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HIPAA Health Insurance Portability & Accountability Act. By: Cindy Quisenberry. HIPAA. Established in 1996 to enforce standards for electronic health information & enhance the security and privacy of health information. PHI – Protected Health Information.

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Health Insurance

Portability &

Accountability Act

By: Cindy Quisenberry

  • Established in 1996 to enforce standards for electronic health information & enhance thesecurityand privacy of health information
PHI – Protected Health Information
  • Any information, including demographic information that can be used to identify the patient
  • Notice – explanation to the patient how his/her PHI may be used and their rights
PHI – Protected Health Information
  • Patient Rights under HIPAA include:
    • Right to receive a Notice of the privacy practices the first time they present for services
    • Right to request additional privacy protection and confidentiality
    • Right to request access to their PHI
    • Right to request an amendment to their PHI
    • Right to know to whom their PHI has been disclosed
Legal Responsibility
  • Privileged Communication – refers to information that is held private within a protected relationship, such as that between a physician and patient
Legal Responsibility
  • Privileged Communication
    • It is illegal and unethical for a healthcare worker not to observe confidentiality.
    • Privileged communication refers to information held confidential within a protected relationship.
Legal Responsibility
  • Privileged Communication
    • Keeping client medical information confidential means:
      • Not informing any unauthorized person about the information contained in a patient’s medical records.
      • Not showing written information to an unauthorized third party.
      • Taking proper precautions when communicating such information over a computer, telephone, or fax machine.
    • Written consent must be obtained before releasing information to a third party.
Legal Responsibility
  • Privileged Communication
    • Guidelines to follow if you have access to a patient’s information:
      • Do not decide if information is confidential based on your approval or agreement.
      • Do not reveal financial information about a patient.
      • Do not use the patient’s name or other information if others in the room might overhear.
      • Use caution in giving the results of medical tests to patients over the telephone.
Legal Responsibility
  • Privileged Communication
    • Guidelines to follow if you have access to a patient’s information:
      • Do not leave medical charts or insurance reports where patients or others can see them.
      • If the patient has not given written permission to release information, do not release it.
      • Do not discuss patients in public places where others may overhear, such as the cafeteria or elevator.
Legal Responsibility
  • Privileged Communication
    • Confidentiality for patient medical records may be waived under the following circumstances:
      • When a third party requests a medical examination, such as a pre-employment examination, and that third party pays the patient’s bill.
      • When a patient sues a physician or other healthcare practitioner for malpractice.
      • When the patient signs a waiver allowing the release of information.
Legal Responsibility
  • Privileged Communication
    • Clients have the following rights under HIPAA law:
      • The right to notice of privacy practices.
      • The right to limit or request restriction on their PHI and its use and disclosure.
      • The right to confidential communications.
      • The right to inspect and obtain a copy of their PHI.
      • The right to request an amendment to their PHI.
      • The right to know if their PHI has been disclosed and why.
Patient Rights
  • The right to notification of his or her rights.
  • The right to exercise individual rights regarding care.
  • The right to be informed of the policies and procedures governing patient conduct and duties.
  • The right to be informed of services available, the charges of these services, charges not covered by payor, and charges not included in the basic room rate.
Patient Rights
  • The right and need for effective communication. This includes the right to be informed by a physician of his/her medical condition unless the physician orders otherwise. The patient can expect to be advised if the hospital proposes to engage in or perform human experimentation affecting his/her care or treatment. (The patient is given the opportunity to take part in planning his/her medical treatment and given the choice of participating in experimental research to include refusing to participate in research projects.) The patient can also expect if he/she has a special problem or speaks another language, the hospital will try to help him/her understand his/her care. When possible, he/she will be provided an interpreter.
Patient Rights
  • The right to receive from his/her physician information necessary to give informed consent prior to the start of any procedure and/or treatment.
Patient Rights
  • The right to formulate advance directives (which may include living wills, durable power of attorney for healthcare decisions, or similar documents portraying his/her preference) and to designate a representative decision-maker in the event the patient becomes incompetent to make healthcare decisions. Once completed the patient has the right to review and/or revise his/her advanced directive.
Patient Rights
  • The right to refuse treatment to the extent permitted by law and to be informed of the medical consequences of his/her action.
  • The right to expect that every consideration of his/her privacyregarding medical program, case discussion, consultation, examination and treatment areconfidential and should be treated discreetly. Those not directly involved in his/her care should have permission of the patient to be present or share information.
Patient Rights
  • The right to expect that, within its capacity, a hospital must make a reasonableresponse to the request of a patient for service. When medically permissible, a patient may be transferred to another facility only after he/she has received complete information and explanation concerning the needs for, and alternatives to such a transfer. The institution to which the patient is to be transferred must accept the patient prior to transfer.
  • The right to care and treatment in a safe environment free of all forms of abuse or harassment.
Patient Rights
  • The right to expect reasonable continuity of care. The patient has the right to expect that the hospital will provide a mechanism whereby he/she is informed by his/her physician (or physician’s designee) of the patient’s continuing healthcare requirements following discharge.
  • The right to know at all times the identity, professional status, and professional credentials of healthcare personnel, as well as the name of the healthcare provider primarily responsible for his/her care.
Patient Rights
  • The right to have a family member, friend, or other individual to be present for emotional support during the course of stay, unless the individual’s presence infringes on others’ rights, safety, or is medically or therapeutically contraindicated. The individual may or may not be the patient’s surrogate decision-maker or legally authorized representative.
Patient Rights
  • The right to be informed of the facility’s rules and regulations pertinent to patient and visitor conduct. The patient should be informed of smoking rules and can expect compliance with those rules from other individuals. Patients may expect information about the health care facility’s mechanism for the initiation, review and resolution of the patient complaint.
Patient Rights
  • The right to examine and receive an explanation of his/her bill regardless of source of payment. The right to be treated with consideration, respect and full recognition of dignity and individuality, including treatment and care of personal needs.
  • The right to designate a legal representative to act in his/her behalf.
  • The right to freedom from restraints used in the provision of acute medical and surgical care unless clinically indicated.
Patient Rights
  • The right to freedom from restraints used for the management of behavior unless clinically indicated.
  • The right to have reports of pain accepted and managed by health care professionals.
  • The right to request protective services or ask for information regarding agencies and services to meet his/her needs.
Patient Rights
  • The right not to be photographed or have an image captured in any media form unless permission is given by the patient
  • The right to be free from mental, physical, sexual, and verbal abuse, neglect and exploitation.
Patient Rights
  • The right to be informed (or support person, where appropriate) of his or her visitation rights. Visitation rights include the right to receive the visitor(s) designated by the patient, including but not limited to, a spouse, a domestic partner (including a same sex domestic partner), another family member, or a friend. Also included is the right to withdraw or deny such consent at any time.