Resource for late-breaking HIPAA Information:
Resource for late-breaking HIPAA challenges information:
MedicalPrivacy Coalition: www.MedicalPrivacyCoalition.org
Applicationof HIPAA to Small Provider Practices
Download the White Paper "Small PracticeImplementation Guide" from the "White Papers Being Revised"Section: http://snip.wedi.org/public/articles/index.cfm?Cat=17
HIPAA applies to "covered entities." In general,HIPAA applies to a small provider practice if that practice submits claimselectronically either directly or through a billing service or"clearinghouse." HIPAAdoes not apply to a practice that does not submit any information electronicallyto a health plan.1
In addition, Sec. 3 of the Administrative Simplification Compliance Act (signedinto law in December 2001) contains a section entitled "Enforcement throughexclusion from Participation in Medicare" and requires that effective forclaims submitted to Medicare on or after October 16, 2003, "no payment maybe made under part A or part B of [Medicare] for any expenses incurred for itemsor services ... for which a claim is submitted other than in an electronic formspecified by the Secretary."
This payment prohibition does not apply to small practices:
(i) When there is no method availablefor the submission of claims in an electronic form
(ii) In the case of a physician,practitioner, facility, or supplier (other than a "provider" ofservices as defined under Medicare), when the entity has fewer than 10 full-timeequivalent employees
(iii) Undersuch unusual cases as the Secretary may find appropriate. Note: No guidancehas been given regarding what the Secretary might find appropriate.
http://www.ama-assn.org/ama/pub/category/8158.htmlThis free downloadable booklet from the AMA is directed toward physicians, butis useful for all health care providers. The material includes a sample patientletter designed to give patients an understanding of the scope and purpose ofHIPAA.
August 2002 Changes TheDepartment of Health and Human Services published its final changes to the HIPAAprivacy regulations. To read the final modifications to the privacy rule,including the HHS press release and a fact sheet, go to http://www.hhs.gov/ocr/hipaa/.
Does HIPAA apply to your practice? See Decision tree at this link:
Frequently asked questions about CMS ..
CMS is the Centers for Medicare &Medicaid Services. Formerly known as the Health Care Financing Administration (HCFA)
- federal agency responsible for administeringthe Medicare, Medicaid, SCHIP, (State Children's Health Insurance), HIPAA(Health Insurance Portability and Accountability Act), CLIA (Clinical LaboratoryImprovement Amendments), and several other health-related programs.
[FederalRegister: December 28, 2000 (Volume 65, Number 250)] [Rules and Regulations]
TheFederal Register for Thursday December 28, 2000 is reproduced in a printableformat at the following addresses, each part is 50 pp except part 8, which is 19pp.
August 14, 2002 Federal Register- revising consent, regulatory permission, and other content of HIPAA privacyregulations: http://www.hhs.gov/ocr/hipaa/privrulepd.pdf
HIPAA- THE "COUNTRY DOCTOR" ESCAPE ROUTE
Be sure to read the answers to doctors' mostfrequently asked questions about HIPAA
ESCAPE HIPAA "ADMINISTRATIVESIMPLIFICATION"
… You can be a NONCOVERED entity - unlessyou voluntarily relinquish that status.
Despite what you may have been told by thelawyers during hospital "briefings," doctors are NOT required to fileelectronic claims, nor file a HIPAA compliance plan.
Even HHS admits there's an escape route. Inits Motion to Dismiss the AAPS lawsuit against the privacy rule, the Departmentof HHS wrote:
"It bears repeating that the Privacy Ruleapplies only to covered entities.
The proverbial country doctor who deals onlyin paper, or who has a computer but conducts none of the transactions referredto in section 1173(a) electronically, would not be a covered entity and wouldnot be subject to this legislation."
YOU ARE A COVERED ENTITY IF YOU DO ANY OF THEFOLLOWING:
… You transmit any protected health informationelectronically after April 14, 2003.
… You sign an agreement agreeing to be a coveredentity.
… You sign a certification stating that you area covered entity.
YOU MUST MEET ALL OF THE FOLLOWING CONDITIONSTO BE A NONCOVERED ENTITY:
… No "protected health information" istransmitted electronically outside your office.
… The records in your office may all be paper;or you may keep them in a computer. It is the electronic transmission that makesyou a covered entity.
… You file no claims via electronic transmittal- including private and Medicare claims.
… You have not volunteered to become a coveredentity by contract or certification.
PROTECT YOURSELF AND YOUR PATIENTS
… Protect your patients from having their dataentered into a nationwide computer data base.
… Protect yourself from costly but impossibleefforts to comply and from enormous potential fines ($250,000 or more) or evenimprisonment.
Keep the practice of medicine from beingdestroyed by forcing it into a rigid, irrational, inaccurate straitjacket of200,000 government codes.
A Problem-Oriented Approach to the HIPAA Security Standards ”The best way toapproach HIPAA's many security mandates is to break them down into manageablecategories and tasks.”
What You Need to Know About HIPAA Now
”Taken together, the HIPAA standards will require major changes in how healthcare organizations handle all facets of information management, includingreimbursement, coding, security, patient records and care management.”
Consumers can find FORMS TO USE NOW, to informmedical professionals, banks, home health agencies, public health agencies,health insurers and managed care providers, state health departments, and othersNOT TO use, disclose, or sell your personal medical information.
Links to Jaffee-Redmond home page: http://psa-uny.org/jr/index.htm
Although the JAFFEE privilege has been likened by the Supreme Court to the attorney-client privilege, the JAFFEE privilege lacks the latter's many years of common law experience. The way in which the new privilege develops is of major importance to all psychotherapists and their patients. It is the goal of this WWW site to increase public awareness of the JAFFEE privilege and it's important implications for the confidentiality of psychotherapeutic relationships. The tragedy is that the protection supposedly afforded to psychotherapy notesunder HIPAA is so very very limited. See TheContentious Matter of Psychotherapy Notes at this HIPAA Help site.
Articles and discussions regarding HIPAA
Continuallyupdated list of HIPAA compliance articles, media: http://www.hipaacomply.com/news.htm
The 11/02 issue of the American Journal ofPsychiatry contains an overview by Paul Appelbaum, MD "Privacy inPsychiatric Treatment: Threats and Responses." AM J Psych 159:11, November2002 pages 1809-1818. (You can view the entire article at www.psych.org/downloads/privacy.pdf
In his words, theloss of consent "represents the most profound change in traditionalpractices wrought by the HIPAAregulations." Regarding this devastating effect of the amendments he alsosaid, "Thus was lost the historic right of patients to control thedissemination of their medical records."
HIPAAregulations." Regarding this devastating effect of the amendments he alsosaid, "Thus was lost the historic right of patients to control thedissemination of their medical records."
Appelbaum has … faith in our abilities to retainprivacy protections at the state level. However, he does not recognize thetremendous pressure that the insurance industry … will now apply to everystate in the US to eliminate stricter state medical privacy laws. Unfortunately,Paul did not realize the import of the new "federal regulatorypermission" that the HIPAA amendments gave health insurers, which permithealth plans to access everyone's entire medical records without notice and EVENIF PATIENTS REFUSE CONSENT to release the information, for the purposes of"health plan operations."(comments by Deborah Peel, MD)
The American Psychiatric Organization andother groups have expressed strong concern that the finalregulations do not provide adequate protection against the disclosure ofpatients' medical information. The APA response to the August 2002 changes canbe found at http://www.psych.org/pub_pol_adv/hhs81302.pdf
AMERICAN PSYCHIATRIC ASSOCIATION Documentationof Psychotherapy by Psychiatrists
http://www.psych.org/archives/200202.pdf This document provides a suggested format for documentation ofpsychotherapy notes pursuant to the new HIPAA regulations.
AMERICAN PSYCHIATRIC ASSOCIATION MinimumNecessary Guidelines for Third-Party Payers for Psychiatric Treatment http://www.psych.org/archives/200211.pdf
This is a position statement on the"minimum necessary" information required under the HIPAA Privacy Ruleto process an insurance claim for psychiatric treatment.
http://www.managedcareandpatientprivacy.com/Whilenot a HIPAA case, the suit of Daniel S. Shrager, MD, a member of thePennsylvania Psychiatric Society practicing in Pittsburgh, ... in hisfight to preserve patient confidentiality and his credentialed status in theMagellan network. ... the underlying issue of dispute is the extent towhich a managed care organization has the right to view patient records, inparticular for site reviews. ... everyeffort must be made to preserve the confidentiality of patient records and thepatient’s right to provide truly informed consent. Magellan firstdecredentialed Dr. Shrager after he failed to set up a site visit, as requested,for Magellan to see patient records in order to review his record-keepingpractices. He had asked Magellan to reconsider, citing the need for a signed,informed consent from the patient and the negative effect which loss ofconfidentiality has on patient care.
TheMyth of Patient Confidentiality November 1999
(One)medical-privacy threat comes from a new data collection system being implementedby the federal Health Care Financing Administration (HCFA), which oversees thewide-ranging Medicare program. Called the Outcome and Assessment Information Set(OASIS)
SUE BLEVINS: A threat to medical privacy … (November 21, 1999 More than 8 million Americans may soon find federal health nannies pouring over their most private medical records …
HCFA(Health Care Financing Administration) Consumer Information site devoted toHIPAA, Mental Health Parity, etc.
Welcometo HIPAA OnLine . Thisinteractive tool, provided by the Federal Government, helps answer yourquestions about health coverage and your rights and protections under the HealthInsurance Portability and Accountability Act (HIPAA).If youhave questions on getting and continuing health coverage during events such aslosing or changing jobs, pregnancy, moving, or divorce, you can get answershere.
http://hippo.findlaw.com/hipaa.html HealthHippo: HIPAA Page
Wired Health85%of people in a recent poll felt that maintaining the confidentiality of medicalrecords is absolutely essential or very important innational health care reform, according to one government-sponsored report. Yet80% already feel they have little control over how their personal medicalinformation is used …