HIPAA Privacy Training - DAS Keeping It To Ourselves! Protecting Client Confidentiality…
Introduction • Vin Lombardo Henry Jovanelly Gene Shook (Keane) • Purpose: Comply with the training requirements of HIPAA
Topics of Discussion • What is HIPAA • Privacy and Confidentiality Standards
What This All Really Means • Use or disclose health information that identifies the individual for billing and collection (Payment) purposes only • When you do that, disclose the minimum necessary and know who you disclose to
What is HIPAA? Health Insurance Portability and Accountability Act of 1996 (August 21) Public Law 104 –191 • Guarantees insurability of employees that change jobs (Portability) • Reduces fraud and abuse of federal entitlement programs (Accountability) • Improves efficiency through standardization of electronic transactions and codes • Protects individual’s private health information • Establishes security standards for health care information systems • National standards for unique health identifiers
It came out of the failed health-care reform effort of the Clinton administration. In the early 1990s there was a lot of concern about people who were restrained in moving from one employer to another because they were afraid of losing their health insurance due to pre-existing conditions. So although the overall health-reform efforts failed, one of the things that came out of those efforts was this bill, which was aimed at allowing the portability ofhealth insurance by preventing insurers from imposing requirements about pre-existing conditions when you move from one employer to another. At the time, employerswere concerned that this was going to lead to an increase in health insurancecosts. So there was an effort made to reduce costs in the health-care system as a way of offsetting the increased costs caused by these portability requirements. • People quickly identified the amount of administrative expense throughout the health-care system caused by inefficient communications. For example, there are more than 400different transaction formats in use throughout the country related to services provided and payments made. So HIPAA contains within it a set of provisions under its administrativesimplification section to standardize to 10 transactions. Congress recognized that this was going to result in enhanced flow of individually identifiable health information in electronicformat. There was concern that this would increase the risk of private health information being improperly disclosed. So part of the administrative simplification rules deal with protective measures that health-care providers and payers have to take in order to protectthe privacy and security of this individually identifiable health information.
Enforcement Privacy Time Line Firm Implementation Dates: Estimated (awaiting publication of Final Rules) Security Transactions & Codes Unique Identifiers April2003 Oct 2003 April 2005
Covered Entities • Healthcare Payers (Plan) • An individual or group plan that provides, or pays the cost of medical care • Healthcare Clearinghouses (DAS Collections) • An entity that processes/facilitates processing of health information received from another entity • Healthcare Providers • Who transmit health information in electronic format
HIPAA $30 Billion in savings over 10 years in administration costs ($18 Billion implementation cost) • Title 1 Insurability and Portability • Title 3 Tax Implications • Title 4 Group Health • Title 5 Revenue • Title 2 Administrative Simplification
AdministrativeSimplification Title II. Administrative Simplification • Electronic Health Transaction Standards and Code Sets • Privacy and Confidentiality Standards • Security and Electronic Signature Standards • Unique Identifiers
AdministrativeSimplification • Electronic Health Transactions Standards and Code Sets • All payers, providers and clearinghouses using electronic healthcare transactions, must use a national standard format. The act designates standards for 10 specific transaction sets. (835 Payment, 837 Claim) • Health organizations also must adopt a set of industry standard codes to be used with transactions. Various coding systems are already in use to identify: • diseases • injuries • other health problems (as well as their causes, symptoms, and actions taken)
AdministrativeSimplification 2. Privacy and Confidentiality This rule protects the privacy of information related to an individual's health, treatment, or healthcare payment. • Limits the use of individually identifiable health information, sent or stored in any format (electronic, paper, voice, etc) without patient authorization • Business partners who receive, store or have access to privately identifiable health information must ensure the privacy of the records • Patients may have access to their own medical records
AdministrativeSimplification 3. Security of Health Information & Electronic Signature Standards • A uniform level of security for all health information that is: • housed or transmitted electronically • pertains to an individual • Organizations who use Electronic Signatures will have to meet: • a standard ensuring message integrity • user authentication, and • non-repudiation
AdministrativeSimplification 4. Unique Identifiers for Providers, Employers, and Health Plans • The current system allows for multiple ID numbers assigned by different agencies and insurers. HIPAA sees this as confusing, conducive to error, and costly. • It is expected that standard identifiers will reduce problems. • HIPAA sets a standard identifier for: • Providers • Claims Payers • Employers • Identifier likely to be eliminated: • Unique Patient Identifier
Privacy and ConfidentialityStandards (Policies & Procedures)Limits the use of Protected Health Information (PHI) • Minimum Necessary • Verification Prior to Disclosure • Administrative Requirements • Business Associate Agreements
Minimum Necessary • Protected Health Information (PHI) • Limit Access/Role Bases • Disclosure of Minimum Necessary • De-Identification • Right to Request Privacy Protection/Confidential Communication • Individual’s Access
Minimum Necessary • Protected Health Information (PHI): Protected Health Information (PHI) is information that identifies an individual and relates to the person’s physical or mental health or condition, the provision of health care to that person, or payment for the provision of health care to that person. DAS will limit the disclosure of Protected Health Information (PHI) to the minimum amount necessary to accomplish the intended purpose of the authorized use, disclosure, or request.
Some items that identify an individual are: Name, Address, Telephone or FAX #, Email Address, Names of Relatives, SS#, Birth Date, Account Number, Name of Employers, any other item that can ID a person in a small sample…
Minimum Necessary • Limit Access/Role Bases: DAS will identify and make reasonable efforts to limit the access: To those persons or classes of persons, as appropriate, in its workforce who need access to Protected Health Information (PHI) to carry out their duties
Minimum Necessary • Disclosure of Minimum Necessary: DAS will limit any request for Protected Health Information (PHI): To that which is reasonably necessary to accomplish the purpose for which the authorized request is made
It just means that if a person needs a date from a file, don’t give them the whole file. Give authorized individuals the minimum necessary to get the job done.
Minimum Necessary • De-Identification : DAS will de-identify Protected Health Information (PHI) (eliminate or cross out, identifiers of the individual or of relatives, employers, or household members of the individual), to limit the disclosure of Protected Health Information (PHI) to the minimum amount necessary to accomplish the intended purpose of the authorized disclosure This is not necessary for TPO (to carry out Treatment, Payment or health care Operations)
Minimum Necessary • Right to Request Privacy Protection/Confidential Communication: It is our policy that we respect the right of an individual to request restrictions on uses and disclosures of PHI and permit an individual to request confidential communication of PHI at alternative locations or by alternate means. DAS will document the restriction and termination of the restriction, should it occur.
Minimum Necessary The following will apply to requests for alternative confidential communications: • Request must be received in writing • Determine how payment will be handled, if necessary • Specification of an alternative address or other method of contact is required • Request or denial will be documented. DAS will not require an explanation from the individual The uses and disclosures of PHI are then subject to the agreed upon restriction and/or the confidential communications requirements.
Minimum Necessary • Individual’s Access: DAS will give an individual the right to access and inspect or obtain a copy of his/her PHI for as long as DAS maintains the PHI. DAS will act on a request for access no later than 30 days after receipt of the request.
Verification Prior toDisclosure • ID Person and Authority • Verification Methods • Routine Communication • Non-Routine Disclosures • Recording of Uses and Disclosures • Exercise of Professional Judgment
Verification Prior toDisclosure • ID Person and Authority DAS will verify the identity of a person requesting Protected Health Information (PHI) and the authority of any such person to have access to the Protected Health Information (PHI)
Verification Prior toDisclosure DAS is a Clearinghouse and only uses and discloses healthcare information for Treatment, Payment and Health Care Operations (TPO). The Client Agencies for which it processes the data have already obtained the appropriate authorizations and consents.
Verification Prior toDisclosure All employees are required to sign a confidentiality agreement as a condition of employment whereby they agree not to request, use or disclose protected information unless necessary to perform their job
Verification Prior toDisclosure • Verification Methods: Verification is done when the identity of the requestor is not known or when documentation is required Routine communication, where entity relationships have been established, do not require special verification procedures
Verification Prior toDisclosure Verification Methods Examples: Phone: Caller ID; if they are holding a Statement, ask for identifying information off of the statement; if not, ask Social Security Number, date-of-birth, Letter: Verify name and address Signed Authorization, Claim Number, Company Tax ID Number, Letterhead, Callback, Copy of Appointing Document, Identification Badge, other official credentials; warrant, subpoena, order, or other legal process issued
Verification Prior toDisclosure • Non-Routine Disclosures: Non-routine disclosures, not covered in the Policies and Procedures, must be reviewed on an individual basis by a Team Leader. Unresolved issues are to be brought to the DAS HIPAA Privacy Officer for resolution
Verification Prior toDisclosure • Recording of Uses and Disclosures: A log for the recording of all non-routine disclosures will be maintained. A copy going back six years prior to request will be made available to clients at their request for $.50 per page to cover the cost of copying and mailing
Verification Prior toDisclosure • Recording of Uses and Disclosures: Non-routine disclosures will be recorded on the Avatar Admission Comments Screen, with-in 60 days. Items to be keyed in: Date of disclosure Name of entity or person who received the PHI (address if known) Brief description of PHI disclosed Brief statement of purpose of disclosure
Purpose of Use or Disclosure Routine Verify Identity See Team Leader/ Privacy Officer Record Patient’s Authorization Needed Minimum Necessary Safeguard TPO (Treatment, Payment, Operations) Routine NO* NO NO NO YES YES Law Enforcement/ Legal Proceedings, National Security, National Health Non-Routine YES YES YES NO YES YES Marketing, Fund-Raising, Medical Research Non-Routine YES YES YES YES YES YES *YES, where identity of requester is not known (like an unrecognized voice on the phone)
Verification Prior toDisclosure • Exercise of Professional Judgment : The verification requirements are met if DAS relies on the exercise of professional judgment or acts on a good faith belief in making a disclosure
Administrative Requirements • Privacy Officer • Training • Safeguards • Complaints to DAS • Refraining from Intimidating or Retaliatory Acts • Sanctions • Policies and Procedures
Administrative Requirements • Privacy Officer DAS will create, document and maintain a position of privacy official that is responsible for the development, implementation and maintenance of the policies and procedures of DAS Responsible for receiving complaints regarding privacy of Protected Health Information (PHI)
Administrative Requirements • Training DAS will train all members of its workforce on the policies and procedures with respect to Protected Health Information (PHI) as necessary and appropriate for the members of the workforce to carry out their functions within DAS
Administrative Requirements • Safeguards DAS will have in place appropriate administrative, technical, and physical safeguards to protect the privacy of Protected Health Information (PHI).
Administrative Requirements • Safeguards Administrative: Scalable confidentiality and security procedures, designated security officer, sanctions for violations, signed statement by all employees regarding confidentiality of data
Administrative Requirements • Safeguards Technical: Unique ID and Password, system stores password encrypted, weak passwords not allowed, automatic time logoff, system enforced password changes, firewall, virus checking
Administrative Requirements • Safeguards Physical: Secure computer room, secure access to displays and printers, secure destruction of printouts, other outputs and obsolete equipment, disaster recovery plan in place and tested
Administrative Requirements • Complaints to DAS DAS will document all complaints received, and their disposition, if any, in written or electronic form. These documents must be retained for a period no less than six years
Administrative Requirements • Refraining from Intimidating or Retaliatory Acts DAS will not intimidate, threaten, coerce, discriminate against, or take other retaliatory action against anyone making a Privacy complaint
Administrative Requirements • Sanctions Consistent application of sanctions for failure to comply with privacy policies for all individuals in the organization’s workforce (can result in dismissal, other disciplinary actions, criminal prosecution and/or civil suit)
Administrative Requirements • Policies and Procedures DAS will implement Policies and Procedures with respect to Protected Health Information (PHI) that are designed to comply with the standards, implementation specifications or other requirements of the Health Insurance Portability and Accountability Act of 1996
Business AssociateAgreements • Definitions • Vendor Contracts • Agreements