presented by capture billing and consulting, inc. katie jennings, rn and michelle ivanchukov, cpc,...

Presented by Capture Billing and Consulting, Inc.Katie Jennings, RN and Michelle Ivanchukov, CPC, CCS-P

www.CaptureBilling.com703.327.1800

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Health Insurance Portability and Accountability Act Health Insurance Portability and Accountability Act (HIPAA)(HIPAA)

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Health Insurance Portability and Accountability Act Health Insurance Portability and Accountability Act (HIPAA)(HIPAA)

HIPAA Legislative ActHIPAA Legislative Act

HIPAA Public Law 104-191 is composed of the following:HIPAA Public Law 104-191 is composed of the following:

https://www.highmark.com/hmk2/about/hipaa/hipaaMain.shtml

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Health Insurance Portability and Accountability Act Health Insurance Portability and Accountability Act (HIPAA)(HIPAA)

Administrative SimplificationAdministrative Simplification

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Health Insurance Portability and Accountability Act Health Insurance Portability and Accountability Act (HIPAA)(HIPAA)

Administrative SimplificationAdministrative Simplification

These rules are enforced by the Office These rules are enforced by the Office for Civil Rights (OCR) of the HHSfor Civil Rights (OCR) of the HHS

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Health Insurance Portability and Accountability Act Health Insurance Portability and Accountability Act (HIPAA)(HIPAA)

Covered EntitiesCovered Entities

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Health Insurance Portability and Accountability Act Health Insurance Portability and Accountability Act (HIPAA)(HIPAA)

HIPAA Standards for Privacy of Individually Identifiable HIPAA Standards for Privacy of Individually Identifiable Health Information (Privacy Rule)Health Information (Privacy Rule)

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Health Insurance Portability and Accountability Act Health Insurance Portability and Accountability Act (HIPAA)(HIPAA)

Protected Health Information (PHI)Protected Health Information (PHI)

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Health Insurance Portability and Accountability Act Health Insurance Portability and Accountability Act (HIPAA)(HIPAA)

Use and Disclosure LimitationsUse and Disclosure Limitations

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Health Insurance Portability and Accountability Act Health Insurance Portability and Accountability Act (HIPAA)(HIPAA)

Permitted UsePermitted Use

andand

DisclosureDisclosure

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Health Insurance Portability and Accountability Act Health Insurance Portability and Accountability Act (HIPAA)(HIPAA)

Notice of Policy PracticesNotice of Policy Practices

Covered Entities must provide a notice of its Privacy Practices to include:

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Health Insurance Portability and Accountability Act Health Insurance Portability and Accountability Act (HIPAA)(HIPAA)

Administrative RequirementsAdministrative Requirements

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Health Insurance Portability and Accountability Act Health Insurance Portability and Accountability Act (HIPAA)(HIPAA)

De-identificationDe-identification

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Health Insurance Portability and Accountability Act Health Insurance Portability and Accountability Act (HIPAA)(HIPAA)

Enforcement and ComplianceEnforcement and Compliance

Violations occurring on or after 2/18/2009:

Penalty Amount $100 to $50,000 or more per violation Calendar Year Cap of $1,500,000 Penalties may not be imposed in certain circumstances

• Failure to comply was not due to willful neglect and was corrected during a 30-day period after entity knew or should have known failure to comply occurred• Department of Justice has imposed a criminal penalty for failure to comply

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Health Insurance Portability and Accountability Act Health Insurance Portability and Accountability Act (HIPAA)(HIPAA)

Criminal ProsecutionCriminal Prosecution

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Health Insurance Portability and Accountability Act Health Insurance Portability and Accountability Act (HIPAA)(HIPAA)

HHS Case ExamplesHHS Case Examples

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Health Insurance Portability and Accountability Act Health Insurance Portability and Accountability Act (HIPAA)(HIPAA)

HIPAA Violations Found on the web…HIPAA Violations Found on the web…

Nurses Fired Over Cell Phone Photos Of Patient

– Case Referred To FBI For Possible HIPAA Violations

Team 4 Uncovers HIPAA Records Violations

Cignet fined $4M for HIPAA violation Cignet Health of Prince George’s County has been fined a total of $4.3 million for alleged violations of the Health Insurance Portability and Accountability Act of 1996. The Department of Health and Human Services Office of Civil Rights alleges Cignet violated 41 patients’ rights in 2008 and 2009 by not providing them access to their medical records in a reasonable amount of time.

Two to plead guilty to fraud, HIPAA violations

UCLA Medical Center agrees to settle HIPAA violation charges for $865K

Local psychiatrist faces federal charges in HIPAA case

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ReferencesReferences

Department of Health and Human Services:Department of Health and Human Services:http://www.hhs.gov/ocr/privacy/hipaa/understanding/index.html

Department of Medical Assistance Services:Department of Medical Assistance Services:http://www.dmas.virginia.gov/hpa-hipaa_faqs.htm

Highmark Blue Cross Blue Shield:Highmark Blue Cross Blue Shield:https://www.highmark.com/hmk2/about/hipaa/hipaaMain.shtml

Department of Labor:Department of Labor:http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html