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HIPAA Privacy Training Your Name Here
© 2004 MHM Resources Inc.2 HIPAA Background Health Insurance Portability and Accountability Act of 1996
© 2004 MHM Resources Inc.3 HIPAA Part One – Portability, access, and renewability requirements
© 2004 MHM Resources Inc.4 HIPAA Part Two – "Administrative Simplification” Standards for maintenance and transmission of health information
© 2004 MHM Resources Inc.5 HIPAA Part Three – Privacy The privacy regulations govern how individually identifiable medical information must be protected.
© 2004 MHM Resources Inc.6 HIPAA The Flexible Benefit Plan Connection The Health FSA, or unreimbursed medical portion of a cafeteria plan; or a Health Reimbursement Arrangement (HRA) are considered to be health and welfare benefit plans.
© 2004 MHM Resources Inc.7 HIPAA Definitions Covered Entity A healthcare provider that conducts certain transactions in electronic form A healthcare clearinghouse A health plan - includes all the employer's welfare benefit plans like health insurance, a Health FSA within a cafeteria plan, and any HRAs.
© 2004 MHM Resources Inc.8 HIPAA Definitions If you are an employer, you are not a covered entity. Employees, the plan, and its Business Associates may not freely share information with the employer unless firewalls exist to contain the information.
© 2004 MHM Resources Inc.9 HIPAA Definitions Covered Transactions Healthcare or dental claims administration Healthcare eligibility Benefits enrollment and maintenance Payroll deduction and group premium payment Retail pharmacy transactions
© 2004 MHM Resources Inc.10 HIPAA Definitions Business Associate A person, business, or agency that conducts covered transactions for another legal entity.
© 2004 MHM Resources Inc.11 HIPAA Definitions Business Associate Agreement The health plan must engage in a Business Associate Agreement with all Business Associates.
© 2004 MHM Resources Inc.12 HIPAA Definitions Small Plans A plan with $5 million or less in annual receipts. For a self-funded plan (including Health FSAs and HRAs) this means claims paid in the preceding fiscal year.
© 2004 MHM Resources Inc.13 HIPAA Definitions Protected Health Information (PHI) Individually identifiable medical information in any form, including oral communication that is created or received by a covered entity or employer.
© 2004 MHM Resources Inc.14 HIPAA HIPAA Overview Individuals “own” their PHI HIPAA defines what PHI is Privacy notice tells employees how their PHI will be used and disclosed. No other notice is required Privacy notice gives employees certain rights to their PHI
© 2004 MHM Resources Inc.15 HIPAA Where does PHI come from? Mail Fax Front desk Phones Electronically
© 2004 MHM Resources Inc.16 HIPAA Who can see PHI? Covered entities with privacy policies in place Business Associates that have signed Business Associate Agreements in place with the covered entities and also have privacy policies in place Individual employees may review and change their own PHI
© 2004 MHM Resources Inc.17 HIPAA When can you reveal PHI? Healthcare operations Payment Treatment As permitted or required by law Pursuant to an authorization
© 2004 MHM Resources Inc.18 HIPAA When can you reveal PHI? Identify individual with whom you are speaking Verify SSN, gender, birth date, and/or address Authorization signed by participant “Minimum Necessary” standard Reveal the minimum necessary information when releasing information
© 2004 MHM Resources Inc.19 HIPAA HIPAA privacy applies to all covered entities. Employers are not covered entities A covered entity may not freely share an individual's PHI with the employer or a non-health plan.
© 2004 MHM Resources Inc.20 HIPAA Protecting PHI in your office Train all workers with access to PHI Don’t enter PHI into a software system or program unless protected by firewall Create a “clean desk” policy Store PHI under lock and key Don’t discuss an individual’s health information in public Identify callers
© 2004 MHM Resources Inc.21 HIPAA Protecting PHI in your office Letters to participants should not contain their SSNs Offsite storage Retain complete list of claim forms, etc. offsite Use security tape on boxes to reveal unauthorized entry. Trash Shredding
© 2004 MHM Resources Inc.22 HIPAA Protecting the participant’s privacy Right to inspect and copy Accounting of disclosures Amend Request restrictions Request confidential communications Right to receive a paper copy of the privacy notice
© 2004 MHM Resources Inc.23 HIPAA Employers Employer puts in place HIPAA privacy policies and procedures Amend plan documents and Summary Plan Descriptions for all employer-sponsored health plans Employer must certify to plan that HIPAA privacy rules are being followed The health plan must adopt and distribute a notice of privacy practices for employees Business Associate Agreements must be in place
© 2004 MHM Resources Inc.24 HIPAA Plan Service Provider HIPAA privacy policies and procedures Business Associate Agreements must be in place between the plan service provider (Business Associate) and the plan.
© 2004 MHM Resources Inc.25 HIPAA Exception to Privacy Compliance All plans, except "Small" plans, had to comply by April 14, 2003 "Small" plans have until April 14, 2004 Self-administered health plans with fewer than 50 participants are exempt from privacy compliance
© 2004 MHM Resources Inc.26 HIPAA Substantial civil and criminal penalties apply to noncompliance of HIPAA regulations Be aware of your state laws Get legal counsel
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