HIPAA and HITECH AHE 110 Flashcards
What does HIPAA stand for
Health Insurance Portability and Accountability Act
Which Year was HIPAA signed
1996
HIPAA is a law with how many standards
4 standards meant to PROTECT and SECURE electronic patient information
What is the purpose of HIPAA
To keep a person’s health information secure
How does HIPAA keep Health Info secure?
- Regulates who has the right to view a person’s medical records, data and other personal information
- Sets standards on how a person’s protected health info is to be stored and transmitted,
- Requires health care orgs to set policies allowing pt or res to have access to own med records
Which Agency is Responsible for HIPAA
US Dept of Health and Human Services (HHS)
Which Agency is Responsible for HIPAA violations?
HHS Office for Civil Rights (OCR)
What is the goal of HIPAA? (why)
Administrative Simplification,
Simplify exchange of info through consistent Electronic Exchange of Information,
Same coding sys, same requirements = decreased clerical burden and increase elec transaction adoption
How is HIPAA going to Simplify Administration
- use same coding systems,
2. use same requirements for the exchange of information
What is meant by CODING SYSTEM
Coding system uses characters like symbols and numbers to represent things like medical procedures or diseases
HIPAA STANDARD 1
Related to TRANSACTIONS AND CODE SETS
What happened Standard 1
HHS adopted standard transactions for the electronic exchange of administrative health care information
Standard 1 includes:
insurance claims,
payments,
insurance eligibility information.
Also MANDATES universal coding systems
Goal of Standard 1
to speed up the process of
a. identifying insurance benefits,
b. submitting insurance claims,
c. receiving payment
speed, money = identify, submit, receive $
Why do we use universal systems
process is more efficient when everyone uses same system
What is CPT
CPT is Current Procedural Terminology -
codes procedures and services
What is ICD
ICD is international Classification of Disorders - codes diseases and disorders
HIPAA STANDARD 2 Is concerned with
the PRIVACY RULE
Comprehensive federal protection guidelines for the privacy of health info
What is the Privacy Rule
Personal Medical info shared with dr’s, hospitals etc. and those who provide and pay for Hc are protected.
health care facilities, insurance companies and other need to protect the written, electronic, oral patient health information
What is the Goal of the Privacy Rule
imposes restrictions by defining and limiting situations when pt’s info can be Used and Disclosed,
What 3 things does the privacy rule do?
- imposes restrictions on use and disclose of personal health information,
- gives pt greater access to med records,
- gives pt greater protections of med records
restrictions on u and d, access, protection
What Rights does Privacy Rule give patients
- examine health records,
- obtain copies of health records,
- request corrections to be made if incorrect
examine, obtain copies, corrections
What is Meant by Use
PHI is USED when
a. shared,
b. examined,
c. applied,
d. analyzed
What is meant by Disclosure
PHI is DISCLOSED WHEN
a. released or transferred and
b. in any way made accessible to anyone outside of the CE
release, transfer, accessible to outsiders
What is meant by a COVERED ENTITY
any facility, provider, plan or clearing house t hat transmits protected health information electronically
Who are included as Covered Entities?
PROVIDERS; MD,DO, NP, PA etc. Dentists, chiropractors, psychologists,
FACILITIES; nursing homes, pharmacies, ambul. Care
COMPANIES; health ins., govt insurance, HMOs,
CLEARINGHOUSES, BILLING SERVICES
Rules Covered Entities must comply with
- safeguard all pt info,
- ensure BA keep PHI private,
- written agreement with BA on how to safeguard PHI,
4 CE cannot give PHI to BA without written signed agreements - only PHI required for the job can be given to the BA
Define Claims Clearing house
an organization that accepts the claim data from the provider,
reformats the data to meet specifications outlined in ins. Plan
and submits the claim
accepts, reformats, submits claims