As HIPAA Progresses

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As HIPAA Progresses..

• What you need to know to keep up

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HIPAA Progresses

• HIPAA EDI (Electronic Data Interchange)
• HIPAA Unique Provider Employer ID
• HIPAA Security
• HIPAA Privacy Compliance
• NOA References to help you with HIPAA

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HIPAA Progresses

• HIPAA EDI (Electronic Data Interchange)
• HIPAA Unique Employer ID
• HIPAA Security
• HIPAA Privacy Compliance
• NOA References to help you with HIPAA

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EDI (Electronic Data Interchange)

• If you use EDI it must comply with HIPAA
• HIPAA does not force you to use EDI except for
  Medicare claims under limited circumstances

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EDI (Electronic Data Interchange)

• Why HIPAA EDI?
• Prior to HIPAA EDI multiple EDI data forms
• Different entities could not communicate
• Delays and confusion in claims

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HIPAA Administrative Simplification

• Sets standard data sets
• Routine Care (VSP, EyeMed, CVC)
• Medical Claims (Medicare, BCBS)

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Affects most electronic health data

• Claims/Encounter submission
• Payment remittance notices
• Insurance eligibility
• Claim status
• and

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Additional electronic health data

• Group Health enrollment
• Health insurance premium payments
• Other Internet health data

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End Result

• When the data ends up at 3rd party payer it must
  be in HIPAA EDI format
• Examples Follow Current Method vs. HIPAA EDI

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Current vs. New Authorization

• Current Method
• Provider seeks authorization over Internet ?
• 3rd Party Payer receives and replies
• HIPAA EDI
• Provider seeks authorization over Internet ?
• HIPAA compliant site or program intervenes ?
• 3rd Party Payer receives in HIPAA format and
  replies
• WYNTD Test

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Current vs. New Routine Care Claims

• Current Method
• Provider completes web page form over Internet ?
• 3rd Party Payer receives and replies
• HIPAA EDI
• Provider completes web page form over Internet ?
• HIPAA compliant site or program intervenes ?
• 3rd Party Payer receives in HIPAA format and
  replies
• WYNTD Test

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Current vs. New Medical Claims

• Current Method
• Providers paper data ?
• Billing service - Clearinghouse ?
• 3rd Party Payer
• HIPAA EDI
• Providers paper data ?
• HIPAA compliant Billing service - Clearinghouse ?
• 3rd Party Payer
• WYNTD Test

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Current vs. New Medical Claims

• Current Method
• Providers data ?
• Computer program ?
• 3rd Party Payer
• HIPAA EDI
• Providers data ?
• HIPAA compliant computer program ?
• 3rd Party Payer
• WYNTD Test

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Testing NOW (yesterday!) is imperative

• If you wait, you will be delayed by a traffic jam
• Payment will be delayed until you comply
• It is anticipated that many practitioners will
  not comply
• It is anticipated that back-up systems will be
  swamped
• Fax
• Phone
• Paper
• Non-electronic filers should anticipate delays as
  well

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Contact all 3rd parties for immediate testing if

• You file claims electronically with them.
• You communicate with them electronically in any
  way except
• voice phone
• paper fax

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Contacting 3rd parties

• NOA August issue of 3rd Party Newsletter contains
  pages of information on what questions to ask.
• Newsletter available at the NOA Website if you
  dont have a printed copy

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Contacting 3rd parties

• Respective 3rd party contact information should
  be available in their manual.
• NOA 3rd Party HIPAA web page will contain as many
  contact sites as Dr. Quack can find.
• Please email Dr. Quack of other sites not listed
  on NOA HIPAA Web page so he can add them to the
  list.

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Medicare and EDI

• If you have 10 or more FTE employees you must
  file with Medicare via EDI
• Most offices of this size already use EDI
• If you have less employees you do not have to
  tell Medicare (no waiver needed)
• No official employee counter has been appointed
  to Dr. Quacks knowledge

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Medicare and EDI

• Electronic filers should TEST as described
• Delays in paper claim payments expected since
  more paper claims -with errors- are anticipated

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HIPAA EDI Bottom Line

• TEST
• IMMEDIATELY

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HIPAA Continues

• HIPAA EDI (Electronic Data Interchange)
• HIPAA Unique ID
• HIPAA Security
• HIPAA Privacy Compliance
• NOA References to help you with HIPAA

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National Identifiers

• Requires standard Identifier for
• Health care providers
• Health-related Employers

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Applies to

• All health plans,
• All health care clearinghouses, and
• Any health care providers that transmit any
  health information in electronic form

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Electronic transmissions include all media

• Magnetic tape
• Disk
• CD media

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Transmissions include

• Internet
• Extranet
• Leased lines
• Dial-up lines
• Private networks.

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Not Included

• Telephone voice response
• Fax back systems

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Estimated time of implementation

• Mid-2004 (Dr. Quack wonders)

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Action needed at this time

• None

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HIPAA Continues

• HIPAA EDI (Electronic Data Interchange)
• HIPAA Unique Employer ID
• HIPAA Security
• HIPAA Privacy Compliance
• NOA References to help you with HIPAA

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HIPAA Security and Electronic Signature Standards

• Requires health care information be protected to
  ensure privacy and confidentiality when
  electronically
• stored,
• maintained, or
• transmitted.

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HIPAA Security and Electronic Signature Standards

• The proposed security standards also specify a
  standard for electronic signature
• but does not require the use of an electronic
  signature

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Applies to

• All health plans,
• All health care clearinghouses, and
• Any health care providers that transmit any
  health information in electronic form

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Electronic transmissions include all media

• Magnetic tape
• Disk
• CD media

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Transmissions include

• Internet
• Extranet
• Leased lines
• Dial-up lines
• Private networks.

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Not Included

• Telephone voice response
• Fax back systems

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Estimated time of implementation

• 2005

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Action required at this time

• None

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HIPAA Continues

• HIPAA EDI (Electronic Data Interchange)
• HIPAA Unique Employer ID
• HIPAA Security
• HIPAA Privacy Compliance
• NOA References to help you with HIPAA

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HIPAA PRIVACY What do we do now?

• Dr. Quack has been receiving many Questions
  regarding HIPAA Privacy
• Some show fear and over-reaction
• Others reflect lack of compliance
• ERGO
• 15 Minute review of HIPAA Privacy basics
• For those that already understand, please be
  patient!

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HIPAA PRIVACY What do we do now?

• Read aloud your Notice of Privacy Practices at
  staff meetings once a quarter.
• Follow it with a HIPAA discussion of
• reasonable safeguards
• minimum necessary
• Your Privacy Officer should review and update
  your HIPAA Privacy Manual once a quarter.

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OCR Guidance

• Privacy Rule permits certain incidental uses
  disclosures of PHI when the covered entity uses
• reasonable safeguards
• minimum necessary policies procedures

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Reasonable Safeguards

• Speaking quietly when discussing a patients
  condition with family members in a waiting room
  or other public area
• Avoiding using patients names in public hallways
  elevators

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Reasonable Safeguards

• Posting signs to remind employees to protect
  patient confidentiality
• By supervising, isolating, or locking file
  cabinets or records rooms
• By providing additional security, such as
  passwords, on computers maintaining personal
  information.

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More Safeguards

• Ask waiting customers to stand a few feet back
  from a counter used for patient counseling.
• Use of cubicles, dividers, shields, curtains, or
  similar barriers where multiple patient-staff
  communications routinely occur

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OCR Guidance

• Privacy Rule permits certain incidental uses
  disclosures of PHI when the covered entity uses
• reasonable safeguards
• minimum necessary policies procedures

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Minimum Necessary Rule

• Requires limit of access to PHI, based on needs
  to perform job duties.
• Unimpeded access to PHI, where not necessary for
  the job at hand, is not applying the minimum
  necessary standard.
• Any incidental use or disclosure that results
  from not applying the Minimum Necessary Standard
  would be an unlawful.

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Minimum Necessary Rule

• The minimum necessary standard does not apply to
  disclosures, including oral disclosures, among
  health care providers for treatment purposes

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FAQs

• Frequently Asked Questions.

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OCR Guidance FAQs....... confidential
conversations

• Q Can health care providers engage in
  confidential conversations with other providers
  or with patients, even if there is a possibility
  that they could be overheard?
• A Yes, when using reasonable safeguards.

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OCR Guidance FAQs....... confidential
conversations

• Free to engage in communications as required for
  quick, effective, high quality health care.
• Overheard communications in these settings may be
  unavoidable are allowed as incidental
  disclosures.

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OCR Guidance FAQs....... confidential
conversations

• When using Reasonable Safeguards
• Health care staff may orally coordinate services
  at hospital nursing stations.
• Staff may discuss a patients condition over the
  phone with the patient, a provider, or a family
  member.
• A health care professional may discuss lab test
  results with a patient or other provider in a
  joint treatment area.

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OCR Guidance FAQs....... confidential
conversations

• HIPAA Privacy does not require
• Private rooms.
• Soundproofing of rooms.
• Encryption of wireless or other emergency medical
  radio communications
• Encryption of telephone systems.

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OCR Guidance FAQs....... Mailings phone calls

• Q May physicians offices or pharmacists leave
  messages at patients homes, either on an
  answering machine or with a family member, to
  remind them of appointments or to inform them
  that a prescription is ready? May providers
  continue to mail appointment or prescription
  refill reminders to patients homes?

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OCR Guidance FAQs....... Mailings phone calls

• A Yes.
• Limit the PHI disclosed on the answering machine.
  
• Consider leaving only name number PHI
  necessary to confirm an appointment
• Or ask the individual to call back.
• May leave a message with a family member or other
  person who answers the phone when the patient is
  not home.

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OCR Guidance FAQs....... Confidential Conversation

• Where a patient has requested confidential
  communication, you must accommodate that request,
  if reasonable. Examples,
• mailings in an envelope, not postcard.
• mail sent to a P.O. box, not to home
• receive calls at the office, not at home

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OCR Guidance FAQs....... Sign-in sheet

• Q May physicians offices use patient sign-in
  sheets or call out the names of their patients in
  their waiting rooms?
• A Yes. But the sign-in sheet may not display
  medical information that is not necessary for the
  purpose of signing in.

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OCR Guidance FAQs....... Charts on doors

• Q Are charts outside of exam rooms prohibited
• A No. Using reasonable safeguards the minimum
  necessary rule, covered entities must simply
• evaluate what measures make sense in their
  environment
• tailor their practices safeguards to their
  particular circumstances.

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OCR Guidance FAQs....... Charts on doors

• You May maintain patient charts outside of exam
  rooms, displaying patient names on the outside of
  patient charts
• Possible safeguards may include
• Supervise area
• place patient charts facing the wall or otherwise
  covered

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OCR Guidance FAQs....... Announcing names

• You May Announce patient names other
  information over a facilitys public announcement
  system.
• Possible safeguards may include
• limiting the information disclosed over the
  system, such as referring the patients to a
  reception desk.

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OCR Guidance FAQs....... Overheard conversation

• A provider may be overheard, in the reception
  area, instructing staff to bill a patient for a
  particular procedure
• A health plan employee discussing a patients
  health care claim on the phone may be overheard
  by another employee who is not authorized to
  handle patient information.

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OCR Guidance FAQs....... Office re-design

• Q Are covered entities required to restructure
  workflow systems, redesign office space
  upgrading computer systems to comply with the
  HIPAA Privacy Rules?
• A The Department generally does not consider
  facility redesigns as necessary to meet the
  reasonableness standard for minimum necessary
  uses.
• Use reasonable safeguards and minimum necessary
  rule listed earlier

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OCR Guidance FAQs....... Business Associate

• Examples of Business Associates.
• A health care clearinghouse that translates a
  claim from non-standard to standard format
  forwards to a payer.
• An independent medical transcriptionist that
  provides transcription services to a physician.
• A collection agency
• Software personnel who have access to PHI

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OCR Guidance FAQs...... No permission needed

• Q Can a patient have a friend or family member
  pick up a prescription for her?
• A Yes. A pharmacist may use professional
  judgment experience with common practice to
  make reasonable inferences of the patients best
  interest in allowing a person, other that the
  patient, to pick up a prescription.

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OCR Guidance FAQs...... No permission needed

• Q Does the HIPAA Privacy Rule permit a covered
  entity or its collection agency to communicate
  with parties other than the patient (e.g.,
  spouses or guardians) regarding payment of a
  bill?
• A Yes. A covered entity or their business
  associate (e.g., a collection agency), may
  disclose PHI as necessary to obtain payment for
  health care, there is no limit to whom such a
  disclosure may be made.

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OCR Guidance FAQs...... No permission needed

• However, the Privacy Rule requires you
• Place a reasonable limit the amount of
  information disclosed,
• Abide by any reasonable requests for confidential
  communications
• Honor any agreed-to restrictions on the use or
  disclosure of PHI.

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OCR Guidance FAQs...... No permission needed

• Q Does the HIPAA Privacy Rule prevent health
  plans providers from using debt collection
  agencies?
• A The Privacy Rule permits use of debt
  collection agencies through a business associate
  arrangement.
• Disclosures to collection agencies are governed
  by provisions such as the business associate
  agreement minimum necessary requirements.

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OCR Guidance FAQs...... No permission needed

• Q Does the HIPAA Privacy Rule permit an eye
  doctor to confirm a contact prescription received
  by a mail-order contact company?
• A Yes. The disclosure of PHI by an eye doctor
  to a distributor of contact lenses for the
  purpose of confirming a contact lens prescription
  is a treatment disclosure, is permitted under
  the Privacy Rule at 45 CFR 164.506.

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OCR Guidance FAQs...... No permission needed

• Q Is a hospital permitted to contact another
  hospital or health care facility, such as a
  nursing home, to which a patient will be
  transferred for continued care, without the
  patients authorization?

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OCR Guidance FAQs...... No permission needed

• A Yes. The HIPAA Privacy Rule permits
  disclosure of PHI without authorization to
  another health care provider for treatment or
  payment purposes, as well as to another covered
  entity for certain health care operations of that
  entity.

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Physical Changes

• HIPAA does not require that you make radical,
  expensive changes to your office.
• The following are some reasonable alterations in
  office layout to assist in complying with HIPAA

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Doors

• Close doors (anonymity)
• Especially when discussing PHI, e.g.,
• History
• Pre-examination
• Examination

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Always speak quietly

• Hearing impaired?
• Speak slowly
• Get closer
• Take special care when speaking in hallways and
  other common areas

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Multi-patient areas (Check-in, Check-out,
Dispensary)

• Speak reasonably quietly
• Use PLEASE WAIT HERE signs if appropriate
• Provide PLEASE WAIT HERE chairs if appropriate
• Incidental disclosure is acceptable

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Business Office Areas

• Place HIPAA reminder signs at work stations
• Place HIPAA reminder signs on computer monitors
• Place HIPAA reminder signs on file cabinets

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Computer Monitors

• Rotate screen away from public
• Put a plant next to monitor
• Use Screen saver or Minimize screen
• Place HIPAA reminder sign on monitor
• Remember, patients can see their own PHI!

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Minimize ---
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Patient Records

• Keep records closed except when in use
• When practical, divide each record into sections,
  e.g.,
• Demographics
• Examination
• Claims
• Staff should use only that portion of record
  needed for the task at hand

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Patient Record Storage

• Post HIPAA reminder signs in record storage areas
• Reasonably monitor record storage areas
• Reasonably monitor records in hallways

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HIPAA Continues

• HIPAA EDI (Electronic Data Interchange)
• HIPAA Unique Employer ID
• HIPAA Security
• HIPAA Privacy Compliance
• NOA References to help you with HIPAA

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Dr. Birthday MMDDYY
Dr. lastname only All lower case
Check this box
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http//www.cms.hhs.gov/medicaid/hipaa/adminsim/
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THANK YOU FOR YOUR ATTENTION!