When the Quality Improvement Organizations (QIO) took over the role of education and enforcement for the 2-midnight rule on October 1, 2015, many anticipated that their reviews would only look at records from that date forward. But in an unpleasant turn of events, some hospitals have reported QIO records requests zeroing in on cases as far back as May 2015.
Prevention is better than a cure. In the world of HIPAA privacy and security, training and awareness are among the most important aspects of prevention. The best laid policies and procedures won't keep your patient's PHI safe if no one knows how or why to follow them. But effective and engaging training methods can be elusive. Employees and administrators might begin to treat their annual training as routine, going through the motions to get their certificate, and then falling victim to a phishing attack that could have been avoided. New hires may be overwhelmed by the scope of HIPAA?it's a huge law?or struggle to connect it to their job duties. Developing education and awareness strategies that capture employees' attention and build privacy and security into the culture of their workplace can be a tall order.
Security officers may sometimes feel that they're asked to do too much with too little. Limitations surrounding staffing, budgets, or resources, or an administration that simply doesn't understand the importance of information security, can make a difficult task even more complicated. In some organizations, information security is a relatively new department and might lack the connections and relationships that more well-established departments rely on for support. Security needs allies. Fortunately, there's one they may already work closely with who is ideally suited: internal auditors.
Submit your HIPAA questions to Associate Editor Nicole Votta at nvotta@hcpro.com and we will work with our experts to provide you with the information you need.
Q: Our front desk receptionist has asked the following question regarding residents who are admitted to our long-term care facility. If someone calls the front desk asking for information on a resident, such as "Is (resident) in your facility?" or "What is their room number?", would this information be considered PHI?
A: The answer is not straightforward when it comes to long-term care. It all depends on the care setting. If care is provided in an assisted living facility and the assisted living facility does not provide healthcare services, such as nursing care related to treatment or a clinic on-site, the information is not PHI. On the other hand, if the facility is a skilled nursing facility (SNF) and is providing what HIPAA defines as healthcare, it would be considered PHI. That doesn't mean the receptionist cannot share the information about whether a resident is at the facility or the resident's room number. Similar to a hospital, a long-term care facility could maintain a facilities directory. Unless the resident has specifically requested he or she not be included in the facility directory, you can share whether a resident is at the facility and where the resident is located in the facility. Providing more information would be prohibited. Review the long-term care regulations in the state in your state.
Editor’s note: Chris Apgar, CISSP, president of Apgar and Associates in Portland, Oregon, answered this question. This information does not constitute legal advice. Consult legal counsel for answers to specific privacy and security questions.
CMS giveth and CMS taketh away. More than $21 billion in payments under the Medicare EHR Incentive Program and more than $10.1 billion in Medicaid EHR Incentive Program payments has been doled out between 2011 and 2015?but not every payment remains with its intended recipient. Contractors will perform audits to ensure that those eligible for the program can support their attestation through examination of supporting documentation to back a claim that a provider or hospital has fulfilled the requirements for meaningful use.
CMS contracted Figliozzi and Company to conduct pre- and postpayment desk audits of the meaningful use program.
"What we have been seeing from our clients' experience is Figliozzi is attempting to perform audits on 5% of attestations submitted to CMS," says David Holtzman, JD, CIPP, vice president of compliance at CynergisTek, Inc., in Austin, Texas.
Holtzman also notes a spike in state Medicaid offices and the Office of Inspector General (OIG) performing audits for those attesting to meaningful use. These audits are conducted on site by a team of auditors.
"Both Medicaid and Medicare meaningful use audits are pass-fail audits," Holtzman says. "Therefore, if any requirement or measure is not met, the result is that the provider or hospital will not receive the incentive payment in the case of a prospective audit or will be required to return any payment received for the prior period as a result of the audit."
Under the Affordable Care Act, the latter would be considered an overpayment by Medicare or Medicaid, and the provider or organization would be required to return the incentive dollars within 60 days or face fines and penalties subject to the False Claims Act.
"There is increased attention by the U.S. Attorney's Office and the Office of Inspector General for investigating and prosecuting fraudulent attestations for meaningful use that results in incentive payments," Holtzman says. "I look at this as a claims recovery effort."
CMS may occasionally report on overall rates of audit failure by eligible providers and hospitals. However, it will not provide any specific guidance on how to resolve identified issues, Holtzman says. "Once the reporting year has ended, the attestation is filed or the hospital/provider selected for audit, no substantive changes are permitted," he says. "Best practices are to carefully review documentation for meaningful use attestation using internal experts or bring in a third-party reviewer to ensure accuracy."
