HIPAA

what does HIPAA stand for

health insurance portability and accountability act

title 1

health care access, portability, and renewability

enables people to carry insurance from one job to another
provide tax breaks
regulate the time that insurers can delay coverage

title 2

preventing health care fraud and abuse

privacy rule

privacy rule

PHI must be protected and not disclosed unless authorized

except: used for communication between providers, submission for reimbursment, completing quality assurance activities

covered entities must:

ensure protection

conduct employee training

create mechanisms for addressing complaints

designate privacy officer

direct PHI

directly identify someone

name, SSN, DL#, insurance #, biometrics, photos

indirect PHI

require a couple to identify

DOB, address, phone, email

patient rights

notice of privacy practices

access to medical records (not free)

request an amendment of records

restrict access to records

civil penalties

unknowingly

reasonable cause

willful neglect but corrected

willful neglect not corrected

criminal penalties

knowingly obtaining/disclosing

violation under false pretenses

committed with intent to cause harm

code for diagnosis

ICD-10CM

international classification of disease, clinical modification

code for physicians services

CPT-4

current procedural terminology

label what we do with this

1 unit=__

15 min

timed codes

billed in 15 min increments

service codes

billed when performed regardless of time spent

timed codes examples

E stim
ionto
contrast bath
US/phono
laser
exs
neuro re-ed
aquatic
gait
massage
manual
theraputic activites
self-care
wheelchair
physical performace testing
orthotic
prosthetic
orthotic/prosthetic management

service code example

heat/cold
traction
infrared
ultraviolet
E stim unattended
group therapy
vasopneumatic
paraffin
whirlpool
diathermy
low/med/high complex eval
PT re-eval

therapeutic exercise code

used when developing strength, endurance, ROM, flexibility

single parameter

neuromuscular re-ed code

used for re-ed of movement, balance, coordination, kinesthetic sense, posture, proprioception

therapeutic activates code

use of dynamic activities to improve functional activities

low complexity code

no personal factors/comorbidities

address 1-2 elements

stable

moderate complexity code

1-2 personal factors/comorbidities

address 3+ elements

evolving

high complexity code

3+ personal factors/comorbidities

address 4+ elements

unstable

group therapy code

treating two or more pts at once

administrative security rule

administrative actions, policies, procedures

physical security rule

physical measures

locks, cabinets doors

technical safeguards of electronic PHI security rule

technology

any breach of data must be reported to the individual within __

60 days

if __ people or more are involved than __ must be notified in addition

500, HHS

employers are identified by___

employer identification number EIN

providers are identified by__

national provider identifier (NPI)

office for civil rights (OCR)

responsible for investigating complaints and conduction compliance reviews

department of justice (DOJ)

handles criminal investigations