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Flashcards in HIPAA Deck (20)
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1

Review of Health Information Portability & Accountability Act (HIPAA)  Administrative Simplification 

2

What does the HIPAA Privacy Rule Do?

3

How does the School of Dentistry do this?

Patient Notification of HIPAA Privacy  Policy 


•Right to request privacy protection
•Access of individual to their own protected health information (PHI)
•Right to request amendment of PHI
•Accounting of disclosures of PHI
•Right to Restriction

The School’s Accountability 

4

Minimum Necessary Rule


•PHI should not be used or disclosed when it is not necessary to satisfy a particular purpose or carry out a function
 


•The SOD should take reasonable steps to limit disclosures 
 

5

Limit Disclosure
Electronic Communication 

6

The Privacy Rule permits the SOD to use and disclose protected health information 


•Treatment

•Payment
 

7

Security

Security Rule: 
•Builds on effort to comply with Privacy Rule

Privacy Rule:
•Covers:
•PHI in oral, written, & electronic form
 

Security Rule: 
•Covers PHI in ELECTRONIC Form only 
•EPR & MIPACS
 

8

State & Federal Regulations


•HIPAA is
the minimum standard for privacy 

•Patient privacy compliance requires knowledge of both State and Federal laws

•The provision that provides the greatest privacy protection will prevail
 

9

Health Information Technology for Economic and Clinical Health Act (HITECH)  
& State Attorney Gen

State AG

Authorized to bring civil action on behalf of state residents for HIPAA violations

Obtain damages

HIPAA

  violators accountable with civil and criminal penalties 

10

HITECH Breach Notification Rule

11

HITECH, Cont. 


•Definition of Breach

Impermissible use or disclosure under the Privacy Rule that compromises the security or privacy of the protected health information

•Results in a significant risk of

  Financial

  Reputational

  Other harm to the affected individual 

 

 

12

13

PHI & Technology


•USB Memory Stick & Portable  Devices

•De-identify patient PHI or Encrypt before saving

•Lok-IT secure flash drive



 

14

PHI  & Technology, Cont.

15

SOD and a legally defensible EHR

16

Principles of Documentation and Billing


•EHR
•Document all Clinical Services
•Follow Established Standard of Care
•Bill
•Needed & Documented
•Necessity for the visit or service
•Documentation should spell out the specific service provided
 

17

Billing & Compliance

18

Preventing, Detecting, & Reporting

FRAUD

19

ABUSE


•Any activity that results in excessive or unreasonable cost to the university, or other state  or federal agencies 
 

20

Examples of a False Claim



•Billing for procedures not performed

•Falsifying information in the patient record

•Duplicate billing

•Falsifying claim forms to receive overpayment for services provided