Compliance 360 Compliance

Many healthcare professionals and organizations have not been following the regulations set forth by HIPAA. Whenever violations of HIPAA’s privacy or security laws occur the organizations responsible must be held accountable resulting in a fine or penalty. Penalties provide incentive for organizations to guarantee patient privacy and security. Recently, certain people have failed to follow through with the laws and restrictions and were forced to accept the penalty. This paper will provide three real examples of such HIPAA violations as well as solutions or ways each violation could have been prevented.

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

Regulation placed upon the healthcare system only seek to improve safety and security of the patients we care for. The enactment of the Health Insurance Portability and Accountability Act (HIPPA) and the enactment of Meaningful Use Act the United States government has set strict regulations on the security of health information and has allotted for stricter penalties for non-compliance. The advancement of electronic health record (EHR) systems has brought greater fluidity and compliance with healthcare but has also brought greater security risk of protected information. In order to ensure compliance with government standards organizations must adapt

Due to the high risk to information systems, many organizations do not conduct a periodic risk analysis and are not able to know where they stand. This may seem blatantly obvious, but it is something many of the healthcare organizations continue to wonder about. In order to improve the effectiveness and proficiency of the health care system, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law 104-191, includes Administrative Simplification requirements for HHS to accept national standards for electronic health care operations and code sets, unique health identifiers, and security (Sullivan, 2014). Enforcement of the Privacy Rule that began on April 14, 2003 for most HIPAA covered objects.

There are numerous rules and regulations that have been a huge impact to healthcare organizations. The one major rule that has affected the healthcare industry in so many ways is The Health Insurance Portability and Accountability Act, also known as HIPAA. This report will examine how HIPAA relates to healthcare organizations by explaining how HIPAA is implemented, Identifying which agency or regulatory body is responsible for overseeing HIPAA and Explain how Healthcare Organizations or Healthcare Industries are impacted by HIPAA.

Most people have a basic understanding about HIPAA and what it entails, but for future healthcare leaders, it is a critical issue. The goals behind the HIPAA privacy rules are very beneficial for keeping individual’s health information private, but it does place a heavy burden on organizations to ensure the information remains protected. Healthcare leaders have always had to adapt to change, but it is becoming increasingly necessary to have leaders that can adapt quicker than ever. Not only do they need to keep up with the technological advances in healthcare, but they also need to become compliant with the new and ever-changing healthcare laws. Numerous modifications have been implemented under HIPAA in the

Id. In order for providers to avoid costly claim denials, a risk management and compliance program should be in place and annual monitoring and auditing of internal controls needs to occur on a regular basis. This text will review the issues that medical providers face with coding and billing regulations, the consequences of improper billing and coding, and resolutions that will aid in the prevention of claims being denied.

Attempts to stop fraud were enhanced under Public Law 104-191, the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The purpose was to improve the Medicare program under title XVIII of the Social Security Act, the Medicaid program under title XIX of such Act, and the efficiency and effectiveness of the health care system. This public law encouraged the development of a health information system through standards and requirements for the electronic transmission of certain health information (aspe.hhs.go). The Act established a program to take action against fraud committed against public and private health plans. The legislation required the establishment of a national Health Care Fraud and Abuse Control Program (HCFAC), under the joint direction of the Attorney General and the Secretary of the Department of Health and Human Services (HHS) acting through the Department 's Inspector General (HHS.gov). The HCFAC program is designed to coordinate Federal, State and local law enforcement activities with respect to health care fraud and abuse. The Act requires HHS and Department of Justice (DOJ) detail in an Annual Report the amounts deposited and appropriated to the Medicare Trust Fund, and the source of such deposits. (HHS.gov) I will summarize the impact of these laws as it pertains to how they are impacting the healthcare delivery system. (HHS.gov)

The Medicare Learning Network aims to solve that problem by providing a variety of training and educational materials that break down Medicare policy into plain language with actionable tips to use in day-to-day work. CMS has created a Quarterly Provider Update system as another tool to assist affected entities. The Quarterly Provider Update system. The QPU is intending to make it easier for providers, suppliers, and the public to understand the changes we are suggesting or making in the programs we administer. CMS publishes the QPU at the beginning of each quarter to inform the public about regulations currently under development during each quarter. The clear majority of CMS regulatory issuances involve modifications to prior regulations. Compliance systems and instructions already exist for the prior regulations, and are revised as regulations are amended. For example, there are rules establishing “Conditions of Participation” for most types of Medicare providers. These rules are proposed to assure patient safety and quality care. Although rules are periodically modified, affected providers are already used to, and competent in complying with the existing rules, and the inspection and other administrative mechanisms used in their enforcement. Genuinely new regulatory requirements that create brand new sets of “compliance” burdens on providers are

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 is a US law aimed to advance the portability and continuity of health insurance coverage in both the group and individual markets, and to combat waste, fraud, and abuse in health insurance and health care delivery as well as other purposes26. The Act defines security standards for healthcare information, and it takes into account a number of factors including the technical capabilities of record systems used to maintain health information, the cost of security measures, the need for training personnel, the value of audit trails in computerized record systems, and the needs and capabilities of small healthcare providers. A person who maintains or transmits health information

The mission was to promote the adoption and meaningful use of health information technology to improve patient care by evaluating utilization and maximizing efficiency as established in subsequent federal regulations. In addition, HITECH Act addresses the privacy and security concerns associated with electronic transmissions of health information with several civil and criminal enforcement provisions of the HIPAA rules.

More methods are being created and taken place to ensure, inspect, repair and correct performance where it is needed to do so. MCOs have developed a new status quo of improving and performing better every year with tools such as the “Quality Drivers of Care” (Miller, 2004). One of these tools, perhaps the most important one, is the voluntary accreditation of MCOs by organizations such as the National Committee on Quality Assurance, the Joint Commission on Accreditation of Healthcare Organizations, and the Utilization Review Accreditation Commission, among others. While MCOs are not required to do so they choose to, to show the industry that they are being assessed in the quality and service they provide and that improvements are in fact being made. They are also drivers in effectiveness and quality assurance as MCOs now find themselves competing amongst each other not only on costs but also on their effectiveness.

Implementing all of these standards and policies within a company is certainly not an easy thing to do, and therefore it is imperative to understand whether or not your company will need it or not. In fact, it is easy to say that any company working within the federal healthcare system, whether it be insurance, practice, healthcare education, or many others, will need this sort of regulation used efficiency internally in order to prevent federal violations, which will be entirely detrimental to your reputation and ability to produce a

Revenue cycle management is the financial method that healthcare facilities utilize to keep record of patient care visits from registration, to appointment scheduling, to the final payment of care expenses. Revenue cycle management combines the business and medical sides of healthcare by connecting administrative information such as an individual's name, insurance and other private information. The revenue cycle management also keeps track of the care a patient receives. Revenue cycle management, communication with health insurance companies is an important aspect of the RCM. After a patient schedules a doctor’s visit, the physician office or the clinical workforce usually recovers the patient's reported insurance coverage prior to the patient's

The plan was developed using a comprehensive analysis of the industry risks and HealthSouth’s historical data. The areas listed on the plan were deemed high priority based on vulnerabilities, regulatory scrutiny, industry trends, and risk assessment results and are monitored and audited regularly. This document is designed to be dynamic and change organically as issues are identified. HealthSouth expects the Compliance Work Plan to be implemented and embraced by all stakeholders in order to ensure success. As they have for years now, the findings are published on the HealthSouth intranet site for employees to view.