Health Insurance Portability and Accountability Act

/in /by

Health Insurance Portability and Accountability Act

A

CASE STUDY

Kerry Kaiser, RHIA, is Getwell Hospital’s HIPAA privacy officer and the chair of its HIPAA Compliance Committee. The committee is concerned with all aspects of HIPAA compliance, including transactions, privacy, and security.

  1. What items might the committee’s agenda include in each of these three areas?
  2. Where might Kerry find resources to assist the committee in carrying out its duties?

Your submission must meet the following: minimum threshold of 300 words

B

  1. How can the health information manager contribute to improved data quality in a variety of settings?
  2. What are some common concerns with regard to health information management in health information exchange, telemedicine, and the longitudinal patient record?
  3. Select a health care setting other than a hospital. What would you expect the similarities to be between the role of the health information manager in a hospital and in one of the other health care settings? What would you expect the differences to be?
  4. If The Joint Commission requires that “the hospital initiates and maintains a medical record for every individual assessed or treated,” what factors allow a hospital to maintain minimal data, such as test results in the case of some referred outpatients?
  5. Select two of the three hospital accrediting organizations mentioned in this chapter, and write a brief essay comparing and contrasting the two organizations that you selected. Use outside resources, if necessary, but remember to think critically and avoid relying heavily on marketing or promotional information.

management team of Efficient Network HMO

C

CASE STUDY

The senior management team of Efficient Network HMO is evaluating the year-end data related to emergency room (ER) expenses. One physician group within the network had ER expenses that were three times. The rate of any other group within the network. Senior management has studied group operations and theorizes that three factors are influencing the high rate of expense. The group does not utilize triage nurses, does not have after-hours urgent care services, and has limited office hours from 8:30 to 11:30 a.m. and 1:30 to 5:00 p.m. An answering service, not staffed by nurses, relays calls during the remainder of the hours.

The physician group is willing to work on the problem but is asking for detailed, comparative information from the HMO’s senior management team before it implements any changes. How would you, as the clinical data specialist for the HMO, answer the following questions?

  1. What information would be useful to the senior management of the HMO and the physician practice in evaluating the ER expenses?
  2. What data sources would you use to obtain data?
  3. How could the reports be structured to provide meaningful information?