HIPAA COMPLIANCE
WHAT YOU NEED
TO KNOW ABOUT
“HIPAA”.
12/4/2011 1
WHAT IS HIPAA?
• Health Insurance Portability &
Accountability Act of 1996 (Federal Law).
• New rules to safeguard employees’
Protected Health Information (PHI).
• Mandates the development of national
standards and requirements to enable the
electronic exchange of certain PHI.
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EXAMPLES OF PHI
• Explanation of Benefits (EOB)
• Doctor’s Certification
• Copies of anything pertaining to hospital
and medical benefits; medical, dental,
reimbursement accounts and vision.
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Who must comply with HIPAA?
• “Covered Entities” – organizations bound by the
privacy standards were required to comply by
April 14, 2003.
– A Health Plan.
– A Health care clearinghouse.
– A Health care provider who transmits any health
information in electronic form. Examples: medical,
dental & flexible spending accounts (health care
reimbursement)
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How do we comply with
HIPAA?
• The privacy rule requires covered entities to
make reasonable efforts to limit use and
disclosure of PHI to the fewest people
necessary.
• ONLY the information obtained or created by
MDC’s health plan will be regulated by the
HIPAA requirements.
• PHI specifically excludes “employment
records.”
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What is our Role with
HIPAA?
• Treat PHI as Private and Confidential.
• Do not transmit or communicate such PHI to
anyone other than the employee, unless we
have the employee’s written permission to do
so.
• When responding to an email containing PHI,
Do Not copy anyone.
• Follow a few simple procedures to ensure
compliance with the new rule.
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The College’s Role with
HIPAA
• The College’s…
– practice is to treat employees’ personal
information with confidentiality.
– Policy II-81A was established to ensure
that MDC complies with HIPAA
regulations.
www.MDC.edu/policy/Chapter2/02-II-81A.pdf
– systems do not access, use or disclose
Protected Health Information [PHI].
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To Whom should PHI requests
be referred?
• Requests from the employee for their
own PHI – refer to Cigna
• Requests for PHI from other than the
person who is the subject of information
– refer to Cigna
• If unsuccessful with Cigna – refer to
Janik Collin, Benefits Dept. for
assistance with claims. Fax requests &
authorization to (305) 237-0322 or email
jcollin@mdc.edu
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Summary
• HIPAA is a Federal law that
protects employees’ health
information.
• MDC only contracts with
providers that comply with
HIPAA regulations.
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