2. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 3-1 LEGAL AND ETHICAL ISSUES in Medical Practice, Including HIPAA PowerPoint® presentation to accompany: Medical Assisting Third Edition Booth, Whicker, Wyman, Pugh, Thompson

3. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 3-2 3.8Discuss the impact that HIPAA regulations have in the medical office. 3.9 Explain how to protect patient confidentiality. Learning Outcomes

4. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 3-3 Introduction  Reasons to study medical law and ethics Function at the highest professional level Avoid legal problems Add clip art

5. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 3-4 Administrative Duties and the Law  Duties related to legal requirements Insurance billing Patient consent forms Documentation in the medical record Making appointments  Appointment books are a legal document State reporting requirements  Births  Abuse  Certain diseases  Injuries from violent acts  Deaths Phone calls  Maintain privacy

6. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 3-5 Documentation  Clear and complete Referrals Missed appointments Dismissals Patient contact Medical record correction  Medical records Property of facility or physician Retention and storage  Based on state law

7. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 3-6  Legal obligation to maintain confidentiality of patient information  Discuss with patient privately  Share patient information only when appropriate  Do not discuss the case with anyone outside the medical office Confidentiality Issues

8. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 3-7 HIPAA  Health Insurance Portability and Accountability Act (1996) Improve efficiency and effectiveness of health-care delivery Protect and enhance the rights of patients  Access to health-care information  Control inappropriate use or disclosure Improve the quality of health care by restoring trust in the health-care system

9. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 3-8 Title I: Health Care Portability  Increases workers’ ability to get health-care coverage when starting a new job  Reduces workers’ probability of losing existing health-care coverage  Helps workers maintain continuous health-care coverage when changing jobs  Helps workers purchase health insurance on their own if they lose coverage under an employer’s group plan and have no other health-care coverage available

10. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 3-9 Title II: Prevention of Health Care Fraud and Abuse, Administrative Simplification and Medical Liability Reform  HIPAA privacy rules Give patients more control over their health information Set boundaries on the use and release of health-care records Establish appropriate safeguards to protect the privacy of health information Hold violators accountable if they violate patients’ privacy rights Strike a balance when public responsibility supports disclosure of some forms of data

11. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 3-10 HIPAA (cont.) HIPAA allows the provider to use health-care information for: ayment perations reatment Providers are allowed to share information to provide care to patients. Providers are allowed to share information to receive payment for the treatment provided. Providers are allowed to share information to conduct normal business activities, such as quality improvement.

12. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 3-11 HIPAA (cont.)  Protected health information (PHI) Uses  Movement within an organization Disclosure  Transmitted between or among organizations Managing and storing Sharing Patient notification  Notice of privacy practices Security measures  HIPAA Security Rule Computer networks The Internet Disks, other storage media, and extranets  Chart  Reception area and clinical stations  Fax, copier, and printer

13. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 3-12 HIPAA (cont.)  Violations and penalties Civil Criminal  For knowing, wrongful misuse of health information  Administrative simplification Standardizing patient information Standardized codes

14. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 3-13 Apply Your Knowledge While you are documenting on the computer, you are called to a patient room for an emergency. What should you do before leaving the computer? ANSWER: You should close the patient record and log off the computer to protect the confidentiality of patient information.

15. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 3-14 Confidentiality Issues and Mandatory Disclosure Principles for preventing improper release of information 1. When in doubt, do not release information. 2. It is the patient’s right to keep patient information confidential or disclose it. 3. All patients should be treated with the same degree of confidentiality. 4. Be aware of all applicable laws and of the regulations.

16. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 3-15 Confidentiality Issues and Mandatory Disclosure (cont.) Principles for preventing improper release of information 5. When necessary to break confidentiality and when there is a conflict between ethics and confidentiality: Discuss it with the patient. If the law does not dictate what to do in the situation, the attending physician should make the judgment based on the urgency of the situation and any danger that might be posed to the patient or others. 6. Get written approval from the patient before releasing information.

17. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 3-16 A police officer enters the physician’s office where you work and requests information about a patient. May you release this information? What should you do? Apply Your Knowledge ANSWER: No, you should not be the person to release this information. You should refer the officer to the patient’s physician, who will make the judgment based on the urgency of the situation and any danger that might be posed to the patient or others.

18. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 3-17 Code of Ethics  Principles of right and wrong Laws are based on ethical considerations  Medical professionals are expected to act ethically Will have a positive effect  On your reputation  Employer’s practice

19. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 3-18 Let no one come to you without leaving better and happier. —Mother Theresa