HIPAA for Medical Office Personnel

by Krager, Dan; Krager, Carole

• ISBN13: 9781401865740
• ISBN10: 1401865747
• Edition: 1st
• Format: Paperback
• Copyright: 2004-07-22
• Publisher: Cengage Learning

Summary

HIPAA for Medical Office Personnel will provide information to learners on how the HIPAA ruling of 1996 affects their behavior when on the job. The book provides a brief background on the ruling; outlines the five titles included in the ruling, and delineates items from Title II that affect the medical office environment and what changes are necessary to be in compliance with this ruling.

Table of Contents

Introduction	p. vii
About the Authors	p. ix
Acknowledgments	p. xi
Introduction to HIPAA	p. 1
Chapter Outline	p. 1
Key Terms	p. 2
Think About It	p. 2
True Stories	p. 2
Introduction	p. 4
Overview of the Rulings	p. 5
Development of the Rulings	p. 5
Titles in HIPAA	p. 6
Health Insurance Access, Portability, and Renewal	p. 6
Preventing Health Care Fraud and Abuse	p. 6
Tax-related Provisions	p. 7
Group Health Plan Requirements	p. 7
Revenue Offsets	p. 7
Other Titles in HIPAA	p. 7
General Provisions, Peer Review, and Administrative Simplification	p. 7
Assuring Portability, Availability and Renewability of Health Insurance Coverage	p. 8
HIPAA: An Organizational and Business Challenge	p. 8
Summary	p. 11
End of Chapter Questions	p. 12
Scenarios	p. 12
References	p. 13
Privacy Issues Explained	p. 15
Chapter Outline	p. 15
Key Terms	p. 16
Think About It	p. 16
True Stories	p. 16
Introduction	p. 17
To Whom Does Title II Apply?	p. 17
Who is a "Covered Entity"?	p. 18
The HIPAA Officer	p. 19
Locating the Latest Title II Rules and Changes	p. 20
What is Protected Health Information?	p. 21
Authorization Versus Consent	p. 22
Protected Health Information Concerns and Disclosures	p. 23
Required Disclosures	p. 24
Permitted Use and Disclosure Without Authorization	p. 24
For Individual Access	p. 24
For Treatment, Payment, and Health Care Operations	p. 24
When Permission to Disclose is Obtained	p. 24
Disclosures that are Incidental	p. 25
Disclosures for Public Interest or to Benefit the Public	p. 26
Disclosures for Research	p. 27
Permitted Use and Disclosure With Authorization	p. 27
Disclosure of Psychotherapy Notes	p. 27
Disclosure for Marketing Purposes	p. 27
Limiting Uses and Disclosures	p. 28
Minimum Necessary Uses	p. 28
Business Associates under Privacy Ruling	p. 29
Training of Workforce and the Public	p. 29
Enforcement Guidelines	p. 30
Summary	p. 31
End of Chapter Questions	p. 32
Scenarios	p. 33
References	p. 34
Transaction Standards and Code Sets	p. 35
Chapter Outline	p. 35
Key Terms	p. 36
Think About It	p. 36
Introduction	p. 36
Purpose of Transaction Standards	p. 37
Designated Code Sets	p. 39
Diagnosis Codes	p. 39
Inpatient Procedure Codes	p. 40
Outpatient Procedure Codes	p. 40
Dental Procedure Codes	p. 41
Drug Codes	p. 41
Non-medical Code Sets	p. 42
ASC X12 Nomenclature	p. 42
Data Overview	p. 43
Architecture	p. 43
Use of Loops	p. 46
Sample of EDI Claim Data	p. 48
Limitations to Claims Encounters	p. 51
Remittance Advice and Secondary Payer	p. 51
Working with Outside Entities	p. 52
Trading Partner Agreements	p. 52
Business Use and Definition	p. 52
Summary	p. 53
End of Chapter Questions	p. 53
Scenarios	p. 56
References	p. 56
HIPAA Security Ruling	p. 57
Chapter Outline	p. 57
Key Terms	p. 58
Think About It	p. 58
True Stories	p. 58
Introduction	p. 59
Core Requirements	p. 59
Administrative Safeguards	p. 61
Security Management	p. 61
Assigned Security Responsibility--Security Officer	p. 62
Workforce Security	p. 63
Information Access	p. 63
Security Awareness and Training	p. 63
Security Incidents	p. 64
Contingency Plan	p. 64
Evaluation of Security Effectiveness	p. 65
Business Associate Contracts	p. 65
Physical Safeguards	p. 65
Facility Access Controls	p. 65
Workstation Use or Access	p. 66
Workstation Security	p. 66
Device and Media Controls	p. 67
Technical Safeguards	p. 67
Access Control	p. 68
Audit Controls	p. 69
Integrity	p. 69
Person or Entity Authentication	p. 69
Transmission Security	p. 70
Organizational Requirements	p. 70
Policies, Procedures, and Documentation	p. 70
Impact on Organizations	p. 71
Challenges to Compliance	p. 72
Summary	p. 73
End of Chapter Questions	p. 74
Scenarios	p. 75
References	p. 84
Unique Health Identifiers and Misconceptions	p. 87
Chapter Outline	p. 87
Key Terms	p. 88
Think About It	p. 88
Introduction	p. 88
Reasons for Identification Numbers	p. 88
Employer Identifier	p. 89
Health Care Provider Identifier	p. 90
Health Plan Identifier	p. 91
Personal Identifier	p. 91
What is Important to Know About HIPAA?	p. 94
Misconceptions About HIPAA	p. 94
Summary	p. 98
End of Chapter Questions	p. 99
Scenarios	p. 100
References	p. 100
Resources for Further Information	p. 99
Required and Addressable Security Standards	p. 103
Further Scenarios and Questions for Consideration	p. 107
Glossary	p. 109
Index	p. 115
Table of Contents provided by Ingram. All Rights Reserved.