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Administrative Simplification Rules:
The Three Basic Rules that You Need to Know about Electronic
Filing Systems
An Information Systems Graduate Level Presentation conducted by Aaron Varrone
This Presentation utilizes the presence of speakers!
Before proceeding, please turn your speakers on, or you will not receive the 100% full core knowledge of this presentation!
Abstract Introduction to HIPAA Background Information Goals & Objectives The “Privacy Rule” Why Privacy? The “Security Rule”
The “Privacy Rule” vs The “Security Rule”
The Transaction and Code Sets Rule” (TCS)
Closing Remarks/Recap Questions
HIPAA Title II was establish to… Take Advantage of 21st century technology Increase Efficiency Eliminate Redundancy & Manual ProcessesThis Presentation is to examine… An in-depth look at HIPAA Title II How Technology has enhanced Healthcare Goals & Objectives of HIPAA and Title II The 3 Basic Rules of Title II
HIPAA= Health Insurance Portability and Accountability Act
Enacted for following reasons… Keeping health insurance while
changing/losing jobs Reduce health care fraud & abuse To Mandate an industry-wide standard for
health care information Keeping health information protected
This presentation focuses on Title II, Administrative Simplification: Establishes national standards for electronic health
care transactions & national identifiers for providers, health plans, & employers
Intended to improve the effectiveness & efficiency of various health programs of the healthcare industry
Simplifying Administration + Adopting HIPAA Standards= Improved Effectiveness of Nation’s health care system
Standardizing is good, but will increase the potential for abuse of people’s medical information: Measures to take…
Standardizing the confidentiality & security of people’s health information, aka (ePHI)
Incorporating HIPAA Compliance & Privacy Regulations
Encouraging the use of electronic media to conduct health care transactions
Standardize & improve the oversight of health information
Simplify the “administration” piece Ensure the continuity of health care coverage
of people who: change jobs, combat waste, fraud, & abuse
Require new safeguards to protect Security & Privacy of health information
A national standard to protect individuals medical records & other health information
Requires the appropriate safeguards to protect the privacy of one’s personal health information
Gives patients right over their own health information, including rights to evaluate and obtain a copy of their record
People have the right to have their own personal information protected
Privacy is necessary to secure effective, high quality healthcare
Examples of recent health-related privacy breaches with the use of technology: A Michigan-based health system
inadvertently posted medical records of thousands of patients on the Internet.
Consists of standards & implementation requirements for healthcare organizations
General Requirements of this rule:1. Ensure confidentiality, integrity, and availability of
all electronic protected health information (ePHI)2. Protect against threats or hazards to security or
integrity of such information3. Protect against uses or disclosure of such
information without proper authorization4. Ensure compliance by the workforce
Privacy & Security jointly rely heavily on the other Security Rule defines the administrative,
physical, & technical safeguards needed to protect the confidentiality, integrity, and availability of ePHI
Privacy Rule sets standards for how ePHI & non ePHI should be controlled
Regulates to a uniformed standard that healthcare organizations must adhere to
Created to establish efficiency & better manage the flow of information
Transaction are defined as… Electronic exchanges involving the transfer of
information between two parties for specific purposes
Examples: claims & encounter info, payment & remittance advice, claims status, eligibility, enrollment, disenrollment, referrals and authorizations, and premium payments
Title II was established because… Of the lack of standardization Inefficiency in processing financial and
administrative transactions Take advantage of available technology (21st
century) Simplify administration pieces
Title II is effective because… Privacy & Security Concerns are addressed:
-Requiring new safeguards and rules; help reduce waste, fraud, and abuse in the health insurance & healthcare industry.
