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HIPAA Basics Health Insurance Portability and Accountability Act of 1996

HIPAA Basics - DWC training · 2015. 3. 4. · violaon of HIPAA could mean the loss of your job, the loss of whatever professional licenses you may have, the payment of a large fine,

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Page 1: HIPAA Basics - DWC training · 2015. 3. 4. · violaon of HIPAA could mean the loss of your job, the loss of whatever professional licenses you may have, the payment of a large fine,

HIPAABasics

HealthInsurancePortabilityandAccountabilityActof1996

Page 2: HIPAA Basics - DWC training · 2015. 3. 4. · violaon of HIPAA could mean the loss of your job, the loss of whatever professional licenses you may have, the payment of a large fine,

WhatIsHIPAA?HIPAA:•  Protectstheprivacyofhealthcareinforma@onforallAmericans,includingtheindividualsyousupport

•  ProtectstheprivacyofProtectedHealthInforma@on(PHI)

•  SetsrulesandlimitsonwhocanlookatandreceivePHI

•  Providesthefreedomofconfiden@almovementofinforma@onbetweenhealthcarebenefitplans

Page 3: HIPAA Basics - DWC training · 2015. 3. 4. · violaon of HIPAA could mean the loss of your job, the loss of whatever professional licenses you may have, the payment of a large fine,

Whatareaperson’srightsunderHIPAA?

•  Access:Therighttoreviewandobtainacopyoftheirprotectedhealthinforma@on

•  Amendment:Therighttoamendorhavecorrec@onsmadetotheirprotectedhealthinforma@on

•  DisclosureAccoun@ng:Therighttoknowhowtheirprotectedhealthinforma@onhasbeenshared

Page 4: HIPAA Basics - DWC training · 2015. 3. 4. · violaon of HIPAA could mean the loss of your job, the loss of whatever professional licenses you may have, the payment of a large fine,

Whatareaperson’srightsunderHIPAA?

•  Restric@onRequest:Therighttorequestthatthesharingofcertainprotectedhealthinforma@onberestrictedundercertaincircumstances

•  Alterna@veCommunica@ons:Therighttorequestanalterna@veloca@on,sayapostofficeboxinsteadofatradi@onalhomeaddress,oralterna@vemeans,forinstanceviae‐mailinsteadofbytelephone,forreceivingcommunica@onsoftheirPHI

Page 5: HIPAA Basics - DWC training · 2015. 3. 4. · violaon of HIPAA could mean the loss of your job, the loss of whatever professional licenses you may have, the payment of a large fine,

WhodoesHIPAAapplyto?

•  HealthCareProviders:Mostdoctors,nurses,pharmacies,hospitals,clinics,nursinghomes,healthcareandotherproviders

•  HealthPlans:Healthinsurancecompanies,HMOsandemployerhealthplans

•  BusinessAssociates:PersonsorcompaniesthatperformservicesforHealthCareProvidersorHealthPlansthatinvolvetheuseorsharingofhealthinforma@on

•  EmployeesofHealthCareProvidersorHealthPlans

Page 6: HIPAA Basics - DWC training · 2015. 3. 4. · violaon of HIPAA could mean the loss of your job, the loss of whatever professional licenses you may have, the payment of a large fine,

WhodoesHIPAAapplyto?

Basically,HIPAAappliestoanyonewhoprovidescare,hearsconversa@ons,andhasaccesstoaperson’shealthinforma@onand/orbillsforhealthcareservices.

Page 7: HIPAA Basics - DWC training · 2015. 3. 4. · violaon of HIPAA could mean the loss of your job, the loss of whatever professional licenses you may have, the payment of a large fine,

Whatinforma@ondoesHIPAAprotect?

ProtectedHealthInforma@on(PHI)isdefinedasindividuallyiden@fiablehealthinforma@onthatistransmiWedormaintainedinanyformofmedium(electronically,oral,orwriWen),asitrelatesto:•  Thepast,present,orfuturephysicalormentalhealthcondi@onofa

person

•  Theprovisionofhealthcaretoaperson•  Thepast,present,orfuturepaymentfortheprovisionofhealthcare

toaperson

Page 8: HIPAA Basics - DWC training · 2015. 3. 4. · violaon of HIPAA could mean the loss of your job, the loss of whatever professional licenses you may have, the payment of a large fine,

Whatinforma@ondoesHIPAAprotect?

Informa@onbecomes“individuallyiden@fiable”ifitdefinesthepersonorthereisareasonablebasistobelievetheinforma@oncanbeusedtoiden@fytheperson.

Page 9: HIPAA Basics - DWC training · 2015. 3. 4. · violaon of HIPAA could mean the loss of your job, the loss of whatever professional licenses you may have, the payment of a large fine,

Whatinforma@ondoesHIPAAprotect?

•  PersonalIden@fyingInforma@on(Name,Address,SS#,etc.)

•  HealthStatus(Diagnosis,MedicalRecords)

•  ProvisionofCare(Servicesreceived)•  PaymentofServices(Howpaymentwillbemade)

•  Billinginforma@on

Page 10: HIPAA Basics - DWC training · 2015. 3. 4. · violaon of HIPAA could mean the loss of your job, the loss of whatever professional licenses you may have, the payment of a large fine,

Whatinforma@ondoesHIPAAprotect?

Anyoneofushasthepoten@altoviolateanindividual’sprivacyandconfiden@ality.ThisiswhyitisimportantforyoutoknowandunderstandhowHIPAAcomplianceprotectstheprivacyandconfiden@alityofthoseyousupport.

Page 11: HIPAA Basics - DWC training · 2015. 3. 4. · violaon of HIPAA could mean the loss of your job, the loss of whatever professional licenses you may have, the payment of a large fine,

Whatinforma@ondoesHIPAAprotect?

HIPAAisallabouttheuseanddisclosureofinforma@on,including:•  Whousesit?•  Whoitisreleasedto?•  Howmuchinforma@onisreleased?

•  Whyinforma@onisreleased?

Page 12: HIPAA Basics - DWC training · 2015. 3. 4. · violaon of HIPAA could mean the loss of your job, the loss of whatever professional licenses you may have, the payment of a large fine,

Whatinforma@ondoesHIPAAprotect?

Individualsyousupporthavetherighttoprivacywhenitcomestothedisclosureoftheirpersonalhealthinforma@on.

Theyhavetherighttocontroltheirpersonalinforma@onandtonothaveitdivulgedorusedbyothersagainsttheirwishes.

Youmustmaintainconfiden@alitybymakingaconsciousefforttokeepprivateANYinforma@onprovidedbyanyoneonbehalfoftheindividualsyousupportintheprocessofreceivingservices.

Page 13: HIPAA Basics - DWC training · 2015. 3. 4. · violaon of HIPAA could mean the loss of your job, the loss of whatever professional licenses you may have, the payment of a large fine,

Whatinforma@ondoesHIPAAprotect?

AsDirectCareprofessionals,youareresponsibletomonitoryourownbehaviorandthebehaviorofothers.Youarelegallyresponsibleforprotec@ngthehealthinforma@onoftheindividualsyousupport.

Page 14: HIPAA Basics - DWC training · 2015. 3. 4. · violaon of HIPAA could mean the loss of your job, the loss of whatever professional licenses you may have, the payment of a large fine,

WhencanPHIbeshared?

ProtectedHealthInforma@onmaybesharedfor:•  Treatment(residen@alservices,dayprograms)

•  Payment(billingforservices)

•  HealthCareOpera@ons(qualityassurance,programoversight)

Onlytheminimumamountofinforma@onnecessarytoaccomplishtheintendedpurposeshouldbeprovided.

Page 15: HIPAA Basics - DWC training · 2015. 3. 4. · violaon of HIPAA could mean the loss of your job, the loss of whatever professional licenses you may have, the payment of a large fine,

WhencanPHIbeshared?

AccessingPHIwithnolegi@mateneedorwithoutspecificpurposetodelivercareisaviola@onofanIndividual’sconfiden@ality.

AsDirectSupportProfessionals,youmustbecarefultonotbecomecasualwithPHIrememberingalwaysyourresponsibilitytokeepprivateinforma@onprivate.

Page 16: HIPAA Basics - DWC training · 2015. 3. 4. · violaon of HIPAA could mean the loss of your job, the loss of whatever professional licenses you may have, the payment of a large fine,

ThereareanumberofotherpossiblecircumstanceswhenPHImaybedisclosedfor“publicneed”[email protected],butarenotlimitedto:•  GovernmentAudits•  PublicHealthandSafety•  AsubpoenafromtheCourts

WhencanPHIbeshared?

Page 17: HIPAA Basics - DWC training · 2015. 3. 4. · violaon of HIPAA could mean the loss of your job, the loss of whatever professional licenses you may have, the payment of a large fine,

Whenisanauthoriza@ontosharePHIneeded?

Anauthoriza@on/consentmustbeobtainedinwri@ngforanyuseorsharingofprotectedhealthinforma@onthatisnotfortreatment,payment,healthcareopera@ons,orotherwiseallowed.

Allauthoriza@onsmustbewriWeninplainlanguage.

Page 18: HIPAA Basics - DWC training · 2015. 3. 4. · violaon of HIPAA could mean the loss of your job, the loss of whatever professional licenses you may have, the payment of a large fine,

Whenisanauthoriza@ontosharePHIneeded?

Theauthoriza@onmust:

•  Describetheprotectedhealthinforma@ontobeshared

•  Iden@fytheperson(s)whomayshareandreceivethePHI,aswellasthepurposeofthesharing

Page 19: HIPAA Basics - DWC training · 2015. 3. 4. · violaon of HIPAA could mean the loss of your job, the loss of whatever professional licenses you may have, the payment of a large fine,

Otherrequirementsinclude:

•  Anexpira@ondate•  Statementsrela@ngtocancellingandre‐sharingofinforma@on

•  Givingtheindividualacopyoftheauthoriza@ononceithasbeensignedanddated

Whenisanauthoriza@ontosharePHIneeded?

Page 20: HIPAA Basics - DWC training · 2015. 3. 4. · violaon of HIPAA could mean the loss of your job, the loss of whatever professional licenses you may have, the payment of a large fine,

Whatstepsmustbetakentoprotectaperson’sPHI?

•  HIPAArequiresthataperson’sprotectedhealthinforma@onremainssecure.

•  Itisyourresponsibilitytobeawareandtofollowthepoliciesandproceduressetforthbyyouremployerwithrespecttotheconfiden@ality,integrity,andavailabilityofprotectedhealthinforma@on.

Page 21: HIPAA Basics - DWC training · 2015. 3. 4. · violaon of HIPAA could mean the loss of your job, the loss of whatever professional licenses you may have, the payment of a large fine,

Whatstepsmustbetakentoprotectaperson’sPHI?

•  Confiden'alitymeansthatprotectedhealthinforma@onisonlyusedbyauthorizedpeople.

•  IntegritymeansthatPHIisnotalteredordestroyed.

•  AvailabilitymeansthatPHIcanbeusedasneededbyanauthorizedperson.

•  Itisalsoimportantforyoutoprotectagainstthreats,hazards,ormisuseofPHI.

Page 22: HIPAA Basics - DWC training · 2015. 3. 4. · violaon of HIPAA could mean the loss of your job, the loss of whatever professional licenses you may have, the payment of a large fine,

Whatstepsmustbetakentoprotectaperson’sPHI?

•  Don’tdiscussinforma@onaboutindividualsyousupportinapublicplacewhereotherscanoverhear

•  Makesurefilesarenotle`whereunauthorizedpeoplecanseethemandthattheyareinasecureloca@onwhennotinuse

•  WhensendingaFAX,makesureanauthorizedpersonisontheotherendtoreceiveit

Page 23: HIPAA Basics - DWC training · 2015. 3. 4. · violaon of HIPAA could mean the loss of your job, the loss of whatever professional licenses you may have, the payment of a large fine,

Whatstepsmustbetakentoprotectaperson’sPHI?

•  Computers:– Allcomputersshouldbepasswordprotected

– Yourcomputerscreenshouldfaceawayfrompublicarea/viewing

– Whensteppingawayfromacomputerinuse,youcanprotectinforma@onbyclosingallapplica@onsandusingascreensaver

– DonotsendPHIviae‐mailunlessitisencrypted

Page 24: HIPAA Basics - DWC training · 2015. 3. 4. · violaon of HIPAA could mean the loss of your job, the loss of whatever professional licenses you may have, the payment of a large fine,

•  Verifytheiden@tyofanypersonreques@nganIndividual’spersonalhealthinforma@ontoensuretheycanreceivetheinforma@on

•  Donotgiveoutinforma@onoverthetelephoneunlessyouhaveauthoriza@ontodoso

•  DonottakeanIndividual’spersonalhealthinforma@onoutofthehomeorworkprogramunlessauthorizedtodoso

Whatstepsmustbetakentoprotectaperson’sPHI?

Page 25: HIPAA Basics - DWC training · 2015. 3. 4. · violaon of HIPAA could mean the loss of your job, the loss of whatever professional licenses you may have, the payment of a large fine,

•  Keepconfiden@alinforma@onconfiden@al•  Whenindoubt,donotgiveanyinforma@onout

•  Youshouldreviewyouremployer’spoliciesandprac@ceswithrespecttokeepingPHIsecureandconfiden@al

Whatstepsmustbetakentoprotectaperson’sPHI?

Page 26: HIPAA Basics - DWC training · 2015. 3. 4. · violaon of HIPAA could mean the loss of your job, the loss of whatever professional licenses you may have, the payment of a large fine,

HowtodisposeofdocumentscontainingPHI?

AnythingcontainingPHIhastobedisposedofinawaythatmakestheinforma@onunreadable,suchasshredding.

Page 27: HIPAA Basics - DWC training · 2015. 3. 4. · violaon of HIPAA could mean the loss of your job, the loss of whatever professional licenses you may have, the payment of a large fine,

Howtoreportaviola@on?

IfyoususpectorareawareofaHIPAAviola@onregardingprotectedhealthinforma@on,youmustact.

FollowthespecificwriWenpoliciesandproceduressetforthbyyouremployerwhichmayincludeimmediatelycontac@ngyoursupervisororyouragency’sPrivacyOfficer,orfillingoutawriWenreport.

Page 28: HIPAA Basics - DWC training · 2015. 3. 4. · violaon of HIPAA could mean the loss of your job, the loss of whatever professional licenses you may have, the payment of a large fine,

Howtoreportaviola@on?

Inaddi@on,ifyouareabletotakereasonablecorrec@veac@ontolessentheHIPAAviola@on,youshoulddosoimmediately.

Page 29: HIPAA Basics - DWC training · 2015. 3. 4. · violaon of HIPAA could mean the loss of your job, the loss of whatever professional licenses you may have, the payment of a large fine,

WhatcanhappenifyouviolatetheHIPAAlaworyourcompany’s

privacyprac@ces?•  Apersonwhopurposelyusesorsharesindividually

iden@fiablehealthinforma@oninviola@onofHIPAAfacesafineof$50,000anduptooneyearinjail

•  Thecriminalpenal@esincreaseto$100,000anduptofiveyearsinjailiftheviola@oninvolvesfalsepretensesorlying

•  Iftheviola@oninvolvesthesaleoruseofindividuallyiden@fiablehealthinforma@onforpersonalgainormaliciousharm,thecriminalpenal@esincreaseto$250,000anduptotenyearsimprisonment

Page 30: HIPAA Basics - DWC training · 2015. 3. 4. · violaon of HIPAA could mean the loss of your job, the loss of whatever professional licenses you may have, the payment of a large fine,

•  Aviola@onofyouremployer’sHIPAAprivacyprac@cescanleadtocompanypenal@esuptoandincludingtermina@onofyourjob

•  Youcouldpoten@allyloseanyprofessionallicense(s)thatyoumayneedtoperformyourjob

•  PleaserememberthatsimplyviewingthePHIofanyonewhoisnotunderyourcareandsharingsuchinforma@onwithothersisaviola@onofHIPAA

WhatcanhappenifyouviolatetheHIPAAlaworyourcompany’s

privacyprac@ces?

Page 31: HIPAA Basics - DWC training · 2015. 3. 4. · violaon of HIPAA could mean the loss of your job, the loss of whatever professional licenses you may have, the payment of a large fine,

•  TheboWomlineisthatjustoneviola@onofHIPAAcouldmeanthelossofyourjob,thelossofwhateverprofessionallicensesyoumayhave,thepaymentofalargefine,andajailterm

•  HIPAAisseriousbusinessandneedsyourundividedaWen@on

WhatcanhappenifyouviolatetheHIPAAlaworyourcompany’s

privacyprac@ces?

Page 32: HIPAA Basics - DWC training · 2015. 3. 4. · violaon of HIPAA could mean the loss of your job, the loss of whatever professional licenses you may have, the payment of a large fine,

Howdoyoupreventthisfromhappeningtoyou?

•  FollowEmployerpoliciesandprocedures:YouremployershouldhavepoliciesandproceduresthatcoveralmostanyHIPAAissuethatyouarelikelytoencounter

•  Strictlyobserve“MinimumNecessary”(NeedtoKnow):Onlyusespecificinforma@onthatyourequireforthatpar@cularjobfunc@on

Page 33: HIPAA Basics - DWC training · 2015. 3. 4. · violaon of HIPAA could mean the loss of your job, the loss of whatever professional licenses you may have, the payment of a large fine,

Howdoyoupreventthisfromhappeningtoyou?

•  BeCau@ous:Nevervieworuseprotectedhealthinforma@onunlessyouhaveaproperreasonfordoingso

•  UseandsharePHIonlyaspermiWedbylawandyourapplicableemploymentpoliciesandprocedures

•  Usecommonsenseandwhenindoubt,ASK


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