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HIPAA and Confidentiality

            Brandy Press-Smith
                     MHA 690
               March 15, 2012
What is HIPAA?
• “The HIPAA Privacy Rule, also called the
  Standards for Privacy of Individually Identifiable
  Health Information, provided the first nationally-
  recognizable regulations for the use/disclosure of
  an individual's health information.”
• “The Privacy Rule defines how covered entities
  use individually-identifiable health information or
  the PHI (Personal Health Information).”

                                  http://whatishipaa.org/
HIPAA Privacy


• Rule addresses all issues
  concerned with
  saving/accessing/sharing
  medical & personal
  information of an individual.




                                  http://whatishipaa.org/
Privacy Rule
• Gives patients control over the use of their health
  information
• Defines boundaries for the use/disclosure of health
  records by covered entities
• Establishes national-level standards that healthcare
  providers must comply with
• Helps to limit the use of PHI and minimizes chances of its
  inappropriate disclosure
• Strictly investigates compliance-related issues and holds
  violators accountable with civil or criminal penalties for
  violating the privacy of an individual's PHI
• Supports the cause of disclosing PHI without individual
  consent for individual healthcare needs, public benefit and
  national interests
                                      http://whatishipaa.org/
Who must follow these laws?
• Health Plans, including health insurance companies, HMOs,
  company health plans, and certain government programs that pay
  for health care, such as Medicare and Medicaid.

• Most Health Care Providers—those that conduct certain business
  electronically, such as electronically billing your health insurance—
  including most doctors, clinics, hospitals, psychologists,
  chiropractors, nursing homes, pharmacies, and dentists.

• Health Care Clearinghouses—entities that process nonstandard
  health information they receive from another entity into a standard
  (i.e., standard electronic format or data content), or vice versa.


                                    http://www.hhs.gov/ocr/privacy/hipaa/und
                                    erstanding/consumers/index.html
Personally-identifiable health
            information….what is it???
• Health information that relates to a specifically identifiable
  individual; it generally includes the following, whether in electronic,
  paper, or oral format:
• Health care claims or health care encounter information, such as
  documentation of doctor's visits and notes made by physicians and
  other provider staff
• Health care payment and remittance advice
• Coordination of health care benefits
• Health care claim status
• Enrollment and disenrollment in a health plan
• Eligibility for a health plan
• Health plan premium payments
• Referral certifications and authorization
• First report of injury
• Health claims attachments        http://www.twc.state.tx.us/news/efte/hipaa_basics.html
Health Information can be used and shared:
• For your treatment and care coordination
• To pay doctors and hospitals for your health care
  and to help run their businesses
• With your family, relatives, friends, or others you
  identify who are involved with your health care or
  your health care bills, unless you object
• To make sure doctors give good care and nursing
  homes are clean and safe
• To protect the public's health, such as by
  reporting when the flu is in your area
• To make required reports to the police, such as
  reporting gunshot wounds
                               http://www.hhs.gov/ocr/privacy/hipaa/u
                               nderstanding/consumers/index.html
Think before you peak….


            • Before viewing
              medical records,
              make sure you have
              a valid reason.

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Confidentiality and hipaa

  • 1. HIPAA and Confidentiality Brandy Press-Smith MHA 690 March 15, 2012
  • 2. What is HIPAA? • “The HIPAA Privacy Rule, also called the Standards for Privacy of Individually Identifiable Health Information, provided the first nationally- recognizable regulations for the use/disclosure of an individual's health information.” • “The Privacy Rule defines how covered entities use individually-identifiable health information or the PHI (Personal Health Information).” http://whatishipaa.org/
  • 3. HIPAA Privacy • Rule addresses all issues concerned with saving/accessing/sharing medical & personal information of an individual. http://whatishipaa.org/
  • 4. Privacy Rule • Gives patients control over the use of their health information • Defines boundaries for the use/disclosure of health records by covered entities • Establishes national-level standards that healthcare providers must comply with • Helps to limit the use of PHI and minimizes chances of its inappropriate disclosure • Strictly investigates compliance-related issues and holds violators accountable with civil or criminal penalties for violating the privacy of an individual's PHI • Supports the cause of disclosing PHI without individual consent for individual healthcare needs, public benefit and national interests http://whatishipaa.org/
  • 5. Who must follow these laws? • Health Plans, including health insurance companies, HMOs, company health plans, and certain government programs that pay for health care, such as Medicare and Medicaid. • Most Health Care Providers—those that conduct certain business electronically, such as electronically billing your health insurance— including most doctors, clinics, hospitals, psychologists, chiropractors, nursing homes, pharmacies, and dentists. • Health Care Clearinghouses—entities that process nonstandard health information they receive from another entity into a standard (i.e., standard electronic format or data content), or vice versa. http://www.hhs.gov/ocr/privacy/hipaa/und erstanding/consumers/index.html
  • 6. Personally-identifiable health information….what is it??? • Health information that relates to a specifically identifiable individual; it generally includes the following, whether in electronic, paper, or oral format: • Health care claims or health care encounter information, such as documentation of doctor's visits and notes made by physicians and other provider staff • Health care payment and remittance advice • Coordination of health care benefits • Health care claim status • Enrollment and disenrollment in a health plan • Eligibility for a health plan • Health plan premium payments • Referral certifications and authorization • First report of injury • Health claims attachments http://www.twc.state.tx.us/news/efte/hipaa_basics.html
  • 7. Health Information can be used and shared: • For your treatment and care coordination • To pay doctors and hospitals for your health care and to help run their businesses • With your family, relatives, friends, or others you identify who are involved with your health care or your health care bills, unless you object • To make sure doctors give good care and nursing homes are clean and safe • To protect the public's health, such as by reporting when the flu is in your area • To make required reports to the police, such as reporting gunshot wounds http://www.hhs.gov/ocr/privacy/hipaa/u nderstanding/consumers/index.html
  • 8. Think before you peak…. • Before viewing medical records, make sure you have a valid reason.