Information Systems Technology -hipaa Security

In my role with Liberty Mutual, I drove adoption of Medicare reimbursement models through public affairs involvement with multiple state workers' compensation committees seeking to update their reimbursement schedules in response to the implementation of ICD-10 coding requirements in October of 2015. With the state workers’ compensation authorities seeking to adopt CMS reimbursement type models, my involvement was directed at securing the inclusion of specific CMS rules governing correct coding and reimbursement practices including National Correct Coding Initiative Guidelines (NCCI), Medical Unlikely Edits (MUE), along with the Resource Based Relative Value System (RBRVS) for reimbursement rate setting.

ICD-9-CM procedure codes had about 3,000 codes, ICD-10-PCS has over 72,000 codes. The way the new system has been set up this number has the ability to grow as well.

There are two trends that I have learned about from UMA and TV. ICD-10 replacing IDC-9. ICD-10 will provide the medical billing/coder with more descriptions for describing encounters and hospital stay for patients. Where ICD-9 had 3,824 procedure codes and 14,025 diagnosis codes, ICD-10 on the other hand, has 71,924 procedure codes and 69,823 diagnosis codes that is a big difference. The affordable care act also made an impacted on billing/coding since more people are getting procedures done. These procedures will need to be coded and documented for doctors and hospitals to get paid.

Modern communications capabilities open up a world of possibilities for all types of medical practices to develop deeper connections with their patients and to manage health care remotely. The HIPAA Privacy Rule gives patients the right to obtain copies of their medical records, treatments and protected health information or PHI. These requirements go further if medical providers want to receive reimbursement from Medicare and Medicaid -- patients must be able to access their records online, download copies and transmit the information to third-party providers. Most medical practices are finding it necessary to develop patient portals where patients and physicians can interact, share information and perform important functions such as practices billing patients and accepting payments online. HIPAA 's rules require that these patient portals have strong security and privacy protections to prevent unauthorized access of these confidential PHI records.

The continue use of ICD-9 codes after the effective date could result in the denial of reimbursement claims. This task can be assigned to the healthcare organization’s management team to determine a solution avoiding a break down in the system. Rahmathulla states, “In instances of an audit, appropriate documentation will make the query process substantially easier while enabling coders to clarify issues without having to query the provider multiple times for answers” (“Migration To The ICD-10 Coding System S187). It is important to accurately document to reduce the amount of claim denials. With the new specificity requirement of the ICD-10 and documentation supporting a claim, lowers the chances of healthcare fraud. The healthcare management team will oversee the process to prevent the risk of exposure.

A few things are happening soon and for us to be excited about. One is for this Saturday's picnic we will close at 4:30pm as the email stated yesterday. I do hope to see all of you there to enjoy a nice evening by of the family and shorebirds and of course the food!!! We also will be starting to use ICD-10. This is being used all over. From the billing prospective this is a wonderful way of documenting. When we first start this it may take us a few extra minutes with our time patients that have been here before, however; once we do this we will not have to do it again since the codes will then be ICD-10. More information is coming on this.

I am choosing ICD-10 Codes. The reason I have chosen ICD-10 codes is because every medical facility uses the ICD-10 codes for the billing and coding. That is the only way they get paid is by using ICD-10 codes. They will all receive adequate payments using the updated codes and the right type of billing.

In the past, small medical offices were sometimes not as up on HIPAA as they should have been, but that has been changing. The Internet is helping to ensure that even small providers are up to speed on this vital piece of legislation that protects the privacy of their patients. Complying with it also protects their medical business. Here are a few ways small providers are working hard to comply with HIPAA:

ICD-10 is a huge change from ICD-9, the main purpose was to help coders code more specific. One benefit of ICD-10 is to give the doctor an electronic trail of proof for payments from patients, insurance, government, and hospitals. ICD-9 having diagnosis codes ranging from three to five digits but ICD-10 having diagnosis codes ranging from three to seven digits will automatically give you a more detailed code. Using ICD-10 gives you a lesser risk of getting audited. Giving a specific description on claim forms will make it harder to get the wrong code. ICD-10 will improve healthcare, the codes are more detailed making the data and communication flow faster. ICD-10's will help guarantee the physician reputation; the electronic trails are reported

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

The healthcare policy surrounding the RACs is complex. The overriding issue is Medicare fraud and government waste. Both are high priority topics. The AHA reports that two-thirds of the medical records review

Due to ICD-9-CMS’ ability to provide necessary detail for patients’ medical conditions or the procedures and services performed on hospital patients, ICD-10-CM/PCS was implemented.

ICD-10, which is the tenth revision of the International Statistical Classification of Diseases and Related Health Problem, refers to a medical classification inventory for the coding of diseases, their signs, symptoms and causes (Center for Disease Control and Prevention 1). The use of this revised version in the United States is scheduled to begin officially on the first of October 2013. Currently, ICD-10 is being used for diagnosis coding, in procedure coding systems and for inpatient procedure coding.

Information security and privacy is occupying a most important role in the healthcare territory in order to deliver protected information process to their patients (Appari, & Johnson, 2010). As healthcare department is the organization with vast data and essential information the hospitals has to keep a useful information security technique in their enterprise process (Mishra et al., 2011). Information security is one such phase in the healthcare sphere which is extremely problematic to describe and evaluate even to the individuals who are working on the process. In the healthcare organization, information is of many types which required for the work and even the security is a main control for almost all the practices which are transmitted out in the healthcare field (Appari, & Johnson, 2010). Hospitals, in specific, have been instructed to create a new set of security specialists to protect healthcare data tools techniques upon which exists may rely. Healthcare data is very critical for patients because it is very confidential records. If a medical apparatus is filled with a computer virus it can even exemplify a possibility to patients ' lives. Hence, hospitals should design alertness of the risk, to defend against concerns to healthcare databanks and be concerned about the high risk of infected computers or medical tools being connected to their networks (Mishra et al., 2011).

The rapid changes in technology over the past few decades has left the healthcare industry ill-prepared to operate in today’s environment. Most substantial protections of sensitive consumer information has come as a result of federal regulation, most notably in 1996 with the Health Insurance Portability and Accountability Act and 2009 as part of the American Recovery and Reinvestment Act. Protection of information in the healthcare industry has lagged behind all other industries, perhaps because the records aren’t financial in nature or sensitive government information. Implementing simple steps for many organizations may be enough to limit the vast majority of breaches, although a layered, comprehensive security approach should be the ultimate goal for companies.