HIPAA and Medical Records Review

Flashcards covering the definitions, purposes, compliance standards, and key abbreviations related to the Health Insurance Portability and Accountability Act (HIPAA).

HIPAA

Health Insurance Portability and Accountability Act of 1996

HIPAA Privacy Rule

Federal protection for patients’ health information and standards for individuals' rights to understand and control how their health information is used.

Major Goal of HIPAA Privacy Rule

To ensure individuals’ health info is properly protected while allowing the flow of info needed to provide high quality health care and protect public health.

PHI

Protected Health information

Examples of PHI Identifiers

Name, Address, Relatives’ and employers names, Birth date, Telephone/Fax numbers, Email, SSN, Medical record number, Health Plan beneficiary number, Account number, License number, Serial numbers, Website Address, Fingerprints/voiceprints, and Photographic images.

Exceptions to Disclosure Standards

Court Orders, Workers’ compensation cases, Statutory reports, Research, Correctional institutions, and National Security or intelligence purposes.

Purposes of HIPAA

Protect and enhance patients rights; Increase healthcare efficiency and effectiveness; Restore trust in the healthcare system.

Required Patient Medical Record Documentation

Patient’s name, DOB, encounter date/reason, appropriate history, Review of System, physical examination, test/drug orders, diagnosis, plan of care, prognosis, instructions, and professional signature.

Review of System

A summary of all signs and symptoms documented in a patient's medical record.

Covered Entities (CE)

Healthcare Providers (hospitals, pharmacies, physician practices, etc.), Healthcare plans, and Healthcare Cleaninghouses.

Patient HIPAA Rights

Right to copy/access/inspect PHI, timely access for a reasonable fee, request amendments, obtain accounting of disclosures, receive communications, complain about violations, and request restrictions.

HIPAA Governing Agencies

HHS, the Office for civil rights (OCR), and CMS.

Types of HIPAA Penalties

Civil and Criminal penalties.

CMS

Centers for Medicare and Medicaid services

OCR

Office for civil rights

ROI

Release of information

TPO

Treatment Payment and operation

HHS

Health and Human Services

CE

Covered Entity

EMR

Electronic Medical Record