HIPAA for Health Care Professionals Book

Preface     iii
About the Authors     v
Acknowledgements     vi
Introduction to HIPAA     1
Introduction     2
How the Rules Came into Existence     3
Titles of HIPAA Law     5
Health Insurance Access, Portability, and Renewal     5
Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform     5
Group Health Plan Requirements     7
Other Titles in HIPAA     7
HIPAA: An Organizational and Business Challenge     8
Who Is a "Covered Entity?"     10
The HIPAA Officer     11
Summary     12
Review Questions     24
References     25
Privacy Issues Explained     26
Introduction     27
To Whom Does Title II Apply?     27
What Is Protected Health Information?     28
Authorization versus Consent     30
Concerns about Protected Health Information and Possible Disclosures     32
Required Disclosures     32
Permitted Use and Disclosure without Authorization     33
For Individual Access     33
For Treatment, Payment, and Health Care Operations     34
When Permission to Disclose is Received     35
When Incidental     36
For Public Interest or to Benefit the Public     36
For Research     38
Permitted Use and Disclosure with Authorization     38
Disclosure of Psychotherapy Notes     38
Disclosure for Marketing Purposes     39
Disclosure for Directory Purposes     40
Limiting Uses and Disclosures     40
Minimum Necessary Uses     41
Business Associates under the Privacy Rule     42
Training of the Public and Workforce     43
Amending Protected Health Information     44
Enforcement Guidelines     45
Civil Penalties under HIPAA     46
Criminal Penalties under HIPAA     47
What the HIPAA Privacy Rule Covers     49
Summary     50
Review Questions     51
References     52
Transactions and Code Sets     54
Introduction     55
Purpose of Transaction Standards     56
Designated Code Sets     59
Diagnosis Codes     60
Inpatient Procedure Codes     61
Outpatient Procedure Codes     61
Dental Procedures     62
Drug Codes     62
Nonmedical Code Sets     63
ASC X12 Nomenclature     64
Data Overview     64
Architecture     65
Use of Loops     68
Sample of EDI Claim Data (UB-04, Hospital Billing Form)     69
Limitations of Electronic Claims     74
Remittance Advice and Secondary Payer     74
Working with Outside Entities     75
Trading Partner Agreements     76
Business Use and Definition     76
Enforcement of Transactions and Code Sets     77
Summary     78
Review Questions     79
References     80
Security Rule Explained     82
Introduction     83
Core Requirements     84
Administrative Safeguards     85
Security Management     86
Assigned Security Responsibility-Security Officer     88
Workforce Security     88
Information Access     89
Security Awareness and Training     90
Security Incidents     90
Contingency Plans     91
Evaluation of Security Effectiveness     92
Business Associate Contracts     92
Physical Safeguards     92
Facility Access Controls     93
Workstation Use     94
Workstation Security     94
Device and Media Controls     95
Technical Safeguards     96
Access Control     96
Audit Controls     98
Integrity     98
Person or Entity Authorization     99
Transmission Security     99
Organization Requirements     100
Policies, Procedures, and Documentation     101
Impact on Organizations     101
Challenges to Compliance and Enforcement     102
Summary     104
Review Questions     106
References     107
Unique Health Identifiers and HIPAA Myths     109
Introduction     110
Reasons for Identification Numbers     111
Employer Identifier     111
Health Care Provider Identifier     113
Health Plan Identifier     115
Personal Identifier     115
What Is Important to Know about HIPAA?     118
Locating the Latest Title II Rules and Changes     119
Legal Ramifications of HIPAA      120
Myths about HIPAA     123
Summary     128
Review Questions     129
References     130
HIPAA for Health Care Professionals     131
Covered Entity Charts     132
CMS Regional Offices and Government Resources     135
HIPAA Non-Privacy Complaint Form     147
Security Standards Matrix     150
Resources for HIPAA Information     153
Introduction to HIPAA-Chapter 1     153
Privacy Rule Resources-Chapter 2     153
Transactions and Code Sets Resources-Chapter 3     153
Names and Web Sites of Designated Standards Maintenance Organizations (DSMOs)-Chapter 3     154
Security Rule Resources-Chapter 4     154
Identifier Rule Resources-Chapter 5     155
Glossary     157
Index     166