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publishers of The New England Journal of Medicine
Massachusetts Medical Society
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© Copyright 2004



Development of a HIPAA Compliance Strategy
The Time to Act Is Now

By Paul W. Shaw and Jerome B. Tichner, Brown Rudnick Freed & Gesmer
Still in the wake of preparation for the anti-climactic Y2K bug, physicians now face another significant and potentially expensive hurdle: compliance with regulations arising out of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

On Dec. 20, 2000, President Bill Clinton issued final HIPAA privacy regulations establishing standards for the protection of patient records and health care data. These regulations, coupled with recently enacted rules for the standardization of electronic claims and transactions, have placed significant pressure on physician practices to evaluate their methods for handling, transferring and storing patient information.

Here we attempt to provide a basic roadmap for evaluating your practice and implementing a compliance plan.

Early Action Can Save Dollars and Headaches
The deadline for physician practices to conform with these new HIPAA standards is in two years (three years for some small practices). However, it is crucial to begin developing a compliance strategy now. For most physicians, achieving compliance will involve modifying and/or developing new policies, procedures, and information systems, as well as adapting existing contracts and/or relationships with what HIPAA calls "business associates" (for example, software vendors or billing consultants).

Since a mere review of these practice elements can take months, those who delay developing a compliance strategy will likely find themselves running out of time as the compliance deadline approaches.

Violation of HIPAA's privacy regulations can lead to significant fines and potential criminal prosecution. Therefore you should start now to take the following measures:

  • Familiarize yourself and your staff with HIPAA requirements including:
    1) obtaining patient consent prior to treatment, payment or health care operations; 2) obtaining patient authorizations before releasing patient information to third parties, such as a patient's employer or insurance plan; 3) exceptions to the consent and authorization requirements; 4) standards regarding relationships with business associates; and 5) rights of patients to access their own data.
  • Designate a privacy officer. Privacy officers are responsible for coordinating the development and modification of the practice's privacy policies and employment handbooks, coordinating the education of all practice staff, and overseeing the development and implementation of the practice's compliance strategy. Privacy officers should coordinate their efforts with members of the practice's billing, information technology, and medical staff to ensure that compliance efforts include all aspects of the practice.
  • Analyze the manner in which your practice handles patient information. A flow chart detailing how and by whom information is handled will enable you to identify potential compliance issues and trouble spots.
  • Establish a comprehensive compliance strategy and prioritize items to be completed, including timelines for performance.
  • Work with counsel to review current contracts and relationships with business associates, such as billing companies. To comply with HIPAA, a contract with a "business associate" must, among other things, 1) prohibit the improper release or use of protected information; 2) require safeguards for use of protected information; 3) require the return of any protected information upon termination of the contract.
  • Update practice forms and informational materials. Develop notices to patients regarding your practice's use of their medical information. Update consent forms and authorization forms to satisfy HIPAA requirements.
  • Review all electronic systems to determine noncompliance. Work with software and hardware vendors to ensure that system upgrade needs can be satisfied. Many software/hardware agreements may already entitle your practice to free upgrades and systems review.
  • Analyze the overall financial and nonfinancial impact of HIPAA compliance on your practice. This will allow you to set appropriate goals and establish a budget for compliance activities. Software/hardware upgrades can be very expensive and, therefore, warrant advance planning.
  • Create an awareness in your practice about HIPAA and involve staff in the compliance process. Awareness will enable support staff, the individuals generally handling the day-to-day transactions involving health care data, to assist with compliance efforts and to contribute ideas for practice modification.

Compliance strategies will differ depending on practice size and structure. It is important to customize your practice's compliance efforts as needed.

For all practices, regardless of size and structure, early action makes for easier implementation. Delaying compliance efforts is likely to result in an eventual shortage of time and increase in expense. Addressing these issues in the near future can transform HIPAA compliance into a manageable step-by-step project to be implemented gradually.

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Time Stamp 25-Feb-05 02:37 PM
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User Agent
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14:37:00.000 - Expression Exception - in D:\webfiles\MassMed\WWW\AM\TemplateSection.cfm : line 34
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MASSMED | Development of a HIPAA Compliance Strategy - Vital Signs
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Debug Rendering Time: 63 ms