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Health Insurance And Portability And Accountability Act 101

Healthcare is complicated. The issue comprises statutes, judicial decisions, myriad federal regulations, Guidance documents from the United States' Department of Health and Human Services, regulation...

Healthcare is complicated. The issue comprises statutes, judicial decisions, myriad federal regulations, Guidance documents from the United States' Department of Health and Human Services, regulations of State Departments of Health, and standards of accreditation organizations such as the Joint Commission on the Accreditation of Health Care Organizations (JCAHO).

But, perhaps, the largest bit of regulatory reform that hospital executives and General Counsel have to cope with, is the HIPAA which was passed in 1996. Billions of healthcare compliance dollars have been spent on HIPAA consulting entities and more, perhaps, on HIPAA lawyers. HIPAA is incredibly cumbersome, outlined in the better part of 800 pages. Penalties for not being in HIPAA compliance can be up to $1.5 million. So, ensuring compliance is amazingly important. As the first rays of daylight often chase away the monsters children are sure they have seen lurking under their beds all night, comprehension of these basic HIPAA tenets can dry the organization's night sweats by providing clear focus for this healthcare compliance initiative.

The HIPAA regulations are divided into two Rules: HIPAA Privacy and Security. The latter is designed to ensure compliance with the former by providing a series of standards which provide administrative, physical and technical protections for electronic health information. The Privacy Rule is designed to prevent unauthorized use or disclosure of Protected Health Information (PHI). PHI covers both paper and digital medical information. The Privacy Rule states that PHI is any information regarding an individual's treatment or treatment requests. Privacy covers the dissemination of such information in a way that allows for an individual person to be identified by one or more of 18 ways (photographic likeness, medical record number, etc).

Privacy is a regulation of exclusion; it states that PHI may not be used or disclosed except for purposes or treatment, payment or operations of the healthcare provider or plan, unless the patient authorizes the use or disclosure in writing or the use or disclosure falls within one or the exceptions in the regulations. Exceptions include emergencies, as defined, uses or disclosures required by law, and provision of PHI to third-party contractors whose work requires access to PHI. Such contractors are known in the industry as Business Associates. Privacy Rules mandate that a Business Associate Agreement be signed wherein parties agree to follow the regulations set forth by HIPAA. After February 1, 2010 however, these Associates are required to abide by HIPAA, which means that even they must comply with the law's requirements as though they were healthcare providers or plans.

Healthcare consulting entities and HIPAA lawyers (healthcare attorneys with a specialty in HIPAA law) can, by being outside entities, facilitate the necessary discussions to focus this healthcare compliance initiative by preparing Gap Analysis Reports, in which they review policies and procedures on handling of healthcare information and make recommendations to bring those protocols into compliance. In its most basic form, the underlying basis for HIPAA compliance is not too difficult. use or disclose patient information only for the permitted purposes, and secure patient authorization to sue it for anything not permitted by the Regulations. A culture of privacy is already a pervading theme within the cultures of a majority of hospitals. As such, bringing organizations into compliance with these regulations can usually be done without greatly affecting the culture.

Article Tags: Healthcare Compliance

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Laura Young frequently writes on all sorts of topics including how to bring your organization into healthcare compliance, or how to find a hipaa lawyer.

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