1. 2 HIPAA, HITECH, and Medical Records

2. Learning Outcomes When you finish this chapter, you will be able to: 2.1Discuss the importance of medical records and documentation in the medical billing process. 2.2Compare the intent of HIPAA and ARRA/HITECH laws. 2.3Describe the relationship between covered entities and business associates. 2.4Explain the purpose of the HIPAA Privacy Rule. 2.5Briefly state the purpose of the HIPAA Security Rule. 2.6Explain the purpose of the HITECH Breach Notification Rule. 2-2

3. Learning Outcomes (Continued) When you finish this chapter, you will be able to: 2.7Describe the HIPAA Electronic Health Care Transactions and Code Sets standards and the four National Identifiers. 2.8Explain the purpose of the Health Care Fraud and Abuse Control Program and related laws. 2.9Identify the organizations that enforce HIPAA. 2.10Discuss the ways in which compliance plans help medical practices avoid fraud or abuse. 2-3

4. Key Terms abuse American Recovery and Reinvestment Act (ARRA) of 2009 audit authorization breach breach notification business associate (BA) Centers for Medicare and Medicaid Services (CMS) 2-4 clearinghouse code set compliance plan covered entity (CE) de-identified health information designated record set (DRS) documentation electronic data interchange (EDI) electronic health record (EHR)

5. Key Terms (Continued) electronic medical record (EMR) encounter encryption evaluation and management (E/M) fraud Health Care Fraud and Abuse Control Program Health Insurance Portability and Accountability Act (HIPAA) of 1996 2-5 HIPAA Electronic Health Care Transactions and Code Sets (TCS) HIPAA final enforcement rule HIPAA National Identifier HIPAA Privacy Rule HIPAA Security Rule HITECH Act informed consent malpractice medical record

6. Key Terms (Continued) medical standards of care minimum necessary standard National Provider Identifier (NPI) Notice of Privacy Practices (NPP) Office for Civil Rights (OCR) Office of the Inspector General (OIG) 2-6 password protected health information (PHI) qui tam relator respondeat superior subpoena subpoena duces tecum transaction treatment, payment, and health care operations (TPO)

7. 2.1 Medical Record Documentation 2-7 A patient’s medical record contains facts, findings, and observations about that patient’s health Documentation is the recording of a patient’s health status in a medical record history Medical standards of care—state-specified performance measures for health care delivery – Medical records and documentation act as legal documents and help physicians make accurate diagnoses – Malpractice—failure to use professional skill when giving medical services that results in injury or harm

8. 2.1 Medical Record Documentation (Continued) 2-8 Encounter—an office visit between a patient and a medical professional Evaluation and management (E/M)—provider’s evaluation of a patient’s condition and decision on a course of treatment Electronic health record (EHR)—computerized lifelong health care record with data from all sources Electronic medical record (EMR)—computerized record of one physician’s encounters with a patient

9. 2.1 Medical Record Documentation (Continued) 2-9 Informed consent—process by which a patient authorizes medical treatment after a discussion with a physician

10. 2.2 Health Care Regulation: HIPAA and HITECH 2-10 The main federal government agency responsible for health care is the Centers for Medicare and Medicaid Services, also known as CMS The foundation legislation for the privacy of patients’ health information is called the Health Insurance Portability and Accountability Act (HIPAA) of 1996 – Protects private health information, ensures coverage, uncovers fraud and abuse, and creates industry standards

11. 2.2 Health Care Regulation: HIPAA and HITECH (Continued) 2-11 American Recovery and Reinvestment Act (ARRA) of 2009—law with provisions concerning the standards for the electronic transmission of health care data – Contains the HITECH Act—law promoting the adoption and use of health information technology