Preview

How Hipaa Violations Affect the Medical Billing Process

Powerful Essays
Open Document
Open Document
1705 Words
Grammar
Grammar
Plagiarism
Plagiarism
Writing
Writing
Score
Score
How Hipaa Violations Affect the Medical Billing Process
How HIPAA Violations Affect the Medical Billing Process
HCR/220
October 7, 2012

How HIPAA Violations Affect the Medical Billing Process In this paper we will discuss how HIPAA violations affect the medical billing process and why HIV and AIDS information is more sensitive than other types of health conditions. We will also examine the social, legal, and ethical ramifications of improper information disclosure. In 1996 on August 21, the Health Insurance Portability and Accountability Act (HIPAA) was enacted by the Federal Government and signed into law by President Bill Clinton (HIPAA – The Health Insurance Portability and Accountability Act, 2011). According to “Health Insurance Portability and Accountability Act” (2012), “HIPAA does the following; provides the ability to transfer and continue health insurance coverage for millions of American workers and their families when they change or lose their jobs, reduces health care fraud and abuse, mandates industry-wide standards for health care information on electric billing and other processes, and requires the protection and confidential handling of protected health information” (What is HIPAA?). The main reason HIPAA was enacted was to protect patient’s personal health information regardless of its severity. Their personal health information is just that, theirs! For that reason, among many other, it is very important to know that a patient’s personal health information is not to be shared with any unauthorized person for any reason. Kibbe (2001) states “every practice regardless of its size will have to comply with the HIPAA security, privacy, and transactions regulations” (Key Points). HIPAA has rules and regulations for a reason, and they must be followed. It is important to note that if they are not, there are serious repercussions in which we will discuss a little later on in the paper. HIPAA has a lot to do with the medical billing process because it is designed to make sure that



References: Amaguin, R. (2011). HIPPA Law Protects Against Improper Disclosure of Health Information by Health Care Providers. Retrieved from http://www.amaguinlaw.com. Center of Disease and Control (2011) HIPPA: HIV & AIDS Laws and Policy. Retrieved from http://www.hivatwork.org/law/hipaa.cfm. Health Insurance Portability and Accountability Act. (2012). Retrieved from http://www.dhcs.ca.gov/formsandpubs/laws/hipaa/Pages/1.00%20WhatisHIPAA.aspx HIPAA-The Health Insurance Portability and Accountability Act. (2011, July). National Nurse, 107(6), 20-27. Retrieved from http://ehis.ebscohost.com/eds/pdfviewer/pdfviewer?sid=bcc5cba0-d1eb-477b-ab37- 4bf70e7aebbe%40sessionmgr111&vid=2&hid=121 Kibbe, D.C. (2001). aafp.org. Retrieved from http://www.aafp.org/fpm/2001/0300/p43.html Mayo Clinic Staff. (2012). HIV/AIDS. Retrieved from http://www.mayoclinic.com/health/hiv- aids/DS00005 U.S. Dept. of Health & Human Services. (2003). Understanding HIPPA Laws and Regulations. Retrieved from http://www.hhs.gov/policies/index.html. Valerius, J., Bayes, N., Newby, C., & Seggern, J. (2008). Medical Insurance: An Integrated Claims Process Approach (3rd ed.). Boston: McGraw-Hill.

You May Also Find These Documents Helpful

  • Satisfactory Essays

    When it comes to HIPAA, ICD, CPT, and HCPCS on how they influence each of the ten steps of the medical billing process, HIPAA influences the billing process by maintaining HIPAA compliance, as far as confidentiality and the handling of the medical record. When it comes to ICD, CPT, and HCPCS they influence the billing process they are the reference source where the codes are contained that are used to find the diagnosis, procedure, and the supply codes. But the HIPAA, ICD, CPT, and HCPCS they are all some kind of way related to have something to do with the billing process, but the ten steps during the process are…

    • 366 Words
    • 2 Pages
    Satisfactory Essays
  • Satisfactory Essays

    According to the laws concerning HIPAA where it pertains to serving and protecting patients’ rights, HIPAA is put into place to protect patient rights by not allowing any medical professional to discuss a patients prognosis, symptoms or any other specifics regarding their care with another individual not directly involved with their case. Because of this, a patient’s identity and confidential information is kept that way. Violations are punishable by law.…

    • 365 Words
    • 1 Page
    Satisfactory Essays
  • Satisfactory Essays

    In the article “ Hospitals fined $4.8M for HIPAA Violation” by Erin McCann reports that several health care organizations are in HIPAA violation due to human error. A hospital and a medical center were fined because patients information were available on line. The breach was due to a physician who developed an application for the hospital and a medical center. During the process of transferring patient information to one computer at home accidently made the information available on the Internet. A patient’s family member discovered it when they notice their family members private health information was on line.…

    • 160 Words
    • 1 Page
    Satisfactory Essays
  • Better Essays

    The receptionist or other clerical worker will either call, or receive a call from a “patient” or other authorized individual. During this communication, the associate must be careful to observe HIPAA rules related to “protected health information.” when “schedule, canceling, or rescheduling” encounters. When gathering benefit “information,” the representative must be diligent to accurately enter data into the “patient’s” file. Discerning insurance cards, policies, and all applicable guidelines of each plan are applicable to the “front and back” office. Abiding by the payer’s regulations, and the coordination of benefits,” associates will input this data into the patient management program (PMP). During these procedures, insurance specialists will be cautious to correlate the correct information with the correct patient. The “front or back office” will then confirm coverage with designated plans, along with all essentials, such as if a “referral or preauthorization” is a requisite. Prior to consulting with the physician, patients will need to be alerted about their rights, in coordination with HIPAA privacy standards, as well as those of the provider. During that time, if the patient owes any monies for coinsurance, or copayments, this will be submitted to the “front office.” While checking out patients, insurance specialists will transfer the descriptions of “diagnoses and procedures” from the “physician’s report” into appropriate “codes” for ‘claim” generation. This facet is most crucial, because of the HIPAA specifications regarding the transfer of PHI “by covered entities” (Valerius et al., p.…

    • 1235 Words
    • 5 Pages
    Better Essays
  • Powerful Essays

    HIPAA allows patients’ health information to be disclosed under some circumstances, such as 1) to meet law requirements; 2) for reporting of abuse, neglect, and domestic violence; 3) for monitoring of healthcare operations; 4) to be presented as evidence in legal proceedings; 5) for assistance with police investigation; 6) for medical examinations and funerals; 7) for organ donation; 8) for research; 9) to avoid a significant threat to health or safety; 10) for workers’ compensation payments; 11) to execute government…

    • 81 Words
    • 1 Page
    Powerful Essays
  • Good Essays

    In 1996 the U.S. Congress passed the Health Insurance Portability and Accountability Act (HIPAA). The first pro about the HIPAA law is that it protects yours or a patient’s security and privacy rights. Every patient must read and sign that hit the consent form which will allow the patient’s medical records to be released. The patient will also have access and complete control over their medical records. The second pro in the HIPAA law is that it allows Health Care providers to check the patient’s eligibility prior to receiving any medical treatments. Let’s say a patient has a preexisting health condition or issue and they lose their job, the outpatient me continue to stay with the same Health Insurance. The last pro for HIPAA law would…

    • 377 Words
    • 2 Pages
    Good Essays
  • Better Essays

    The Heath Insurance portability Act (HIPPA) of 1996 is a law designed to protect a patients personal and health information from being disclosed, it allows patients great access and control to his or her information, enhances health care, and creates a national framework for health privacy protection. Everyone in the health care business should be aware of the HIPAA law to protect the privacy and confidentiality of anyone who may be cared for in the facility. The patient must also sign and acknowledge the HIPPA privacy statement that is usually received during visits and prescription pickups. HIPAA protects the patient’s medical and personal information from being released to other staff members in a social manner, the patients workplace unless under workman’s comp, and not released to anyone who is not involved in the patients visit. HIPAA is a very important rule when it comes to HIV and AIDS this disease must be handled in a more sensitive manner than other diseases and HIPAA should protect the patient’s information from entering in the wrong hands. HIV and AIDS do have a large amount of stigma, misconception, and discrimination it can cause many problems for patients diagnosed and there information has been leaked. HIV and AIDS is a very touchy subject amongst many people. This disease is one that a person will most likely not recover from as well as a disease that is deadly if not treated. The HIPAA confidentiality is important for the patients who do not want others to know they have the disease. HIV and AIDS is often a lifestyle disease which some people may look at differently than others or may look down on them. Because HIV and AIDS are usually transmitted through sexual intercourse, semen, vaginal discharge, blood, and drug use some people may think this is bad behavior on that person’s part. HIPAA protects the patient’s personal information and protects his or her medical information such as diagnosis, treatments,…

    • 1442 Words
    • 4 Pages
    Better Essays
  • Satisfactory Essays

    HIPAA Privacy Analysis

    • 170 Words
    • 1 Page

    Patient care has been vulnerable by HIPAA; healthcare providers cannot easily share patient’s information. Each patient or power of attorney must give implied permission for a healthcare provider to share any personal information. Deprived of not being able to share patient information between providers, it takes longer time to get critical information that can affect patient care. Healthcare organizations faces supplementary legal costs if they violate HIPAA privacy provisions. These costs make many organizations careful of sharing a patient information, even if the patient has given permission for information sharing, so that’s why everything has to be documented, initial, and signed.…

    • 170 Words
    • 1 Page
    Satisfactory Essays
  • Good Essays

    To understand the implications of both forms of HIV and AIDS from the perspective of Health Insurance Portability and Accountability Act (HIPAA) confidentiality, we must understand what HIPAA is. Congress enacted (HIPAA), in 1996, in an effort to keep patients health information from being used inappropriately. HIPAA has been put into effect to protect patient’s privacy when it comes to their medical records. HIPAA places a restriction on how a patient’s…

    • 1732 Words
    • 7 Pages
    Good Essays
  • Good Essays

    HIPAA is the Health Insurance Portability and Accountability Act 1996, which was originally proposed to assure health insurance coverage after leaving a job. Congress felt the need to add a section to the bill in order to save money; therefore, the Administration Simplification section was included in the bill. The health care industry was in agreeance with the ideas of Congress because standard record formats, code sets, and identifiers in standardized electronic transactions were required. The official bill was passed August 21, 1996. There are two main focuses of HIPAA, which are the privacy and security of the patient’s health information and the covered entities. Being that Congress didn’t provide legislation defining the privacy and security…

    • 595 Words
    • 3 Pages
    Good Essays
  • Good Essays

    HIPAA which stands for the Health Insurance Portability and Accountability Act was passed in 1996. It was made to make sure that health or medical information data is protected. But it 's not just used by the health care industry, employers that offer health insurance must abide by HIPAA. HIPAA defines health information as any data is created or received by health care providers, health plans, public health authorities, employers, life insurers, schools and universities, and health care clearinghouses. This data relates to the health of any individuals past, present, and future health, their physical and mental health and what kind of condition they are…

    • 671 Words
    • 3 Pages
    Good Essays
  • Good Essays

    Ethics HIPAA

    • 805 Words
    • 3 Pages

    The HIPAA act is a law that was enacted by The U.S. Department of Health and Human Services issued the Privacy Rule to implement the requirement of the Health Insurance Portability and Accountability Act of 1996, to keep the welfare of people’s health insurance and health care information confidential and private. In the case of an Indiana woman versus a Walgreen Pharmacist, the Pharmacist violated the HIPAA act. The Indiana Superior Court awarded the woman $1.44 million after the courts argued that the Walgreens Pharmacist shared the woman’s prescription history. The Pharmacists husband had previously had an affair with woman and learned that the woman had also became pregnant as a result of the affair. The Pharmacist accessed the woman’s health information, specifically her prescription history and gave said information to her husband. This was after learning that the woman was asking for child support the child. The information obtained in the prescription history was used by the couple to blackmail the woman so the husband did not have to pay child support.…

    • 805 Words
    • 3 Pages
    Good Essays
  • Satisfactory Essays

    Hipaa

    • 501 Words
    • 3 Pages

    HIPAA came into place “to improve the efficiency and effectiveness of the health care system, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law 104-191, included Administrative Simplification provisions that required HHS to adopt national standards for electronic health care transactions and code sets, unique health identifiers, and security.” (U.S. Department of Health & Human Services) Then after getting all the policy and procedures into place it became effective in February of 2003. The HIPAA policies help to protect all parties in the medical field including the patients and physicians.…

    • 501 Words
    • 3 Pages
    Satisfactory Essays
  • Satisfactory Essays

    The Health Insurance Portability and Accountability Act (HIPAA) of 1996 protects the right to privacy to all individuals medical records and health data. Title I of HIPAA (1996) protects health insurance coverage for workers and families when they change or lose their jobs, and Title II establishes national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers. This set of laws helps to prevent health care fraud…

    • 667 Words
    • 3 Pages
    Satisfactory Essays
  • Satisfactory Essays

    The two major issues identified in this situation is the violation against HIPPA regulations which is a US law designed to provide privacy standards to protect patients ' medical records and other health information provided to health plans, doctors, hospitals and other health care providers. This was an act developed by the Department of Health and Human Services, in which new standards provide patients with access to their medical records and more control over how their personal health information is used and disclosed. The HIPAA Privacy Rule provides federal protections for personal health information held by covered entities and gives patients an array of rights with respect to that information. At the same time, the Privacy Rule is balanced so that it permits the disclosure of personal health information needed for patient care and other important purposes (HHS.gov 2011).…

    • 586 Words
    • 2 Pages
    Satisfactory Essays