effective. Administrative Simplification requires HHS to handle electronic health care, health identifiers, and security through national standards. These provisions were created by US congress which promptly realized that as the technology advances, the risk of invasion of medical privacy can increase. Thus, these provisions were incorporated in HIPAA that made it mandatory to adopt Federal privacy protections to protect identifiable medical information.
Privacy Rule was finalized in December 2000 and was modified in 2002. Privacy Rule creates national standards for three kinds of covered entities:
- Health care clearinghouses
- Health plans
- Health care providers
All of these covered entities perform electronic transactions of health care information, in their own way and they were required to start compliance with this rule from April 14, 2003. Smaller health care plans could start their compliance a year later.
In February 2003, a Security Rule was established to create national standards of confidentiality, access and integrity EPHI (electronic protected health information). Both Privacy rule and security rule are governed by OCR; while other Administrative Simplification Rules in HIPAA are governed by the Centers for Medicare & Medicaid Services.
These rule include:
- Employer Identifier Standard : This rule creates standard for a employer identifier and its usage by Health care providers, health plans and health care clearinghouses
- Transactions and Code Sets Standards – These consist of two rules. In first rule, HHS owns a new Medicaid subrogation standard for pharmacy claims. In the second rule, HHS has modified the standard code sets for medical data.
- National Provider Identifier Standard: The National Provider Identifier is a HIPAA Administrative Simplification Standard. This is an identification number given to help covered doctors and other health care providers.
Besides these, another rule called Enforcement Rule creates standards to enforce all Administrative Simplification Rules. 45 CFR Parts 160, 162, and 164 includes all HIPAA Administrative Simplification Rules.
Health Insurance Portability and Accountability Act (HIPAA) of 1996 was created in United States of America in 1996. The bill was sponsored by Senator Nancy Kassebaum and Senator Edward Kennedy. HIPAA is divided in two titles:
- Title I
- Title II
Title I provides protection to employees and their families who lose their job and consequently, their healthcare. Title II provides guidelines to establish standards for the protection of national identifiers healthcare plans, employers and other providers and also the electronic healthcare transactions. Title II provides provisions for administration simplification which address privacy for medical data concerning the patients. These standards are created to make the health care system more efficient and effective by promoting Electronic Data Interchange.
The transmission of data between two organizations through electronic means is known as Electronic data interchange. Electronic Data Interchange is used to transfer medical data from one computer to another. EDI includes a number of standards, set up by the authorities.
Title II also defines a number of offenses and penalties related to health care. The Title sets up programs to control frauds, violations and abuse in health care system. According to this Title the Health and Human Services department must create rules to increase the efficiency in health care system and provide a fair and effective service to individuals.
HIPAA came into existence, after years’ of complaints by patients regarding misuse of their health records. The United States of America’s Government realized the need to create guidelines for the usage of medical records by health care officials, hospitals, insurance companies etc.
Before the introduction of HIPAA, individuals did not have any rights to promptly access their medical records and procuring them could take weeks as there was no standard procedure to record and store medical records. The law also ensures that an individual continues to have healthcare even after losing his or her job, for a considerable period of time. This gives the individual and his/her family protection until he/she finds a new job.
All in all, Health insurance portability and accountability act of 1996 has transformed the way medical records are used, disclosed and stored by covered entities.
HIPAA privacy rule came in effect on 14th April, 2003 and regulates usage and disclosure of some parts of information that’s held by employer health plans companies, health care providers and clearinghouses. Privacy rule of HIPAA manages Protected Health Information (PHI). PHI mainly includes all the medical records and payment history of a patient.
Under HIPAA privacy rule, covered entities are required to disclose Protected Health Information within 30 days of request to the individual. Covered entities are also required to disclose the information when a professional suspects illegal or criminal activities like child abuse. Such cases are required to be reported state authorities, immediately.
PHI can also be discloses when it is essential for treatment, health care operations or payments. In some other cases, the covered entities will need permission from the individual to disclose his PHI. But the entities must make sure that only as much information is disclosed as essential for the purpose. The entity that’s disclosing the information must make efforts to ensure that no unnecessary information is disclosed. They are also required to inform about the disclosure of information to any authority, in advance.
All the disclosures should be documented and recorded to keep track of PHI given to various sources. A privacy official should be appointed by covered entities to manage all these information. A contact person should also be appointed who will be responsible to handle all the complaints and all the officials in the covered entity should be trained to handle PHI.
The protected individual also gets many rights, under HIPAA privacy rule. He can request the rectification of any inaccurate information. He has the right to expect complete confidentiality of the information he communicates with his doctors and other medical practitioners. He can also ask the doctor to communicate with him in a particular time-span or through a particular channel, to maintain his privacy. The individual can file a complaint in Department of Health and Human Services office, if he finds any violations in his privacy rights.
HIPAA Privacy rule is helping many individuals to protect their privacy and medical history.
HIPAA Security Rule was completed in 2003 and institutions were required to be in compliance with it by April 2005. Unlike privacy rule, which pertains to all the information that’s protected under HIPAA, security rule is deals with electronically stored information of patients’ health records.
There are three main kinds of security rules:
- Administrative Safeguards – These include the following steps
- Covered entities must have privacy procedures and a privacy officer.
- All the procedures must identify the employees who have the access to electronic protected health information (EPHI). This access should be restricted to just those employees who need it to perform their job productively.
- Authorization, termination establishment and modification must be defined extensively
- Training to handle PHI must be given to employees who will be performing the administrative functions.
- Institutes which outsource their processes must ensure that the third-party also complies with HIPAA requirements.
- All entities must put a contingency plan in place for emergencies. All the data must have a backup and there should also be disaster recovery procedures.
- The entities should conduct internal audits to identify potential violations.
- Technical Safeguards – These safeguards enable covered entities to secure all the communication regarding PHI and control the access of people to computer systems containing PHI. Following are the requirements of these safeguards:
- The systems which contain PHI should be protected and secured from any type of intrusions. Information that goes through an open network must possess some kind of encryption.
- The data should not be changed or deleted by any unauthorized person or body.
- While integrating data, methods like data corroboration should be used. All the covered entities should identify other entities to which the data or information is communicated.
- All the HIPAA practices by covered entities should be documented and must be made available to government.
- Information technology documentation should include record of every configuration setting of the network.
- Physical Safeguards – These safeguards control physical access and protect the data against illegal access. Following are the requirements of these safeguards:
- Introduction or removal of software and computer hardware should be controlled. The equipment must be disposed only after ensuring that no protected data falls in wrong hands.
- Covered entities should control and monitor the access to computers and other systems that contain health information.
- Facility security plans, visitors, records, etc. all should be monitored.
- The entities should create policies to ensure right usage of workstations.
HIPAA was enacted in 1996 and its sole objective was to protect patients’ personal information. This law is something that we all have to use at some point of our life. Whether we meet and accident or have a new baby, we provide a lot of personal medical information to our doctors regarding the present and past health history of ourselves and our family members. HIPAA protects this information from falling into wrong hands.
Hipaa law was created while keeping the interest of common consumers in mind. During any kind of treatment, the medical records of a patient pass through many hands. All the nurses, hospital staff, doctors, insurance company officials etc. have access to these records. If not protected, any of these people can leak, steal or misuse our personal details for his private gain or that of the institution he works for. But thankfully, patients can now hold all of these entities responsible, if any of their information is misused.
HIPAA protects our basic health information, address, social security number, records of pre-existing medical conditions, treatments done in the past, pre-existing mental stress, birth date etc. All the information used by doctors is also protected, but they can access your updated medical information without prior permission, in order to provide the best treatment or collect payment from your health insurance.
Under HIPAA, the authorization process is supposed to be written in the most simple and understandable terms, instead of technical jargon. According to the policy makers, the technical terms make it difficult for people to really understand their own records and it is important to make sure that everyone understands their own records.
According to this act, you can also get backup healthcare package, if you want to extend or avail a good healthcare package. Title 1 of HIPAA law abolishes any order or rules which diminish legal right of a consumer to get proper benefits of health insurance. In other words, if you possess a health insurance and you do not have any pending dues or premiums, but still, your health insurance company refuses to provide you medical benefits, then HIPAA will cancel any such orders and protect your right to get insurance coverage.
This law is one of the best assistance that an American healthcare consumer has ever got. The laws of HIPAA are truly for the people.
HIPAA or Health Insurance Portability and Accountability act was introduced to stop the injustices incurred by medical and health insurance institutions regarding patients’ health records. Before the inception of this Act, the entire medical system in United States of America was unregulated and ill-managed. Thankfully, HIPAA has been able to create many positive changes into this.
But there are still many instances of violations in HIPAA and as a patient, you must know what are your rights regarding an apparent violation in this act. But before we come to the violations, you must know the actions which are permitted under this act. HIPPA gives you the right to find out everything about your healthcare and also choose your own doctor. It also improves your accessibility towards group healthcare plans.
Patients are entitled to see and have a copy of their medical records. None of their medical information can be shared without prior notice to them. This act has also empowered people to switch jobs without losing health care. As a result, it became necessary to find a solution that would reduce the cost of administration without compromising with HIPAA and the solution was to computerize the entire medical record system in insurance companies and hospitals.
It must be mentioned that many insurance companies were not in favor of this act, since it caused a lot of financial strain on them. The high level of administrative work required to comply with this act was a major concern for most providers who were not in agreement with HIPPA voiced their displeasure at the privacy requirements; noting that they would put financial strain on providers while they put measures in place to comply. The law originally caused tens of thousands of privacy rule violation complaints.
The electronic system for record keeping has not only made it extremely cost efficient to manage records of patients, but has also been helpful in providing better privacy to the records. Another great advantage of electronic records system is that it allows quick transfer of medical records of a patient from one hospital to another, in case of an emergency. This can be detrimental in saving many lives.
Any individual institution found to be guilty of violating HIPAA, has to pay fine in accordance with the severity of the crime. There have been over 9000 verdicts in civil courts regarding HIPAA violations, ever since it came into force.
HIPPA stands for Health Insurance Portability and Accountability Act. It This act came in force in 1996 to protect unnecessary disclosure and exploitation of health information of consumers. It is made of two major sets of rules.
- HIPAA privacy rule: This rule makes it mandatory to keep the personal health information of a person confidential.
- HIPAA Security Rule: This rule creates privacy standards for electronic health information of patients.
Under HIPPA, following information is protected:
- Medical Records: These include all kinds of identifiable medical information about a person.
- Conversations of a patient with his or her doctors and nurses about the treatment
- Billing information.
- Medical information in the computer systems of Health Insurance Company.
- All the information that unnecessary reveals your medical information.
The entities which are bound to comply with HIPAA are known as “covered entities.”
This Act must be followed by the following people:
- All healthcare providers: These include medical practitioners, clinics, nursing homes and hospitals.
- Health plan providers: These include HMOs, Medicaid, health plans provided by company, insurance companies and Medicare.
But HIPAA is not a universal law. This means that there are still some agencies which are not required to follow the rules of this act. Not every organization that may have the medical records of a patient is a “covered entity.” Life insurance companies, schools, workers compensation providers and employers are not required to comply with the privacy rules of HIPAA. Municipal offices and state and law enforcement agencies have also been exempted from this act.
HIPAA law provides a number of rights to the patient. They have the right to see and possess a copy of all of their health records that any medical institution has in its records. The institution may charge the patient to provide a copy of the records.
The patient is also entitled to know how his information will be protected. He must be informed of all the circumstances in which his information may be used and shared. A patient can also complaint against insurance company, doctor or any other institution, in case his or her information is misused or leaked without permission.
HIPAA is the abbreviation for the health insurance portability and accountability act, which was initially enforced in 1996, but all the rules and regulations, which come under this act, became fully operational only in the year 2003. The main purpose behind the enforcement of HIPAA was that when people will continue to have access to their medical insurance when they are shifting their jobs or even when they are looking for a job. Initially it was a very difficult task to get the medical insurance company changed without paying very heavy premiums. Another benefit of the implementation of HIPAA is that it helps in protecting the medical records and other medical information of patients and this has also created a proper standard or benchmark for the management of the personal medical information of all patients.
Portability is something, which many people have not yet understood. Previously whenever a person quit his job or got fired from his current job, his medical insurance would immediately expire on termination of services from the company. When he applied for medical insurance once again with his new employer his medical state of health would be classified under the tag of pre-existing conditions. Due to this clause, the insurance company was not under any obligation to reimburse the amount, which was being spent in order to cure such a medical condition. When a person has been taking medicines regularly for high blood pressure, the medical insurance company did not have to reimburse the amount spent on these medicines since this is already a pre-existing medical condition.
Under the rules and regulations of HIPAA, no conditions could be laid down by the insurance companies regarding pre-existing conditions, the new employers would have to renew the existing insurance policy and they were also not allowed to charge high premiums. Apart from all these, they have also stated that health insurance should be made portable between companies. This is extremely useful for people who are shifting jobs. They will not have to worry about gaining coverage for their medical insurance and having to pay huge medical bills.
According to HIPAA, accountability means the standards and benchmarks which need to be followed regarding the exchange of private medical information between insurance companies, health care providers, pharmacies, patients and all other covered entities. With the advent of technology and electronic mail, violating the privacy of the medical information of a patient has become much easier.
HIPAA has given the department of Health and Human Services the right to create rules regarding the transfer as well as the management of information, which is sensitive and private. They have also established codes, which will help in the process of identifying medical expenses as well as administrative expenses. A system of creating national Ids for all health care providers as well as insurance companies has also been established by the department of Health and Human Services. All the required policies and procedures should be implemented to make sure that the private medical information of all patients is secured and protected.
HIPAA is the acronym for the health insurance portability and accountability act of 1996. This is the first federal act, which has been passed which has been designed to ensure the protection of the privacy of the personal medical information of the patient. Privacy regulations have been created in order to ensure that the electronic medical records of the patient have been protected in the right manner and kept confidential from the public. It is becoming more and more difficult for health care companies to ensure that they abide by all the legal rules and regulations like HIPAA. These rules make sure that the standards and benchmarks regarding all kinds of electronic transactions with medical information are followed in the right manner.
Nowadays it is becoming more and more difficult of find software, which has been prepared in compliance with all the rules and regulations, which come under HIPAA. Such software is very expensive to procure especially for any small-scale medical office. There are many large scale medical offices and medical billing houses which have already adopted some strong security measures and the implementation of the rules and regulations which come under HIPAA will not mean any kind of dramatic change for them. Small medical billing houses and medical offices will not have the right kind of security measures and polices and they will have to implement some drastic changes in order to ensure that they comply with all the rules and regulations which come under HIPAA.
The rules and regulations, which come under HIPAA, have been classified into four main subdivisions namely administrative safeguards, physical safeguards, security services and security mechanisms. There is no specific software, which can be termed as HIPAA compliant software. The medical practice or the medical office should make all the required arrangements in order to ensure that the organization is following all the rules and regulations which come under HIPAA. Compliance of the rules under HIPAA is a responsibility and obligation, which has to be fulfilled by all medical practices and health care organizations. Workstations should be placed in secure locations inside any organizations any person who does not have the required authorization should not be allowed to access this kind of information.
Software which is being used for medical billing as well as for practice management are two of the most vital areas which have been affected by the changes which have been brought about by HIPAA. According to the security rules, which come under HIPAA, if the health information, which is being stored in an electronic manner, needs to be protected, then all the security rules, which come under HIPAA, will be applicable.
Any kind of medical software, which is being used, should have proper facilities for data backup as well as data restoration. All medical providers should make a proper list as to how information is being created and stored and who has access to all this information and whether they have the authority to modify and delete that information.
Farah Fawcett who is well known all over the world for the famous roles, which she has portrayed on television as well as films, was recently on the news headlines when confidential medical information about her health problems had been leaked to all the tabloids and newspapers. Though many people have made statements about letting film stars and celebrities having some privacy, the act of publicizing the medical details of Ms Fawcett is a violation of a federal law. The Health insurance portability and accountability act of 1996 was created in order to ensure that the medical records of every person are stored and maintained in a confidential manner and no person will be allowed to access this information without the right kind of authorization.
Companies, which are involved in the collection of health, related information from people will be known as covered entities under HIPAA. All these entities will have to abide by all the rules and regulations, which come under HIPAA. All kinds of hospitals, clinics, health insurance companies which deal in medical policies, private practices which are being conducted by general practitioners, specialists, dentists, chiropractors, psychiatrists, psychologists and all kinds of medical billing centers and collection agencies are some of the covered entities which come under HIPAA. It is very essential to safeguard the information pertaining to every patient regardless of how many employees there are in an organization.
Patients who are coming to a clinic or a hospital for medical attention should be rest assured that all their details will be kept confidential. All the employees of the organization should make sure that the privacy of the information with regard to the patient has not been compromised in any manner. All the medical information which come under the purview of these medical laws are details of the prescription, records of the past medical history of the patient, record of all the appointments, messages which have been delivered either over the phone or through voice mail, forms with regard to medical insurance as well as insurance claims and any kind of information with regard to billing.
When the information, which has been stored regarding the patient, becomes outdated, it should be destroyed in such a manner that no traces are left and the privacy of the patient is also protected. All companies and organizations, which have been classified, as covered entities under HIPAA should make adequate arrangements to ensure that all the relevant documents have been destroyed in a proper manner. Every single bit of paper or printout should be eliminated in the right manner. Simply throwing the papers in the garbage dump does not mean that the right measures have been resorted to. It is possible for anyone to find a stray piece of paper inside a garbage dump and this can give them access to a lot of information like credit card numbers as well as addresses. It is always better to make use of professional services in order to make sure that all stale medical records have been shredded and disposed in the right manner.