How Hipaa Violations Affect the Medical Billing Process Essay

Running head: HOW HIPAA VIOLATIONS AFFECT THE MEDICAL BILLING How HIPAA Violations Affect the Medical Billing Process Brenda Beaver Axia Of UOP How HIPAA Violations Affect the Medical Billing Process HIPAA confidentiality is important for very patient but for some reasons when they hear someone has HIV or AIDS it gives them the right to talk about it with others which have no reason to know. I will show why it is so important to be sensitive to this type of health conditions. Will examine the social, legal, and ethical ramifications of improper information disclosure.

HIPAA affects the billing process by making sure that patient demographics are accurate and kept confidential. There should be in the patient’s file an authorization to allow a practice to use the confidential information and to bill that patient information to carrier for services. Without this authorization on file the practice may not release or disclose any patient information regarding any treatment that this patient has had and therefore will not be able to seek reimbursement from the payer (Valerius, Bayes, Newby, & Seggern, 2008).

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A patients’ medical records, the progress notes, reports and other clinical materials are legal documents that belong to the provider who created them. But the provider cannot withhold the information in the records unless providing it would be detrimental to the patients’ health. This information belongs to the patient. Medical insurance specialist handles issues such as requests for information from patient records. They are trained to know what information can be released about patients’ conditions and treatments.

What information can be legally shared with other providers and health plans and what information must the patient specifically authorize to be released (Valerius, Bayes, Newby, & Seggern, 2008). Because the claims are sent electronically, encryption is required for security, the process of encoding information in such a way that only the person with the key can decode it. The Medical specialist will have passwords to access the claims, were receptionist will only have access to appointments; they have no need to know what is wrong with a patient.

When an employee is hired at a physicians office they are given, a set of rules concerning the HIPAA rules that he or she have to adhere to and they sign that he or she understand their responsibility to patient’s privacy should they abuse these rules they would be terminated and depending on the severity they could have charges filed against them. Ethical ramifications of improper information disclosure, of course, ethics is a standard of behavior, moral values serve as the basis for ethical conduct. Medical Laws; a law is a rule of conduct or action.

Criminal and civil laws pertain to health care practitioners. If a patient feels they have been negligent by the physician or health care workers they have to show that the physician failed to comply with the standards of the profession. If a health care worker failed to leave a call button were a patient could not reach it and the patient got out of bed and fell injuring himself or herself and denied that this is what happened. If in this case the health care worker wrote in the chart that the call button was in reach of the patient when it wasn’t there could be a legal ramification.

There is a standard of care that the health care employees must follow to maintain and dispose of regulated substances in compliances with government guidelines, follow established risk-management and safety procedures so their patients are treated fairly (Ramutkowski, Booth, Pugh, Thompson, &, 2008). When we go to the doctors office for the first time we, normally will be given a form telling us about the Privacy Rule and we sign that form, it will stay in our file.

The law does not require us to sign the form but signing it does mean that you have agreed to any special uses or disclosures of our health records. He or she can refuse to sign it and then the provider must keep a record that they failed to obtain your acknowledgement (hhs. gov, 2006). Confidentiality Issues: all patient information must be kept confidential and shared only with the appropriate staff involved in the care of the patient. Patient records must be kept out of sight so that for example the cleaning crew cannot look at it and other patients cannot view it.

Discussing the case with anyone outside the medical office. HIPAA is for the protection, use, and disclosure of protected health information (Ramutkowski, Booth, Pugh, Thompson, &, 2008). People that have AIDS or HIV are more sensitive to sharing their health information than others because it could cost them their job. The people that contract these diseases are subject to scrutiny from the public. Since people automatically think that they are gay or lesbian but they are not the only ones that can get HIV or AIDS.

When a person is revealed to have HIV or AIDS, he or she may be immediately discriminated against. HIV and AIDS require lifetime treatment that is very expensive to treat (HHS. gov, 2006). Unauthorized disclosure of a person’s positive HIV or AIDS status can lead to job loss; cancellation of insurance; evictions; and loss of friends and colleagues. The United States has developed a set of standards to keep a person’s HIV or AIDS status confidential as well as their other medical conditions. This is called the Health Insurance Portability and Accountability Act of 1996.

All information is kept private from anyone except that person a patient authorizes a doctor to disclose information to (HHS. gov, 2006). When appropriate information is disclosed there are social, legal and ethical ramifications to either the victim or the party responsible, and sometimes both. There are many social ramifications when dealing with AIDS or any other illnesses that can come about if the improper information is released. People feel sorry for you or do not want to be near you because they are afraid of being infected.

A cousin has HIV and his brothers and sisters would not allow him to hold or kiss their babies at first, before they really understood they could not be affected. They have struggled but have learned to allow him back into their families lives again. Input from social research field is urgently needed for planning and evaluation of AIDS prevention programs. Social, behavioral and legal research will improve understanding of the dynamics of the pandemic and its impact. It will also help in resolving some of the complex social and ethical issues.

The Privacy Rule gives us, the right to inspect, review and receive a copy of your medical records and billing records that are held by health plans and health care providers covered by the Privacy Rule (hhs. gov, 2006). Anyone should be able to get copies of your records because they have not paid for the services they have received. There may be a fee for the physician’s office making copies. HIPAA rule is there for the protection of patients, to keep the nurses, aids, physicians and even the support departments like, Housekeeping, Food and Nutritionist from talking about what they see and hear while doing their own jobs.

Employees hear so much daily that it is normal to want to talk about it but if they are caught talking they will be terminated after an investigation into the claim that someone has looked at a file illegal or discussed a case with another person who has no business knowing anything about it. An example that I know of is a nurse was real busy and did not have time to complete her charts so she took them home, of course they were noticed that they were missing and she was called and when all said and done she was terminated for taking private information out of the hospital.

Example (2) A co-worker took her son into the hospital because he was 14 years old and had decided to drink alcohol had he had a bad reaction to the alcohol and some other personal issues were going on with the family, months after this happen she was working with another department and was on the phone with them, while she was looking up something she heard the nurse she was talking to tell another nurse, you know her remember her son was brought it in her drinking to much alcohol.

This nurse knew immediately she was wrong but and tried to make amends but the person she was talking about went too personal and she was terminated after an investigation. These are just two examples that actually happened were I work at, but I was told they are very strict about the privacy act at the hospital. I happened to know these two individuals so that was how I used the stories for this with their permission. When working in the health care field no matter what department it is so important to follow the HIPAA Rule, to respect the patients’ rights as you would want them to do for you if the situation was turned around.

HHS. gov, (2006). Your health information is protected. Retrieved from http://www. hhs. gov/ocr/privacy/hipaa/understanding/consumers Ramutkowski, Initials, Booth, Initials, Pugh, Initials, Thompson, Initials, &, Initials. (2008). Medical assisting. Medical Law and Ethics, 3(2), retrieved from http://www. medicaladminonline. com/moodle_docs/MOA/Wk-02/Legal_and_Ethical_handout. pdf Valerius, Initials, Bayes, Initials, Newby, Initials, & Seggern, Initials. (2008). Medical insurance (An Intergrated Claims Process Approach),


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