Situation
The purpose of this SBAR request is to help the Regulatory Compliance and Privacy Team standardize the auditing process, perform more comprehensive auditing, better assist internal and external customers ', and make appropriate recommendations to Executive Management, Hospital Departmental Managers, Physician Practice Administrators, Human Resources professionals, Finance, Administration, Nursing and Medical Staff professionals regarding privacy and compliance incidents and incident investigations that result in employee disciplinary actions and recommended employee terminations.
We are getting significantly more regulatory, privacy, information security and compliance requests from nursing, risk management, legal services,
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As of June 21, 2016, the Compliance and Privacy Department auditors have investigated over 9600 investigations pertaining to regulatory compliance and privacy incidents from June 2015 to June 2016. And thousands more went un-investigated because of insufficient access to the appropriate EPIC modules and systems audit trail viewers.
Background
The Compliance and Privacy Department is a complex unit whose job functions and duties crosses every department in the hospital, from clinical to housekeeping, to administration to finance, and to patient access to information technology, just to name a few. We are required to look at each discipline’s EPIC modules and audit trail viewers to make incident determinations, chart access appropriateness or inappropriateness, and employee disciplinary and termination recommendations to managers, regional medical directors, medical directors, hospital and nursing executive staff members, and human resources professionals.
The Compliance and Privacy Department answers request for assistance from every department, to include: ambulatory care, physician practice, hospital administration, allied health, nursing, transplant, imaging, health information management, pathology, transcription, coding, scheduling, finance, surgery, nurse triage, call management, revenue cycle, patient access, patient finance, pharmacy and information technology.
Currently, the Compliance and
In the health care business, there are certain standards and laws that have been put in place to protect our patients and their personal health information. When a health care facility fails to protect their patient’s confidential information, the US Government may get involved and facilities may be forced to pay huge sums of money in fines, and risk damaging their reputation.
Healthcare technology has grown and evolved over time. With the conversion to electronic medical records and the creation of social media just to name a few, ensuring patient privacy is of the utmost importance for healthcare facilities in this day and age. In order for an organization to avoid hefty fines, it is imperative that a healthcare administrator maintains compliance with the standards and regulations associated with the Health Insurance Portability and Accountability Act (HIPAA). This paper will provide a summary
In most offices, and outpatient services has a team where the physician is unable to monitor the team at all times. For example, in a pharmacy setting there are pharmacists, pharmacy technicians, and clerks at times. The majority of the time the clerks have the most patient contact where the pharmacists are unable to monitor them at all times making sure protected health information is not spread. In the HIPAA rules, covered entities include health plans, health care clearinghouses, and health care professionals who electronically transmit any health information in connection with transactions for which HHS has adopted standards (Tomes, 2007). In writing, the people who are liable for violations are one those providers who bill electronically are covered entities. Directors or officers can commit violations by selling individually identifiable health information to a drug company for marketing purposes, they can also be charged if the director and or officer aided a covered entity’s commission of the HIPAA criminal act, and lastly can be heavily prosecuted if they commit identity theft utilizing patients protected health information (Tomes,
At the level of the external environment, health information management in itself, as well as the people employed in the adjacent departments, are continually impacted by new standards, regulations and initiatives. The scope of these standards, regulations and initiatives is usually that of increasing the efficiency and quality within the health care system, "o provide a secure, nationwide, interoperable health information infrastructure that will connect providers, consumers, and others involved in supporting health and healthcare" (U.S. Department of Health & Human Services).
Even though hipaa violations are an important standard in preventing many individuals from causing several breaches of information from getting out, it is important to work on a strategies within several health care organizations that will work with the privacy rules regarding violation laws. “Jill Granger & Laura Cataldo (2013) reports When working in the healthcare setting, it is important to consult with the guidelines established by one's institution and to participate in any training programs to insure that the appropriate steps are being taken to maintain privacy. There are also a variety of additional resources available from the federal government and professional organizations to assist in the training process that may be especially
The purpose of this assignment is to review the factual content of and critically reflect upon the legal compliance considerations of eight major areas including, the Joint Commission, HIPAA/HITECH, Health Finances, Revenue Cycles, Medicare Recovery Audit Contractors, OIG work plan, OIG Corporate Integrity Agreement (CIA), the False Claims Act, and compliance and Provider Self Disclosure Protocol. These key elements have been provided by the GRC software Compliance 360 webpage.
The Health Insurance Portability and Accountability Act (HIPAA) was signed into legislation in 1996, with the final version of its privacy rules going into effect in 2002. In addition to insurance and healthcare transaction regulations, HIPAA includes two key features. First, the portability of health care for workers who transition between jobs. Second, HIPAA regulates how patient’s health information must be secured with detailed privacy policies. It is important that HIPAA practices are employed by the clinic for several reasons. First and foremost, it is legally required by the Department of Health and Human Services (HHS). HIPAA non-compliance can lead to financial penalties and lost accreditation with The Joint Commission which will have
In order to minimize the risks for potential privacy breaches, the health information management (HIM) director has to understand all facets of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This should include conducting an audit of their practices. In this scenario, an audit would have been useful to detect the improper access by the employee sooner. HIPAA uses both its privacy and security regulations to “protect consumer’s health information, allow consumers greater access and control to such information, enhance health care, and finally to create a national framework for health care privacy protection” (Amaguin, n.d.). These privacy and security regulations serve as the “only national set of regulations that governs
Although the overall state of compliance for the organization is good, there are several areas that have been identified as “Priority Focus Areas” due to a past history of nonconformities. All these areas are related to Information Management and Record of Care, Treatment, and Services, in particular:
The United States Department of Health and Human Services information security and privacy program is accountable for ensuring Operating Division SOP participation in the Privacy Impact Assessments (PIAs) process; reviewing completed PIAs, and confirming that they are adequately and accurately completed prior to SAOP approval for web publishing; submitting the Privacy Management portion of the Department’s annual FISMA report to the SAOP for approval (HHS, 2010); overseeing the coordination of privacy-related reporting activities as mandated by federal legislation and OMB guidance; developing the proper policy and guidance for implementation of information privacy protections, including full compliance with federal laws, regulations, and policies relating to information privacy (HHS, 2010); maintaining appropriate documentation regarding compliance with information privacy laws, regulations, and HHS policies; ensuring the Department’s privacy compliance efforts are ongoing, including reviewing documented information privacy procedures to ensure that they are comprehensive and innovative, and managing revision, as necessary; ensure that 100 percent of department employees and contractors receive annual Information Security awareness training and role-based training in compliance with OMB A-130, Federal Information Security Management Act (FISMA), and National Institute of Standards and Technology
After reviewing the Office of Inspector General (OIG) Supplemental Compliance Guidelines for Hospitals I have found that there is great purpose for a compliance document in a healthcare facility. The purpose of this document in a healthcare facility is to be able to act as a guideline for healthcare facilities to consider, develop, and implement a compliance plan that meets federal regulations. Healthcare facilities have these compliance documents to help to cover and verify all that all services ordered for a patient were reasonable and necessary services for the patient to be treated accordingly and without fail. These compliance documents need to be retained to reflect that the healthcare facility’s efforts comply with Federal health care
Last week it was reported that 500 patient records had been compromised. Our IT Security department has done an extensive audit and concluded that there are many issues with our security system regarding the protection of our patient’s privacy. Outlined below are some issues that were found and how they are going to be addressed going forward.
Leadership in innovation in healthcare is no different, as its initiative is to progress while maintaining strict confidentiality and maintaining an overall safe and trustworthy establishment. Healthcare laws are issued to help safeguard patient information creating a moral medical healthcare environment. Healthcare laws secure patient information and medical history and it has helped against fraudulent practices such as identity theft. Knowledge and practice of such laws strengthen leadership. For example, HIPAA (The Health Insurance Portability and Accountability Act) privacy rule was created as a way to secure patient identifiable healthcare information and limiting its disclosures for legitimate purpose use only. To explain, the HIPAA Privacy Rule is an arrangement of selected models to secure the protection of patients' health records as these guidelines give patients access to their health record and control over how their own health record are utilized and disclosed (2015). In any event, the Privacy Rule addresses a guideline for understanding situations where disclosure can be given without patient consent. For example, court proceedings, insurance billing, and
Principle 1 of the AHIMA Standards of Ethical Coding states that, “the coder must advocate, uphold, and defend the individual’s right to privacy and the doctrine of confidentiality in the use and disclosure of information (www.ahima.org). This standard is important is all who serve in the department confidentiality is important to maintaining positive relationships with the patient’s they serve. The HIMs must ensure that all confidentiality is being followed by the coder when getting request for protected health information and querying information for certain stakeholders.
Attention: all management staff and employees recently the corporate office contacted our offices in regards to CEO Chief Executive Officer Beranger, ”HIPAA Health Information Portability and Accountability Act information request, she is requesting research information from us on the topic. Her plans include moving the health care organization toward the modern age of e-health within the online medical and public domains on the web. The goal is within reach of building sustained longevity within hippa guidelines and federal regulations to meet this request we must start from the beginning of healthcare