HIPAA Flashcards
Protects Privacy and Security of Certain Health info
HIPAA
Establishes national standards for protection of certain health info
Privacy Rule
Establish a nation set of security standards for protecting certain health info held or transferred in electronic form
Security Rule
A person that performs certain Fx or activities that involve use or disclosure of protected health info on behalf of/provides services to entity
Business associate.
Business associates may include
claims, data analysis, billing.
Individually identifiable health info.
what does this include
Protected health information
Demographics.
When is Pt authorization not required for disclosure of PHI
needed for Tx for family/friends involved in care to insure public health/safety prevent danger disclosure in facility directories.
An adequate privacy notice includes
heading
statement of uses/ rights/ entity’s duties
explanation of how to complain
contact information.
e-PHI not available or disclosed to unauthorized
Confidentiality.
Requires HIPAA covered entities to provide notification following a breach of unsecured protect health Info.
Breach notification rule.
impermissible use or disclosure under privacy rules that compromises security of PHI
Breach.
HIPAA considerations for PT Practice
Patient identification Eval Procedure Sign in/out Physical layout of facility computer security
Penalty for violating HIPAA
civil (fines)
or
criminal sanction (jail)
Causes of improper payment
incorrect documentation/coding
not justifying services
How is fraud prevented
gov targets ppl by using profiling techniques.
Knowingly performing something wrong
fraud
inadvertent mistake
abuse
Documenting that you did something that you didnt do or omitting something
that you did do that would support payment
false claims act
Cant pay other HCP or business for patient referrals (payment in
exchange for referrals)
Anti-kickback Statute
(For physicians); cant profit from a business that they have
an ownership in) (ex. Cant profit if they perform more MRIs or prescribe more meds)
Physician Self-referral law
Imposed penalties for fraud
Criminal health care fraud statute
Alerting a higher authority about something fraudulent being performed
(protects the person who blows the whistle against retaliation)
Whistle blower statute
compliance officer whos job is to ensure that you are following the rules
compliance program
Top compliance issues in PT
Documentation/payment rules
who gives PT services that can be billed in medicare
PT/PTA/Physician/NPPs
Physician can bill PT services incident to their scope of practice (physicians are legally entitled to
bill the services provided by individuals-PT/PTA)
incident to
What types of payment for referrals is acceptable under Medicare?
Any kind of equitable sharing of profits that come out of patient referral
