HIPAA Administrative Simplification

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the main objective of Principle III: Obligation to the Profession?

To reduce costs in healthcare management

To promote competition among healthcare providers

To uphold the integrity and dignity of the profession (correct)

To ensure profit maximization in healthcare

According to the OIG, what is the recommended approach to establishing a Compliance Committee?

A committee with a specific composition recommended by the OIG

A committee comprising only medical professionals

A committee with varying perspectives (correct)

A committee without a clear objective

What is a key element of an effective compliance program according to the text?

Mandatory reporting of non-compliance

Regular audits and inspections

Implementation of new technology

Proper education and training of employees (correct)

What is the recommended annual education and training requirement by the OIG?

1-3 hours per year Signup and view all the answers

What is a topic that should be included in general compliance education?

Ethics Signup and view all the answers

What is an example of a topic for specific/focused training?

Conflict of interest Signup and view all the answers

What should a written annual training plan outline?

Training needs, timing, methods, and duration Signup and view all the answers

What is the role of the Compliance Officer in a Compliance Program?

A focal point, but not the only point in a Compliance Program Signup and view all the answers

What is the last resort in dealing with possible misconduct?

Termination Signup and view all the answers

What is the goal of a Compliance Program?

Detection Signup and view all the answers

Why are cover-ups generally not effective?

They cause more problems than they solve Signup and view all the answers

Who should handle internal investigations?

Skilled investigators Signup and view all the answers

How soon must repayment be made to Medicare?

Within 60 days Signup and view all the answers

What is the time limit for returning overpayments?

6 years Signup and view all the answers

What should be the focus of performance reviews?

Both positive and negative feedback Signup and view all the answers

What is the timeframe for reporting misconduct to the OIG?

Within a reasonable period Signup and view all the answers

What are the essential characteristics of a compliance program's enforcement and discipline?

Fair, equitable, and consistent Signup and view all the answers

What should a written policy statement on disciplinary actions include?

A 5-point outline of disciplinary procedures Signup and view all the answers

What is the consequence of failing to report an offense?

Equal discipline as the actual misconduct Signup and view all the answers

Who is responsible for working with management in imposing discipline?

HR Signup and view all the answers

What is the purpose of the first step in the progressive discipline process?

To secure the employee's understanding of the problem and a commitment to correcting behavior Signup and view all the answers

What is the next step after a written warning in the progressive discipline process?

Escalation to a higher authority Signup and view all the answers

What is the purpose of a written warning?

To emphasize the seriousness of the situation and stress the urgency of modified behavior Signup and view all the answers

What is the consequence of intentional or reckless noncompliance?

Significant sanctions Signup and view all the answers

What is the primary objective of the Administrative Simplification Section of Title II of HIPAA?

To develop standardized transaction standards for content and transmission of data Signup and view all the answers

When were the Privacy Rule and Security Rule issued by DHHS?

2003 and 2005 Signup and view all the answers

What is the primary purpose of the Privacy Rule under HIPAA?

To assign rights to individual patients to control their health information Signup and view all the answers

What is a key requirement of the HIPAA Privacy Rule?

Establishment of a Privacy Officer Signup and view all the answers

What is the primary purpose of the HIPAA Security Rule?

To implement safeguards for the protection of health information Signup and view all the answers

What is the relationship between HIPAA and state laws regarding the protection of health information?

HIPAA is a federal regulation and overrides state laws Signup and view all the answers

What is the primary purpose of the HITECH Act?

To promote the adoption of electronic health records Signup and view all the answers

What is the significance of the Omnibus Rule?

It provided additional protections for health information Signup and view all the answers

What is the primary goal of the HIPAA Act in promoting electronic health records?

To reduce the administrative cost of healthcare Signup and view all the answers

What is the result of the expansion of the application of business associate agreements to subcontractors of covered entities?

Subcontractors are required to comply with HIPAA regulations Signup and view all the answers

What is the result of a breach of unsecured information under the HIPAA Act?

Notification is required, and the potential civil monetary penalties for violations of HIPAA are increased Signup and view all the answers

What is the purpose of the Notice of Privacy Practices?

To describe how the covered entity uses and discloses PHI, and provide examples of how health information will be used or disclosed Signup and view all the answers

What is the result of the exemption of the PHI of individuals who have been deceased for more than 50 years?

The PHI of deceased individuals is no longer protected under HIPAA Signup and view all the answers

What is the purpose of the standard transactions under HIPAA?

To reduce the administrative cost of healthcare Signup and view all the answers

What is the result of the prohibition on the sale of PHI without an individual authorization?

Covered entities are prohibited from selling PHI without individual authorization Signup and view all the answers

What is the purpose of the right to access and obtain a copy of PHI?

To allow individuals to access and obtain a copy of their PHI Signup and view all the answers

What is the result of the restriction on information provided to health plans for healthcare for which the individual paid in full out of pocket?

Health plans are restricted from accessing PHI for healthcare paid in full out of pocket Signup and view all the answers

What is the purpose of the privacy regulations under HIPAA?

To place control over health information squarely in the hands of the individual who is the subject of the information Signup and view all the answers

Study Notes

Principle III: Obligation to the Profession

Compliance professionals should strive to uphold the integrity and dignity of the profession
Should advance the effectiveness of compliance programs and promote professionalism in health care compliance
Compliance Officer may be a focal point, but not the only point in a Compliance Program
OIG urges a Compliance Committee be established to advise and assist the CO
Committee should include varying perspectives and develop goals and objectives on an annual basis
- Participating in the identification of risk
- Regularly reviewing and assessing compliance P&Ps
- Assisting with the development of the COC and P&Ps
- Determining strategy to promote Compliance
- Developing a system to solicit, evaluate, and respond to complaints and problems

Education and Training

Education and Training are the first and possibly the most important lines of defense for a Compliance program
Proper education of all officers, managers, and employees, and continual retraining, is a significant element of an effective compliance program
General Training Topics:
- Elements of the compliance program
- The Code of Conduct
- The reporting system
- Individual accountability for reporting suspected non-compliance
- Non-retaliation policy
- Who is the Compliance Officer
- Explanation of FWA
OIG urges a specific number of education hours per year (1-3hrs per yr in corporate integrity agreements)
General Compliance Education should include:
- Ethics
- Code of Conduct
- Obligation to Report
- Privacy
Topics for specific/focused training include:
- Actions outside scope of practice
- Government and private payor reimbursement principles
- Third-party relationships
- Identification of a privacy breach
- Stark/anti-kickback
- Submission of a claim for physician services when rendered by a non-physician
- Signatures for a physician without the physician's authorization
- EMTALA
- Conflicts of interest
- Proper documentation of services rendered
- Directions for conducting investigations
Written annual training plan should outline the training needs, timing, methods, and duration

Enforcement and Discipline

Discipline will be administered for non-compliance
Employees have an obligation to report suspected non-compliance
An outline of disciplinary procedures
A list of the parties responsible for appropriate action
A promise that discipline will be fair and consistent
Failure to report an offense is a serious act of non-compliance and equally deserving of discipline as the actual misconduct
HR is responsible for working with management in imposing discipline
Compliance will monitor consistency for fairness and severity
Intentional or reckless non-compliance = significant sanctions
Progressive discipline = Multi-step process
1. Employee's manager to discuss problem with employee
2. Depending on the situation, next step might be to escalate the issues to a higher authority
3. A written warning
4. Next step could be suspension without pay, or a probationary period
5. Final option is termination, if all other options are exhausted
OIG Recommends a new employs policy:
- Background checks
- Reference checks
- Reviews of the federal health care sanctions list

Responding to Offenses / CAPs

If there's a reason to believe misconduct, response must be timely and appropriate
Detected but uncorrected misconduct threatens an organization's credibility
Cover-ups usually cause more problems than they solve
The goal of a Compliance Program is detection
Depending on severity, you may want to meet with your legal counsel
OIG recommends an investigation anytime a potential violation is identified
Internal investigations must be handled by skilled investigators and documented according to your policy
OIG calls for prompt reporting of [misconduct] within a reasonable period
If a [repayment] is due to Medicare, it must be made within 60 days of identification

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

Learn about the HIPAA Administrative Simplification section, including standardized transaction standards and privacy rules to protect health information.