Welcome to ChiroCare s Fourth Annual Fall Business Summit. October 3, 2013

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1 Welcome to ChiroCare s Fourth Annual Fall Business Summit October 3, 2013

2 HIPAA Compliance Regulatory Overview & Implementation Tips for Providers

3 Agenda Green packet Overview of general HIPAA terms and concepts o Privacy o Security o Breach Notification Important changes in the Final Omnibus Rule (effective 9/23/13) Implementing the rules in a small provider office Top 10 list for implementation

4 HIPAA Privacy Rule: Concepts Covered Entity Business Associate Protected Health Information Treatment, Payment, Health Care Operations Permissive Disclosures Minimum Necessary Individual Rights (notice of privacy practices, access, amendment, accounting of disclosures,) 4

5 HIPAA Privacy Rule: PHI Refresher HIPAA protects Protected Health Information (PHI) PHI is: o Health information that identifies an individual or could be reasonably used to identify an individual; o Is created or received by a Covered Entity; and o Relates to the past, present or future health condition of an individual. This includes The provision of health care services; and Payment for the provision of services. 5

6 HIPAA Privacy Rule: PHI Refresher Examples of PHI include: o Treatment notes and other clinical documentation o Names, addresses, telephone numbers o Date (e.g., birth dates, treatment dates) o addresses o SSNs, medical record numbers, health plan ID numbers o Biometric identifies o Photographs of the individual 6

7 HIPAA Privacy Rule Uses and Disclosures Permissive disclosures without authorization include: o Treatment: The provision, coordination or management of health care by one or more health care providers o Payment: Activities of health care providers to obtain payment or be reimbursed for services; or activities of health plans to obtain premiums, fulfill coverage responsibilities, or provide reimbursement for the provision of health care o Health Care Operations: Activities necessary to run the business and to support the core functions of treatments and payment (e.g., administrative, financial, legal, quality improvement activities, credentialing/licensing, fraud and abuse detection) 7

8 Types of Disclosures HIPAA limits uses and disclosures of PHI Three general categories of uses and disclosures: o Uses and disclosures that do not require authorization o Uses and disclosures that require the opportunity to agree or object o Uses and disclosures that require authorization 8

9 Uses/Disclosures without Authorization The following disclosures may be made without patient authorization, provided that all requirements in the Privacy Rule are met prior to release: o Public health activities o Health oversight activities o Law enforcement o Organ & tissue donation o Averting serious threats to public safety o Workers compensation o Reporting abuse & neglect o Legal proceedings o Information about decedents o Research o Specialized government functions 9

10 Changes in the Final Omnibus Rule that Impact Providers Notice of Privacy Practices update to reflect uses/disclosures Business Associate (BA) Agreements update to reflect BA direct liability Individual Access electronic access, off-site record storage Breach Notification changes to breach standard Restrictions on disclosing PHI to health plans when requested for private pay services 10

11 Updates to Notice of Privacy Practices Marketing and fundraising Requesting restrictions communication and private pay services Requesting electronic records Inform patients of breach notification Limit on use of genetic information 11

12 Breach Notification Changes Breach notification applies to Unsecured PHI Risk of harm standard eliminated! New standard: presume breach of unsecured PHI unless the entity is able to demonstrate and document a low probability that the PHI has been compromised. Must use 4-factor risk assessment: o Nature and extent of PHI involved. o The unauthorized person who received the PHI. o Whether the PHI was actually acquired or viewed. o The extent to which the risk to the PHI has been mitigated. o Other factors may be added to the assessment based on facts of suspected breach. 12

13 Breach Notification Changes (cont d) Document the risk assessment! Determine if a breach has occurred. If so, make proper individual notification. Log breach for annual report to HHS. If breach affects 500+ patients, fulfill additional media and government notification requirements immediately. 13

14 Security Rule Overview Security Rule Compliance is becoming increasingly important. Threats to electronic data are increasing (laptops, smartphones, additional data stored electronically, use of vendors). Risk Assessment must be conducted to comply with the rule: o Physical safeguards o Technical safeguards o Administrative safeguards 14

15 HIPAA Enforcement Overview Individuals, not just CEs, can be subject to criminal penalties for wrongful disclosure of PHI. State attorney general (AG) can bring civil actions (no State action if Health and Human Services [HHS] has instituted an action for the same violation). Civil monetary penalties were increased: 15

16 HIPAA Audits First audits occurred have been performed (health plans, providers, and clearing houses) Scope of audits includes: o Privacy o Security o Breach Notification 16

17 HIPAA Audits Audit Findings: o 60 percent of findings were security based 58 of 59 provider entities had at least one finding No risk assessment in 2/3 of entities o 30 percent of findings were privacy-based o 10 percent of findings were breach-based o Providers had a greater proportion of total findings o Small entities struggled with all three review areas. 17

18 HIPAA Audits Causes of the findings o In 30 percent of findings the entities were unaware of the requirement o Other causes included the following: Lack of application of sufficient resources Incomplete implementation Complete disregard 18

19 HIPAA Audits Privacy administrative findings Source: DHHS OCR, Lessons Learned from OCR Privacy and Security Audits, Presentation at IAPP Global Privacy Summit (03/07/13) 19

20 HIPAA Audits Privacy uses and disclosures Source: DHHS OCR, Lessons Learned from OCR Privacy and Security Audits, Presentation at IAPP Global Privacy Summit (03/07/13) 20

21 HIPAA Audits Security elements Source: DHHS OCR, Lessons Learned from OCR Privacy and Security Audits, Presentation at IAPP Global Privacy Summit (03/07/13) 21

22 Top 10 Implementation Steps 1. Develop privacy policies. Document policies and procedures, including steps to take when a breach occurs. Consider how PHI is used in office when developing policies (sign in sheets, using names in waiting room, photographs of patients in office, etc.) 2. Appoint privacy and security officers. Could be the same or different individuals. This person should be conversant in all HIPAA regulations and policies. 22

23 Top 10 Implementation Steps 3. Conduct regular security risk assessments. Identify vulnerabilities Take steps to minimize risk 4. Adopt policies. HIPAA does not prohibit the use of for transmitting PHI, and it does not require that the be encrypted however, encryption is a safe harbor /best practice If unable to encrypt , make sure your patients are aware of the risks they are facing by asking for health information over 23

24 Top 10 Implementation Steps 5. Adopt mobile device policies. Adopt strict policies regarding storage of PHI on portable electronic devices Regulate the removal of these devices from the premises OCR Guidance Risk Assessments, Policies, Training, etc.: tive/securityrule/remoteuse.pdf 24

25 Top 10 Implementation Steps 6. Conduct training. Train all employees who use or disclose PHI (initial and annual) Document the training 7. Develop Notice of Privacy Practices. Publish and distribute to all patients Display on the organization s website Obtain acknowledgment of receipt from all patients 25

26 Top 10 Implementation Steps 8. Enter into valid business associate agreements. 9. Adopt suspected breach protocols. Document the investigation Conduct the required risk assessment to determine if a breach has occurred Notify the appropriate parties 26

27 Top 10 Implementation Steps 10. Implement policies. Don t just have policies, use them! Create a culture of compliance. Sanction employees who violate policies. 27

28 Questions? Thank you! 28

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