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## XVI HIPAA **4.** Insurance copayments may be waived or written off if access of care is threatened by inability to pay the copayment **5.** Professional courtesy is a tradition ## XV. Professional Rights and Responsibilities ### A. Discipline 1. Physician should expose dishonest, corrupt, inc...

## XVI HIPAA **4.** Insurance copayments may be waived or written off if access of care is threatened by inability to pay the copayment **5.** Professional courtesy is a tradition ## XV. Professional Rights and Responsibilities ### A. Discipline 1. Physician should expose dishonest, corrupt, incompetent, or unethical colleagues ### B. Free Choice 1. Physician in private practice may decline to accept any individual as a patient ### C. Patent 1. Physician may patent any device that he or she discovers or invents ### D. Patient-Physician Relationship 1. Both parties are free to enter into, or decline to enter into, the relationship ### E. Infectious Disease 1. Physician who is infected with an infectious disease should not engage in any patient contact or activity that may create a risk for the patient ### F. Substance Abuse 1. Physician should not practice under the influence of any controlled substance, alcohol, or chemical agents that impair the ability to render treatment ## XVI. HIPAA ### A. HIPAA 1. Involved with privacy, security, and claims issues in the health care system 2. Standards for privacy of individually identifiable health information 3. Allows the flow of health information while protecting the privacy of patients 4. Issues identified by state and federal agencies 5. Failure to comply with mandates can lead to sanctions and fines 6. Enacted in 1996 7. Two provisions: * **Title I: Insurance Reform** * **Title II: Administrative Simplification** 8. Long-term benefits of HIPAA: * Lower administrative costs * Increased accuracy of data * Increased patient and customer satisfaction ## B. Title I: Health Insurance Reform ### 1. General * **a.** Provision of continuous insurance coverage for workers and their insured family members when the worker changes or loses a job * **b.** Limits use of preexisting condition exclusions * **c.** Prohibits discrimination for past or present poor health * **d.** Guarantees individuals the right to purchase gap health insurance coverage after losing a job * **e.** Allows renewal of health insurance coverage regardless of an individual's health condition ## C. Title II: Administrative Simplification ### 1. General * **a.** Focuses on health care setting * **b.** Intended to reduce administrative costs * **c.** Accomplished by standardizing the exchange of health care data * **d.** Includes provisions to ensure the privacy and security of an individual's health data * **e.** Standardization of electronic transmissions to reduce the number of forms and methods used in claims processing * **f.** Two parts to provision: * Development and implementation of standardized electronic transactions using common sets of descriptors (code sets) * Implementation of privacy and security procedures to prevent the misuse of health information and ensure confidentiality ## D. Roles and Relationships ### 1. General * **a.** Department of Health and Human Services (HHS): establishes and implements standards * **b.** Centers for Medicare and Medicaid (CMS): enforces insurance portability and code set requirements of HIPAA * **c.** Office of Civil Rights (OCR): enforces privacy standards * **d.** Covered entity: may be a health plan (e.g., Blue Cross/Blue Shield), health care clearing house, or health care provider * **e.** Electronic media: mode of electronic transmission; may include the Internet, extranet, telephone lines, fax modems, or disks or magnetic tape * **f.** Transaction: transmission of information between two parties; can include