9781579474195

HIPAA Plain and Simple : A Compliance Guide for Healthcare Professionals

by
  • ISBN13:

    9781579474195

  • ISBN10:

    1579474195

  • Format: Paperback
  • Copyright: 2003-08-01
  • Publisher: AMERICAN MEDICAL ASSOCIATION

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Summary

Administrative simplification. That was the goal when the Health Insurance Portability and Accountability Act (HIPAA) was signed into law in 1996. But in trying to make the business of health care easier and more streamlined, everyone from physicians and nurses to coders and billers learned that compliance was going to be challenging -- not only in interpreting the detailed regulations but also in adjusting their day-to-day operations. HIPAA Plain & Simple helps these health care professionals understand how all the HIPAA provisions affect -- and benefit -- the work they do and the patients they serve. In concise and straightforward language, this book offers an overview of the legislation; discusses transactions, privacy, security and code sets in detailed yet simplified terms; and outlines what each member of the medical office staff must know to ensure HIPAA compliance. "What to do" and "how to do it" tips guide readers through office procedures affected by HIPAA, including processing claims; managing protected health information; implementing physical, administrative and technical security safeguards; training staff; and discussing HIPAA with patients. It also includes key HIPAA terms, sample forms and agreements, and other critical points regarding compliance. HIPAA Plain & Simple means HIPAA straight and accurate. It is a resource every staff member can use to achieve true administrative simplification -- and full compliance -- for the medical office. Book jacket.

Table of Contents

Dedication iii
Foreword v
Preface ix
Acknowledgments xiii
About the Authors xv
HIPAA Overview
1(28)
The Pathway to HIPAA
2(1)
Basics of Administrative Simplification
3(4)
Four Sets of Standards
7(1)
Overview of the Four Standards
8(7)
Transactions and Code Sets
8(2)
Privacy Standards
10(1)
Security Standards
11(3)
National Identifier Standards
14(1)
Who Must Comply?
15(3)
Benefits to the Practice Can Be Substantial
18(2)
Implementation May Take a While
20(1)
Enforcement
21(3)
Everyone Has a Specific Role
24(1)
Risk Management
25(4)
From Patient Eligibility to Claim Payment
29(28)
The Eligibility to Claim Payment Process
30(6)
Creating New Patient Records
32(1)
Verifying Records for Returning Patients
33(1)
Understanding the Medical Record
33(1)
Ensuring Quality Control of Health Information
34(2)
A Brief Overview of Transactions
36(1)
A Brief Overview of Coding
36(3)
HIPAA Transactions and Code Set Standards
39(1)
Covered Transactions
40(15)
General Provisions
41(3)
Code Sets
44(3)
Transaction Standards
47(1)
Health Claims or Equivalent Encounter Information
47(3)
Eligibility for a Health Plan, Inquiry, and Response
50(2)
Healthcare Claim Status, Inquiry, and Response
52(2)
Referral Certification and Authorization
54(1)
Identifiers
55(2)
The Privacy Team
57(66)
Start With the Basics
58(11)
A Quick Overview of the Privacy Rule
58(1)
Patient Rights
59(4)
What Does It Mean to Be a Covered Entity?
63(1)
Who's Enforcing the Privacy Rule?
64(1)
Protect Patient Confidentiality
65(1)
Designate a Privacy Official
66(2)
Designate a Privacy Team
68(1)
Develop a Budget and Time-and-Task Chart
68(1)
Start Now---Right Now
68(1)
Develop Your Notice of Privacy Practices
69(3)
Know How and When to Distribute the Notice of Privacy Practices
70(1)
What to Do if Patient Refuses to Sign
71(1)
Revising the Notice of Privacy Practices
72(1)
Get to Know the Six Patient Rights
72(12)
A Patient Can Make a Request to Any Staff Member
74(1)
Requests for Further Restriction
75(1)
Request for Alternative Communications
76(1)
Access to Information and Right to Copy
77(2)
Request to Amend Protected Health Information
79(1)
Accounting of Disclosures
80(2)
File a Complaint
82(1)
No Retaliation
83(1)
No Waiver of Rights
84(1)
Use and Disclosure of Protected Health Information
84(10)
Map Out How Protected Health Information Flows Through Your Office
84(2)
Permitted Incidental Disclosures
86(1)
When Are You Required to Obtain Permission to Use or Disclose Protected Health Information?
87(4)
Uses and Disclosures for the Public Good
91(2)
Minimum Necessary
93(1)
Review and Implement HIPAA's Administrative Requirements
94(14)
Designate a Privacy Official
95(1)
Designate One Person to Be the Contact Person to Receive Complaints
95(1)
Develop HIPAA Policies and Procedures
95(2)
Revising Your Policies and Procedures
97(1)
Develop Documentation Procedures
97(1)
Workforce Training
98(1)
Develop Internal Sanctions If an Employee Breaches Privacy Policies
98(1)
Develop a Process to Mitigate Breaches
99(2)
Develop Administrative, Technical, and Physical Safeguards
101(7)
Special Requirements
108(5)
Verify the Identity of the Person Who Requests Access to Protected Health Information
108(1)
Verify Personal Representatives
109(1)
Minimum Necessary Special Requirements
110(1)
Special Requirements for Marketing
110(1)
Psychotherapy Notes
111(1)
Policies and Procedures Consistent with Notice of Privacy Practices
112(1)
State Laws
112(1)
Develop Business-Associate Contracts with Your Vendors
113(3)
Contents of the Business-Associate Agreement
115(1)
Deadline for Business-Associate Agreements
115(1)
Work with Legal Counsel to Assess Your Compliance Status
116(1)
Train Your Staff
116(4)
Implement Your Plan and Evaluate Your Compliance Status
120(3)
Security
123(40)
About HIPAA's Security Rule
125(6)
Security Standards
131(3)
General Rules
132(2)
Administrative Safeguards
134(17)
Standard: Security-Management Process
135(2)
Standard: Assigned Security Responsibility
137(2)
Standard: Workforce Security
139(2)
Standard: Information Access Management
141(1)
Standard: Security Awareness and Training
142(3)
Standard: Security Incident Procedures
145(1)
Standard: Contingency Plan
146(2)
Standard: Evaluation
148(1)
Standard: Business-Associate Contracts and Other Arrangements
149(2)
Physical Safeguards
151(6)
Standard: Facility Access Controls
152(2)
Standard: Workstation Use
154(1)
Standard: Workstation Security
155(1)
Standard: Device and Media Controls
155(2)
Technical Safeguards
157(6)
Standard: Access Control
157(1)
Standard: Audit Controls
158(1)
Standard: Integrity
159(1)
Standard: Person or Entity Authentication
160(1)
Standard: Transmission Security
160(3)
Communicating HIPAA: Inquiring Patients Want to Know
163(20)
Why Talk about Communication in a HIPAA Book?
164(1)
What HIPAA Says about Oral and Written Communication
165(3)
Oral Communications in the Medical Office
165(1)
Written Communications in the Medical Office
166(1)
Incidental Uses and Disclosures
167(1)
How the Staff Can Confidently Deal with HIPAA
168(2)
What Patients Want to Know about HIPAA
170(3)
Customize Your Internal and External Communication Plan
173(4)
Develop an Internal Communication Plan
173(2)
Develop an External Communication Plan
175(2)
HIPAA Crisis-Communications Management
177(6)
HIPAA Compliance Costs and Return on Investment
183(14)
Questions to Ask as You Build a Budget and Determine Your Return on Investment
184(1)
Putting Your Team Together
184(1)
How Much Will You Save?
185(1)
Will E-Communications Enhance or Detract from Patient Relationships?
186(1)
Internal Investment versus Outsourcing
187(1)
Costs of Technology versus Costs of Policies and Procedures
188(3)
How to Use Your Workforce to Reinvent the Future
191(2)
Raising the Bridge and Lowering the River
193(1)
Your Accountability with Other Healthcare Paradigm Shifts
194(1)
Going Forward
195(2)
Appendix A
197(30)
Notice of Privacy Practices Required Language
198(3)
Notice of Privacy Practices Receipt
201(1)
Request to Access Records
202(1)
Sample Authorization
203(2)
Request to Amend Records
205(2)
Request to Restrict Uses and Disclosures of Protected Health Information
207(2)
Request for Alternative Communications
209(2)
Sample Complaint Form
211(1)
Follow-Up on Privacy Complaint
212(1)
Medical Privacy---National Standards to Protect the Privacy of Personal Health Information: Sample Business Associate Contract Provisions
213(6)
Privacy Official Job Responsibilities
219(2)
Security Official Job Description
221(3)
Twelve-month Training Calendar
224(3)
Appendix B
227(6)
Check for Understanding Self Test
227(5)
Answers to the Check for Understanding Self Test
232(1)
Glossary 233(12)
Index 245

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