HIPAA for Health Care Professionals
Author: Carole Krager
HIPAA for Healthcare Professionals clearly explains HIPAA concepts and brings meaning to the concepts through examples, real-life scenarios, thought-provoking questions, and discussion. Perfect for any allied health professional, coverage includes key information on the HIPAA ruling including fundamentals, privacy issues, explanation of the security ruling, and dispels HIPAA myths.
Table of Contents:
Preface iiiAbout the Authors v
Acknowledgements vi
Introduction to HIPAA 1
Introduction 2
How the Rules Came into Existence 3
Titles of HIPAA Law 5
Health Insurance Access, Portability, and Renewal 5
Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform 5
Group Health Plan Requirements 7
Other Titles in HIPAA 7
HIPAA: An Organizational and Business Challenge 8
Who Is a "Covered Entity?" 10
The HIPAA Officer 11
Summary 12
Review Questions 24
References 25
Privacy Issues Explained 26
Introduction 27
To Whom Does Title II Apply? 27
What Is Protected Health Information? 28
Authorization versus Consent 30
Concerns about Protected Health Information and Possible Disclosures 32
Required Disclosures 32
Permitted Use and Disclosure without Authorization 33
For Individual Access 33
For Treatment, Payment, and Health Care Operations 34
When Permission to Disclose is Received 35
When Incidental 36
For Public Interest or to Benefit the Public 36
For Research 38
Permitted Use and Disclosure with Authorization 38
Disclosure of Psychotherapy Notes 38
Disclosure for Marketing Purposes 39
Disclosure for Directory Purposes 40
Limiting Uses and Disclosures 40
Minimum Necessary Uses 41
Business Associates under the Privacy Rule 42
Training of the Public and Workforce 43
Amending Protected Health Information 44
Enforcement Guidelines 45
Civil Penalties under HIPAA 46
Criminal Penalties under HIPAA 47
What the HIPAA Privacy Rule Covers 49
Summary 50
Review Questions 51
References 52
Transactions and Code Sets 54
Introduction 55
Purpose of Transaction Standards 56
Designated Code Sets 59
Diagnosis Codes 60
Inpatient Procedure Codes 61
Outpatient Procedure Codes 61
Dental Procedures 62
Drug Codes 62
Nonmedical Code Sets 63
ASC X12 Nomenclature 64
Data Overview 64
Architecture 65
Use of Loops 68
Sample of EDI Claim Data (UB-04, Hospital Billing Form) 69
Limitations of Electronic Claims 74
Remittance Advice and Secondary Payer 74
Working with Outside Entities 75
Trading Partner Agreements 76
Business Use and Definition 76
Enforcement of Transactions and Code Sets 77
Summary 78
Review Questions 79
References 80
Security Rule Explained 82
Introduction 83
Core Requirements 84
Administrative Safeguards 85
Security Management 86
Assigned Security Responsibility-Security Officer 88
Workforce Security 88
Information Access 89
Security Awareness and Training 90
Security Incidents 90
Contingency Plans 91
Evaluation of Security Effectiveness 92
Business Associate Contracts 92
Physical Safeguards 92
Facility Access Controls 93
Workstation Use 94
Workstation Security 94
Device and Media Controls 95
Technical Safeguards 96
Access Control 96
Audit Controls 98
Integrity 98
Person or Entity Authorization 99
Transmission Security 99
Organization Requirements 100
Policies, Procedures, and Documentation 101
Impact on Organizations 101
Challenges to Compliance and Enforcement 102
Summary 104
Review Questions 106
References 107
Unique Health Identifiers and HIPAA Myths 109
Introduction 110
Reasons for Identification Numbers 111
Employer Identifier 111
Health Care Provider Identifier 113
Health Plan Identifier 115
Personal Identifier 115
What Is Important to Know about HIPAA? 118
Locating the Latest Title II Rules and Changes 119
Legal Ramifications of HIPAA 120
Myths about HIPAA 123
Summary 128
Review Questions 129
References 130
HIPAA for Health Care Professionals 131
Covered Entity Charts 132
CMS Regional Offices and Government Resources 135
HIPAA Non-Privacy Complaint Form 147
Security Standards Matrix 150
Resources for HIPAA Information 153
Introduction to HIPAA-Chapter 1 153
Privacy Rule Resources-Chapter 2 153
Transactions and Code Sets Resources-Chapter 3 153
Names and Web Sites of Designated Standards Maintenance Organizations (DSMOs)-Chapter 3 154
Security Rule Resources-Chapter 4 154
Identifier Rule Resources-Chapter 5 155
Glossary 157
Index 166
New interesting textbook: A Preface to Economic Democracy or Knock on Wood
How to Make Collaboration Work: Powerful Ways to Build Consensus, Solve Problems, and Make Decisions
Author: David Straus
Collaboration is an everyday practice that many people find to be a frustrating, even exhausting, experience. How to Make Collaboration Work provides a remedy: five principles of collaboration that have been tested and refined in organizations throughout the world. Author David Straus shows that these methods can help any group make better decisions and function more effectively. The five principles are: Involve the Relevant Stakeholders, Build Consensus Phase by Phase, Design a Process Map, Designate a Process Facilitator, and Harness the Power of Group Memory. Each principle addresses the specific challenges people face when trying to work collaboratively, and each can be applied to any problem-solving scenario.
Soundview Executive Book Summaries
David Straus, an innovator of group problem solving, has developed five proven principles of collaboration for almost every situation. Throughout How to Make Collaboration Work, he demonstrates how these principles have worked for big businesses, such as Ford Motor Co. and Kaiser Permanente, as well as public schools and governments. Straus helps to turns collaboration into a positive experience that benefits everyone involved. Copyright (c) 2003 Soundview Executive Book Summaries
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