SymposiumGo

All about HCPCS! Join @lynnanderanin in her latest webinar on #HCPCS Coding ABC’s on Aug 7th. & Learn the HCPCS 1⃣The drug table 2⃣Current CMS DME audits 3⃣Coding & pricing 4⃣Reimbursement ➡️Use LI30 & get $30 off! Click below to attend:

HIPA is universally an agreed-upon process, created to protect sensitive and confidential patient data in the healthcare industry. But, is following HIPAA enough to prepare you for the random audits?

HIPAA, the Health Insurance Portability and Accountability Act, was enacted by the United States Congress in the year 1996. The primary objective was to protect the confidential data of the patient.

HIPAA was mainly initiated to set concrete and detailed standards regarding the secure and uninterrupted flow of sensitive patient data. It is mandatory for an organization to meet HIPAA compliance in order to function permissibly in the healthcare industry. The law has established proper standards which demand maximum confidentiality, security, and utilization of Protected Health Information (PHI) or ePHI. PHI is a health information record-keeping tool in the form of physical as well as an electronic system which helps in identifying a patient or a healthcare plan member in the system.

The advent of the two new ePHI rules has benefitted the healthcare information services (HIS) with a rapid shift in the process of billing, coding as well as in the method of record-keeping. The proposed rules have given a giant push to the control on the privacy of the data and information, fully in the hands of the patients. The amount of paperwork eliminated has initiated developed techniques like electronic passbooks of patients, better analytics tools in chronic treatments along with efficient billing and coding process.  

Why is the confluence of HITECH and HIPAA Act considered essential?

Whether you are a business associate, covered entity, hospital, or any other medical practitioner in the healthcare industry, you are legally abided to follow both HITECH and HIPAA Act.

As part of the American recovery and reinvestment act (ARRA) of 2009, HITECH act was instituted into law in February of 2009. The act was enforced merely to promote the adoption of it in healthcare, i.e., to encourage the hospitals and other healthcare organization to inculcate maximum use of electronic health records (EHR). The act was purposely initiated to rigorously enforce the regulations and standards of HIPAA, which somehow weren’t being correctly followed by the organizations.

In addition to the penalties under the HIPPA act, HITECH also required health and human services HHS to regularly investigate the breaches under any willful violations under HIPAA rule. The HITECH act included another layer of security in the provision of HIPAA. It increased the protection of patient data by applying stringent legal liability for non-compliance of the law.

With this, in the year 2011, HITECH also introduced the practice of monetary incentives for the appropriate and abundant use of electronic health record (EHR). The process of monetary incentives was introduced to encourage more use of technology in hospitals. The design of the reward program has worked wonders in healthcare information services as the whole system started to infuse the use of it in their everyday work.  

The changing pace of hospital and their compliance with HIPAA- How HIPAA auditing kept medical practitioners on their toes.

The HHS Office for Civil Rights (OCR) has embodied the responsibility of conducting periodic audits of covered entities and business associates. The blueprint of HIPAA audit was originated in the year 2001 to ensure full compliance with HIPAA regulation. The audit program worked through a set of policies which selects a random sampling method of auditing to keep all the healthcare organizations updated and in compliance.  

Having regular audits helps an organization to strengthen its privacy and security structure by detecting the place of disclosure of phi. According to OCR, audits are an essential compliance tool for the organizations to roll with all the latest security measures.

The HIPAA audit protocol by OCR is an effort to ensure that the required entities are meeting the HIPAA compliance proactively. It is a protocol where the spectrum of the audit includes an examination of the documents, identification of potential risks, investigation, review, and reporting of the consent documents.

Components and Timeline of HIPAA Audits

Before filing for an audit program, one must be aware of all the procedural actions by the OCR. The program consists of a systematic timeline to ensure a balanced and orderly audit of the organization. For audit protocols to take place, an organization must be legally working in the healthcare industry. Moreover, the auditees must be able to show how they are complying with the HIPAA breach notification rule.

So, Are You One Of The Auditees? - To comply with the audit program, you must come under any of the following heads mentioned below;

•        Covered entities like healthcare clearinghouses, insurance providers, etc

•        Business associates such as billing and faxing companies, practice management firms, third-party consultant, physical and cloud storage providers.

•        An organization (public or private) affiliating with a healthcare entity.

Timeline of HIPAA Audit

1.     Firstly, the auditees are divided into various sections of size, operation, affiliation, etc. Next; the OCR selects the organization from the process of sampling and avoids entities with an open and extensive investigation complaint as they are already undergoing the procedure.

 2.     Once an organization is selected for a HIPAA audit, it is mandatory that they send the requested data to the OCR through the mail within ten business days from the date of the request.

 3.     The documents requested should be submitted in a digital form and after that sent electronically through a secured online portal.

 4.     After reviewing the documents, the auditor will send back the findings to the entity. The organization will then have ten business days to review and respond with a statement, if any, to the auditor.

 5.     Subsequently, the auditor will report the final audit within 30 business days and will also be obliged to send a copy of the report to the concerned auditees.

The Outcome Of The HIPAA Audit Protocol: What happens Once Your Firm Has Been Audited?

Once the final audit is out, the OCR will examine the entity’s reasons for non-compliance with HIPAA as well as HITECH Act. Following the OCR will plan to guide the entity through the necessary changes and compliances needed. If, in any case, OCR finds any compliance issue more severe than others, then they have all the rights to send it for further investigation.

The importance of a HIPAA audit is mainly to ensure that people are regularly complying with federal law or not. And if you are, then the audit program will just enhance your organization’s performance for further reimbursement.

To Summarize

The importance of a HIPAA audit is mainly to ensure that people are regularly complying with federal law or not. And if you are, then the audit program will enhance your organization’s performance for further reimbursement. HITECH act has also contributed to the better functioning of hospitals.

Even though there is an element of sampling in the audit process, the hospitals must comply with the law. HIPAA audit is an initiation by the OCR too ensures that the healthcare organizations are making sure that the patient’s data are secured and not leaked in any way possible.

Wednesday Webinar! Join #Toni_G_Cesta in her upcoming Live Webinar - Compliance Measures for RN and Social Work Case Managers. Attend on: June 26, 2019 For: 60 min & free your practice from all the compliance issues. Use SG50 & get $50 off!

Tuesdays for Toni! Join #Toni_G_Cesta in her latest webinar on Transitions in Care – A Key Role for RN Case Managers and Social Workers.

Key Points: Discharge planning IMPACT Act Patient Choice

Use SYM & get $30 off!

Attend our Live Webinar by Jim Sheldon & learn all the latest changes in the HIPAA privacy rule 2019.

Also, Ransomware 42 CFR Part 2 HITECH Act

Join #Samantha_Fowler in her latest and most talked-about webinar on creating a paperless office.

An E-office is a must in the healthcare industry, more so when it elevates patient care. Join the live session on May 08, 2019

Webinar alert!