2003 HIPAA Desk Reference for Physician Practices: A Guide to Understanding the Administrative Simplification Provision

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ISBN: 9781563299162 | 156329916X
Cover: Paperback
Copyright: 1/1/2002

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(ingenix) Annual practical reference providing a fundamental understanding of the HIPAA provisions. Features provision updates, case studies, alert icons, HIPAA history, HIPAA timeline, key terms, alert symbols, HIPAA dictionary, frequently asked questions, and HIPAA web resources. Includes a review of all HIPAA provisions, security, and privacy. Softcover.

Biography	p. vii
Introduction	p. ix
How HIPAA Got To Be What It Is Today	p. xi
Bringing Order to Chaos?	p. xi
Breaking HIPAA down into (Almost) Bite-Sized Chunks	p. xiii
HIPAA, One Chunk at a Time	p. xiii
Who HIPAA Affects Most: The "Covered Entities"	p. xiv
Keeping up with HIPAA	p. xv
Transactions and Code Sets	p. 1
What You'll Find in This Chapter	p. 1
Terms and Abbreviations Used in This Chapter	p. 2
Standard Transactions vs. Transaction Standards	p. 6
What Transactions Are	p. 6
Types of Transaction Standards	p. 7
Who the Transaction Standards Will Affect	p. 8
Exceptions to the Rule	p. 9
The 10 Specific Transaction Standards	p. 10
How to Obtain Copies of the Standards	p. 12
How Transaction Standards Will Be Maintained	p. 12
Proposed Revisions to ASC X12N Transaction Standards	p. 13
Proposed Revisions to ASC X12N Transaction Standards	p. 14
How Transactions Affect Health Plans	p. 15
How Transactions Affect Providers	p. 16
What Health Care Clearinghouses Do	p. 16
How and Why Trading Partners Are Affected	p. 19
How and Why Business Associates Are Affected	p. 21
Code Sets	p. 22
What Code Sets Are	p. 22
Health Plans' Obligations Regarding Code Sets	p. 23
How Code Sets Will Be Updated	p. 23
Why Dates of Service Will Be Significant	p. 24
Care Needed with Proprietary Code Sets	p. 25
The Significance of Eliminating Local Codes	p. 25
When Transaction and Code Standards Will Go into Effect	p. 26
Transaction Standard FAQs	p. 27
Code Set FAQs	p. 29
Privacy	p. 33
What You'll Find in This Chapter	p. 33
Recapping the Steps that Led to the Final Privacy Rule	p. 36
What's Revised in the Revised Privacy Rule	p. 37
Consent Requirement	p. 37
Notice Requirement	p. 38
Authorization of Disclosure	p. 38
Incidental Uses and Disclosures	p. 39
Clarification of "Health Care Operations"	p. 39
Marketing Uses and Disclosures	p. 40
Accounting for Disclosures	p. 41
Disclosure of Limited Data Sets	p. 41
A Privacy Rule Case History	p. 42
Terms and Abbreviations Used in this Chapter	p. 46
Fundamental Concepts	p. 52
Protected Health Information	p. 52
Use of Protected Health Information	p. 53
Disclosure of Protected Health Information	p. 53
Minimum Necessary Use and Disclosure	p. 54
De-identified Information and Limited Data Sets	p. 56
Business Associates	p. 56
Common Uses of Protected Information	p. 57
Medical Treatment	p. 58
Payment	p. 59
Payment and the Standard Transactions	p. 60
Required, Situational, and Optional Data Elements Compared	p. 61
Health Care Operations	p. 62
Marketing	p. 63
What "Marketing" Includes--and Doesn't Include	p. 63
Newsletters and General Communications	p. 64
Authorization is Required to Use Protected Information in Marketing	p. 65
Anti-kickback Regulations	p. 65
Law Enforcement and Legal Proceedings	p. 65
Regulation, Licensing, and Accreditation	p. 66
Education and Training	p. 66
Research Studies	p. 66
Sharing Patient Information with Specific People and Organizations	p. 67
Other Providers Involved in Treatment	p. 67
Family Members	p. 68
Parents of Minors	p. 69
Regulatory Agencies (Other Than Law Enforcement)	p. 70
Law Enforcement Agencies	p. 71
Disclosures by Whistleblowers	p. 71
The Notice of Privacy Practices	p. 72
Who Must Receive the Notice	p. 72
Good Faith Effort to Obtain Written Acknowledgement of Receipt	p. 73
Content Requirements	p. 74
Request for Restrictions on Use or Disclosure and Confidential Communication	p. 77
Documentation of Compliance	p. 77
Emergency Treatment	p. 77
Content of the Authorization of Disclosure and Use	p. 78
When an Authorization is Required	p. 78
What an Authorization Must Contain	p. 80
Revocation of Authorizations	p. 81
Accounting for Disclosures	p. 81
Fees for Providing an Accounting	p. 82
Documentation of Accountings	p. 83
Inspection and Amendment of Information	p. 83
When an Individual's Access Can Be Denied	p. 83
When an Individual Can Amend Information	p. 85
When a Request for Amendment is Denied	p. 86
Special Considerations	p. 87
Psychotherapy Notes	p. 87
Requests for Confidential Communication	p. 87
Disclosure Following Death	p. 87
Privacy FAQs	p. 88
General	p. 88
Notice and Consent	p. 90
Minimum Necessary Disclosure	p. 92
Business Associates	p. 94
Parents and Minors	p. 94
Marketing	p. 95
Research	p. 95
Government Disclosure	p. 96
Payment	p. 96
Sample Business Associate Contract Provisions	p. 97
Statement of Intent	p. 97
Sample Business Associate Contract Provisions	p. 98
Definitions (Alternative Approaches)	p. 98
Obligations and Activities of Business Associate	p. 99
Permitted Uses and Disclosures by Business Associate	p. 100
Obligations of Covered Entity	p. 102
Permissible Requests by Covered Entity	p. 102
Term and Termination	p. 103
Miscellaneous	p. 104
Security and Electronic Signatures	p. 105
What You'll Find in This Chapter	p. 105
Terms and Abbreviations Used in this Chapter	p. 106
The Purpose of the Security Standards	p. 109
What HIPAA Means by "Secure" and "Security"	p. 110
Characteristics of the Security Standards	p. 110
Who and What the Security Standards Apply To	p. 111
Covered Entities	p. 111
Covered Information	p. 113
Fax Transmissions	p. 113
Telephone Communications	p. 113
Contents of the Security Standards	p. 114
Aspects of Security, Categories of Security Standards, Requirements, and Implementation Features	p. 114
Aspects of Security	p. 115
Categories of Security Standards	p. 115
Requirements and Implementation Features	p. 115
Administrative Procedures	p. 116
Physical Safeguards	p. 122
Technical Security Services	p. 126
Technical Security Mechanisms	p. 127
Electronic Signatures	p. 128
Requirements for Electronic Signatures	p. 129
The Digital Signature Standard	p. 130
Implementation Features for the Electronic Signature Standard	p. 131
Status of the Security Rule	p. 132
Security FAQs	p. 133
Identifiers	p. 137
What You'll Find in This Chapter	p. 137
Terms and Abbreviations Used in This Chapter	p. 138
What Identifiers Are	p. 139
What Identifiers Will Be Used For (In General)	p. 140
What Provider Identifiers Will Be Used For	p. 140
The Benefits of Identifiers	p. 141
Provider Identifiers	p. 142
How National Provider Identifiers Were Developed	p. 142
What a National Provider Identifier Looks Like	p. 143
How HIPAA Defines "Provider"	p. 144
How Providers Will Apply for Their Identifiers	p. 144
How CMS Plans to Phase in Provider Identifiers	p. 146
Information Required to Obtain a Provider Identifier	p. 147
How Identifiers Affect Health Plans	p. 150
How Information Will Be Released	p. 151
How the National Provider File Will Be Updated	p. 151
The National Employer Identifier	p. 151
The Employer Identification Number (EIN)	p. 152
How to Obtain an EIN	p. 152
What the EIN Will Be Used For	p. 153
When Identifiers Will Go into Effect	p. 153
The Status of Provider Identifiers	p. 154
The Status of Health Plan Identifiers	p. 154
The Status of Individual Identifiers	p. 154
Identifier FAQs	p. 155
Claims Attachments	p. 161
What You'll Find in This Chapter	p. 161
Why Claims Attachments Are Important	p. 161
The Claims-adjudication Process	p. 162
Objectives of the Standards for Claims Attachments	p. 163
Status of the Standards for Claims Attachments	p. 164
Claims Attachment FAQ	p. 166
Enforcement	p. 169
What You'll Find in This Chapter	p. 169
The Requirement for Enforcement	p. 169
The Complaint Process	p. 170
How Complaints Will Be Filed	p. 170
How Complaints Will Be Investigated	p. 172
Compliance Reviews	p. 173
Violations by Employees and Contractors	p. 173
Penalties	p. 173
Status of the Penalty Provisions	p. 175
Enforcement FAQs	p. 175
A HIPAA Glossary	p. 177
Index	p. 225
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2003 HIPAA Desk Reference for Physician Practices: A Guide to Understanding the Administrative Simplification Provision

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