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Medical Jurisprudence > Chapter 10 HIPAA > Flashcards

Chapter 10 HIPAA Flashcards

Be knowledgeable about all aspects of HIPAA recounted in the text.

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USMLE® Step 1 flashcards
1
Q

when was HIPAA enacted? and what does it stand for?

A

1996; Health Insurance Portability and Accountability Act

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2
Q

What are some problems to keeping confidentiality?

A

Pts see many doctors, billings must be sent, 3rd parties(insurers) are all involved as well as multiple facilities and vendors for tailored medical equipment; if it is leaked then you have potential embarrassment for the pt.

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3
Q

What was HIPAA originally written for? (4 objectives)

A

1 inc. portability of healthcare
2 combat waste and fraud
3 inc. use of medical savings accounts
4 simplify admin of healthcare

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4
Q

When it was seen that pt info was going to be sent electronically to meet the 4 objectives, what did congress do to ensure the privacy of the info?

A

Congress asked the department of health and human resources (HHS) to write privacy rules.

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5
Q

What is PHI? And some examples?

A

Protected Health Information; examples include any identifiers like SSN, address, phone #, in connection with a person’s medical record/care.

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6
Q

What do the Privacy Rules (written by HHS) include?

A

That all covered entities must abide by standards to ensure PHI is protected. Permission must be gained for disclosure of PHI. Pts must have access to own health records. Only necessary info is disclosed.

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7
Q

What are covered entities?

A

All the people/groups/companies that may come in contact with PHI. They must be in compliance with HIPAA. This doesn’t include the patient.

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8
Q

What must be given to a pt. to sign so their PHI can be disclosed?

A

a Notice of Privacy Practices (NPP)

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9
Q

HIPAA requires disclosure of how much information to carry out medical treatment?

A

The minimum amount, with the fewest people possible.

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10
Q

Can PHI be communicated with vendors?

A

Yes, if they have a written assurance (contract.)

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11
Q

How does the Privacy Rule standardize all transmissions of PHI?

A

With the use of the Employer Identification Standard, which assigns an Employer Identification Number (EIN) to be used in all electronic transmissions.

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12
Q

What is State’s Preemption?

A

State rules concerning privacy trump federal rules when they are more strict or require disclosure for safety reasons. Otherwise, HIPAA federal laws are preemptive.

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13
Q

What must be removed for “deidentifying” PHI? In what instance would you do this?

A

name, address, zip, SSN, licence numbers, photos, emails, medical record #’s, all dates except birth, etc. You might do this to publish statistics about a communities health.

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14
Q

What is the “minimum necessary standard”?

A

It is that a provider has a requirement to provide the minimum necessary information in order to complete a task. (ie: not sending the whole medical file when only part is requested.)

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15
Q

What are the 6 Pt. rights in the NPP?

A

1 Access & copy of medical records
2 request for an amendment to them
3 request an account of disclosures
4 request for alternate method/location for contact
5 request for restrictions on who can have access to the record
6 right to file a complaint

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16
Q

What are the 3 main exceptions to when consent is needed for treatment?

A
  1. Emergency (but it must get signed asap afterwards)
  2. Language barrier and to one to interpret
  3. When treating prison inmates
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17
Q

What is a clearinghouse?

A

It is a covered entity (must follow HIPAA) that processes nonstandard electronic transactions into HIPAA transactions (may be deemed a billing service.)

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18
Q

what is a healthcare plan?

A

an individual or a group that provides or pays for medical care

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19
Q

What does the acronym TPO stand for?

A

Treatment, payment and healthcare operations

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20
Q

What is TPO, what is the designation for?

A

Used to indicate that a healthcare provider may disclose PHI for the treatment of pts, for the payment of the care given, and for healthcare operations, such as quality assurance

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21
Q

What are covered transactions?

A

they are mandated transmissions by HIPAA regulation for the transmission of healthcare information; basically there are rules for these communications

22
Q

What are the 3 basic covered transactions (between covered entities)?

A

1 Physician sending PHI to another Physician
2 Physician sending an electronic claim to an insurance company
3 Physician sending any PHI to a billing service

23
Q

What are the penalties for non-compliance to HIPAA?

A

$100/incidence/person up to 25k/year for minor violations
Up to $50k and 1yr in prison for criminal liability (obtained info under false pretenses)
And if you were going to sell, maliciously use that info for fraud, personal gain, etc… up to 250k and 10yrs in prision

24
Q

What is the HIPDB?

A

The Healthcare Integrity and Protection Data Bank for listing violations, fraud, etc.of providers and is available to fed and gvt. agencies and various healthplans to see who has been naughty or nice.

25
Q

What is a HIPAA-defined permission?

A

a situation when permission must be granted by the pt to disclose PHI

26
Q

What two disclosures are required by HIPAA?

A

Disclosure to the HSS and disclosures that the pt requests.

27
Q

What are the 11 areas of HIPAA-defined permission?

A

1 The required disclosures (to HSS and pt)
2 Valid Pt. authorization
3 Pt. requests for disclosure
4 TPO
5 TPO in other covered entities (attorneys, insurance plans, etc.)
6 Pt. representatives such as family (must have legal document)
7 Disaster relief organizations
8 Incidental disclosures (talking about lab results, calling a pt by name, leaving a covered pt chart outside room, etc)
9 For public purposes (FDA, health dept.)
10 When Identifiers have been removed
11 In limited data sets where certain identifiers have been removed that pts do not have access to. (like in prisons and research projects)

28
Q

Researchers must have what to use medical information?

A

Either a pt. authorization form that complies with HIPAA, or a waiver by an IRB (institutional review board.)

29
Q

May a hospital release PHI to workers comp?

A

Yes

30
Q

Are police privy to PHI?

A

Yes

31
Q

Can a provider communicate with an HR dept, or an attorney?

A

Yes

32
Q

Can church clergy see names of people in a hospital?

A

Yes

33
Q

Can a physician tell family members about the pt if the pt has identified them as involved in their care?

A

Yes

34
Q

Are EMTs free to share PHI?

A

No, they have limitations.

35
Q

Do pts have to sign in to be on the hospital’s directory?

A

No, but they can opt out.

36
Q

What can a physician or physician group do to implement HIPAA?

A

Hire a Privacy officer, do internal assessments, have written agreements with all non-employee service providers who may have access to PHI, implement NPP, revise employee handbooks on HIPAA, train employees, establish complaint procedure for non-compliance, etc…

37
Q

Which entity investigates violations of HIPAA?

A

Office of Civil Rights (OCR)

38
Q

How long must you retain authorizations, NPP copies, and agreements for restriction of PHI from pts?

A

6 years

39
Q

What is the issue with WLANs?

A

HIPAA security rules apply to PHI in electronic forms and many physicians use WLANs– they must have safeguards in place for these devices

40
Q

What is medical informatics?

A

it is the application of communication and information to medical practice, research and education. Seen in the linking of pharmacy and physician’s requests electronically.

41
Q

What is telemedicine?

A

You know. But what is important is that PHI becomes really sticky when you are treating a pt. who is in another state. Security also might be an issue.

42
Q

The original intent of the law being put aside, what does the law designed to do now?

A

to protect the privacy of PHI and to control how it is used, transmitted and disclosed.

43
Q

Who issues fraud alerts to the public and providers?

A

Inspector General of the US HHS

44
Q

What is the Security Rule cover?

A

Protects pt’s electronic PHI.

45
Q

When does confidentiality start?

A

with the initiation of the physician -pt relationship; the offer and acceptance

46
Q

When may confidentiality be breached?

A

For the sake of public health, hazard avoidance, and in child or elder abuse cases

47
Q

How long is PHI protected for?

A

50 yrs after death

48
Q

A pt may complain to HSS, but may not do what when privacy is violated?

A

Sue anyone.

49
Q

What may be obtained from a pt. for disclosure of PHI for TPO?

A

Consent

50
Q

When must authorization be gained by a covered entity from a pt to disclose PHI?

A

When it is not a covered transaction, for TPO, or otherwise allowed in the Privacy Rule.

51
Q

What is the HITECH act?

A

Health Information Technology for Economic and Clinical Health; enacted in 2009 to promote adoption of health IT, address privacy and security, strengthen enforcement, requires notification of breaches of PHI to all affected

Medical Jurisprudence (1 decks)

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