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HIPAA, Health Insurance Portability and Accountability Act
December 4, 2002 |
| Held at Memorial Sloan Kettering Cancer Center, Karen
Pagilaro from the Office of Corporate Compliance at New York
Presbyterian Hospital educated attending DVS' on the details of
this federal law. Overview
- The Health Insurance Portability and Accountability Act
of 1996 Public Law 104-191 (HIPAA) was passed by Congress to
reform the insurance market and simplify health care
administration processes.
- The administration simplification part of HIPAA is aimed
at reducing administrative costs and burdens in the health
care industry by adopting and requiring the use of
standardized, electronic transmission of administrative and
financial data.
- HIPAA will have a significant impact on the health care
industry over the next several years.
- HIPAA requires the Department of Health and Human
Resources (DHHS) to adopt national uniform standards for the
electronic transmission of certain health information.
Goal
The administrative simplification provisions of HIPAA are
intended to reduce the number of forms and methods of completing
claims, and other payment-related documents, and to use a
universal identified for providers of health care. Another goal
is to increase the use and efficiency of computer-to-computer
methods of exchanging standard health care information.
What does HIPAA apply to?
Protected Health Information (PHI)
- Any health information related to:
- past, present or future physical/mental
health/condition
- provision of health care
- past, present or future payment for health care
- Created/received by covered entity
- Individually identifiable (reasonable basis)
- In ANY medium/form (privacy rule)
- written
- verbal
- electronic
Five Specific Areas of Administrative Simplication addressed
by HIPAA are:
- Electronic Data Interchange (ED)
- Code Sets - includes data elements used to uniformly
document reasons why patients are seen and what is done to
them during their health care encounters (procedures)
- Identifiers
- Security
- Privacy
Privacy
- Implementation Date - April 14, 2003
- HIPAA Defines:
(a) who is authorized to access information, and
(b) under what circumstances and guidelines patient
information can be accessed (i.e. the right of individuals
to keep information about themselves from being disclosed)
- Sets forth authorization required to permit necessary
and permitted access (i.e. for treatment purposes,
fundraising and marketing)
- Addresses "de-identification" issues for the use of
aggregate medical information for analysis and research
Penalties
- Civil
- $100 per violation
- $25K annual cap, per requirement/prohibition
- Criminal
- Wrongful disclosure - up to $5K and/or 1 year
- False pretenses - up to $100K and/or 5 years
- For profit/with malice - $250K and/or 10 years
- Other
- Private lawsuits
- Public opinion/reputation risk
- Competitive market position weakness
- Penalites under other Federal & State Laws
Basic Tasks
- Determine the flow of Protected Health Information (PHI)
inside and outside
- Determine "minimum necessary"
- Modify operations to conform to the new law
- Ensure that "business associates" conform
- Develop new policies and procedures
- Train staff - general and specific topics
- Verify compliance
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MARK YOUR CALENDARS
Upcoming Conference
Building Volunteer Communities
How to Make the Generation Gap Work for You
Friday, November 7, 2008,
New York City
Location
United Hospital Fund
Empire State Building
350 Fifth Avenue, 23rd Floor
New York, NY 10118-2300
Registration
On-line: www.uhfnyc.org
By fax: (212) 494-0818 Attn: Norma Gindes
By mail:
United Hospital Fund Attn: Norma Gindes Empire State Building
350 Fifth Avenue, 23rd Floor
New York, NY 10118-2300
Fee: $65 per person ($60 per person for five or more attendees from the
same institution, registering together) including breakfast, coffee break,
lunch, and conference materials.
Payment deadline:
October 24
Space is limited - please register early.
No-shows will be billed.
Cancellations received after
October 29 will be subject to a $15 service charge.
For more information: (212) 494-0724 |
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