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Welcome
Who is HIPAA Soluti=
ons
Rx?
HIPAA defined
HIPAA defined
HIPAA background
Portability Provisi=
ons in
HIPAA (Title I)
Have We Gone Overbo=
ard??
Why do we need HIPA=
A?
Compliance timeline=
s
Compliance timeline=
s
Compliance timeline=
s
Compliance burden s=
ummary
What is Protected H=
ealth
Information?
Examples of PHI =
HIPAA Interaction W=
ith
Other Regs
Penalties for
non-compliance
Steps to compliance=
Steps to compliance=
(cont’d)
Example scenario –
Pre-HIPAA
Example scenario –
Post-HIPAA
Let’s Take A Break<=
/a>
Overview Of The Bin=
der
Tools To Help You
Questions ??
Definitions
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Welcome
HIPAA – What’s in S=
tore for
2004
Peter Cizik
Who is HIPAA Soluti=
ons
Rx?
HIPAA Solutions Rx =
is a firm
dedicated to assisting organizations understand the implications of HIPAA
compliance, providing:
risk assessments
workforce training =
tools
privacy and securit=
y compliance
tools
policy, procedure a=
nd forms
development tools
resources through s=
trategic
partnerships with leading HIPAA authorities and service providers <=
/td>
HIPAA defined
HIPAA defined
HIPAA background
The Health Insurance
Portability and Accountability Act of 1996 (HIPAA)
Governs portability=
of health
benefits, special enrollment rights, and non-discrimination rules. (Title=
I)
Standardizes the wa=
y all health
care related organizations electronically exchange sensitive patient data=
and
protects patients from unauthorized disclosure of their medical records -
whether paper or electronic. (Administrative Simplification) =
3 facets of Adminis=
trative
Simplification
Privacy
Transactions & =
Code Sets
Security
Portability Provisi=
ons in
HIPAA (Title I)
Participants and be=
neficiaries
must be provided with certificates of creditable coverage upon leaving a
group health plan.
The certificates in=
dicate how
long the individual was covered under the group health plan and have the
effect of shortening or avoiding any exclusionary period in a new health
plan.
Issuing the certifi=
cates of
creditable coverage – even if they are considered protected health
information – should create no issue under the Privacy Rule
Provided they are i=
ssued
directly to the participant or beneficiary.
The participant or =
beneficiary
may then voluntarily disclose that protected health information to another
entity.
Have We Gone Overbo=
ard??
Why do we need HIPA=
A?
2001 - Eli Lilly ac=
cidentally
sent e-mail to Prozac users on an informational listserv revealing identi=
ties
of numerous other Prozac users.
1996 - In Tampa, a =
public
health worker sent to two newspapers a computer disk containing the names=
of
4,000 people who tested positive for HIV.
2000 - Darryl Straw=
berry’s
medical records from a visit to a New York hospital were reviewed 365
times. An audit determined less =
than
3% of those reviewing his records had even a remote connection to his car=
e.
Compliance timeline=
s
Compliance timeline=
s
Compliance timeline=
s
Compliance burden s=
ummary
What is Protected H=
ealth
Information?
Protected Health In=
formation
(PHI)
Health information =
is protected
if:
It is created or re=
ceived by a
provider, health plan, employer, or health care clearinghouse;
It relates to the p=
hysical or
mental health or condition of an individual, at any time, past, present or
future (and includes information related to payment of health benefits);<=
/font>
It identifies an in=
dividual or
can be used to identify the individual; and
It is in the posses=
sion or
control of a covered entity (including a group health plan).
Examples of PHI =
Internally administ=
ered plan
records (FSA, EAP)
Enrollment forms
Explanations of Ben=
efits
Provider billings
Referrals
Carrier reports
Check registers
Monthly/Quarterly/A=
nnual
Utilization Analysis
HIPAA Interaction W=
ith
Other Regs
What happens when I=
receive
medical information relating to FMLA, ADA, Title VII, etc., compliance ?<=
/font>
Depends on which “h=
at” you are
wearing
If receiving the information from an emp=
loyee
or medical provider in your role as employer
- then its NOT PROTECTED =
under
HIPAA
If receiving the in=
formation
from the group health plan in its role as plan sponsor - then its PROTECTED under HIPAA
Penalties for
non-compliance
Penalty for failure=
to comply
with regulations
Up to $100 per viol=
ation per
person up to a maximum of $25,000 per year
Penalty for knowing=
ly and
wrongfully disclosing individually identifiable health information:
Up to $50,000 per v=
iolation or
one year imprisonment or both for simple offense
Up to $100,000 per =
violation or
five years imprisonment or both if the offense is "under false
pretenses"
Up to $250,000 or t=
en years
imprisonment or both if committed with intent to sell, transfer or use for
commercial advantage, personal gain or malicious harm
Civil action =
Multiple privacy &a=
mp; fraud
laws can be used to prosecute violations
- the real risk
Steps to compliance=
Develop a plan &=
; budget
time & resources
Prioritize -
not everything has to be done immediately
Understand how HIPA=
A affects
you
Get Privacy Officer=
/staff
trained
Analyze which benef=
its meet the
definition of a "health plan“
FSA’s are a major =
area of
confusion
Examine your servic=
e provider
relationships
Who are your Busine=
ss
Associates?
Get Business Associ=
ate
agreements in place
Make the required p=
lan document
amendments
Create firewalls be=
tween the
group health plan and the HR functions
Minimizing where PH=
I flows
simplifies compliance activities
Employee communicat=
ions
Prepare a Notice of=
Privacy
Practices (NPP) & a plan to distribute
Steps to compliance=
(cont’d)
Develop necessary p=
olicy &
procedures
Restrict communicat=
ion of info
Account for disclos=
ures
Access to records
Request amendments<=
/font>
Employee training
Benefits Dept. 1st
HR Dept. 2nd
Sr. Mgrs 3rd
IT, Fin., 1st<=
/sup> line
mgrs
Prepare for the imp=
act of HIPAA
on your employees
Customer svc/call c=
enter
procedures may need to chg
New forms may need =
to be
created/published
Audit & Fine Tu=
ne
Compliance Is Not A=
One Time
Event
Example scenario –
Pre-HIPAA
Employee wants you =
to help with
an unpaid claim
Pre-HIPAA
Collect pertinent i=
nformation
(PHI) from employee
Request your broker=
’s
assistance to “fix”
Or do it yourself
Info (PHI) gets e-m=
ailed/faxed
to one or more other persons within broker and/or insurance company for
“resolution”
You communicate res=
ults back to
the employee
Example scenario –
Post-HIPAA
Post-HIPAA
Are you sure you wa=
nt to even
want to engage in this practice anymore?
Triggers a high lev=
el of
compliance burden if other circumstances don’t already force you there
You may want the em=
ployee to
sign a “HIPAA compliant” authorization form that authorizes the use of
his/her PHI for this express purpose
Authorizes insuranc=
e company to
release PHI to you
Insurance companies=
may require
it before they will talk to you
Information should =
be sent
securely
Internet is inheren=
tly insecure
– send encrypted if possible
Fax machines should=
be
protected from inadvertent disclosure of PHI
All employees that =
“touch” PHI
should be trained on HIPAA
Policies and proced=
ures should
be created and/or updated to include HIPAA protections
Maintain audit trai=
l of what
was done in case asked where PHI was disclosed
Let’s Take A Break<=
/a>
Overview Of The Bin=
der
Overall Compliance
Checklist - take it out as a guide
Review of the 8 Ste=
ps
Stop at each form a=
nd start to
fill out
Think about how PHI=
is flowing
throughout your company
What P&P’s will=
be needed
Ask questions all a=
long the way
Reference material =
will help
answer the “gray” areas
Additional help on =
Client
Community
Tools To Help You
HIPAA Solutions Rx<=
/font>
Online Training – a=
lways
updated, unlimited access, covers different job functions
Compliance Manuals =
– checklists
that lead you through the process
Model Documents – c=
ustomizable
for your organization
Free monthly email =
newsletter –
stay on top of current HIPAA events
Free Privacy & =
Security
white papers
We stay on top of H=
IPAA for you
www.hipaarx.net
Peter N. Cizik
Pcizik@hipaarx.net<=
/font>
866-447-2211 =
Questions ??
Definitions
Limited-Use SHI
If the plan sponsor=
uses
summary health information only for purposes of modifying, amending, or
terminating the plan, or procuring bids from other health plans for health
insurance coverage, the group health plan might be relieved of parts of t=
he
compliance burden. These uses of summary health information are referred =
to
as "Limited-Use SHI."
Unlimited-Use SHI
If the plan sponsor=
uses
summary health information for other plan administration functions other =
than
modifying, amending, or terminating the plan, or procuring bids from other
health plans for health insurance coverage, the group health plan will be=
subject
to a heavier compliance burden. These uses of summary health information =
are
referred to as "Unlimited-Use SHI."
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