Staying Healthy: HIPAA Rules

The Department of Health and Human Sciences first issued the Health Insurance Portability and Accountability Act of 1996 or HIPAA to set national standards for the protection of patient health information. This law was designed to protect and control how private health information is used. The Office for Civil Rights has the responsibility to implement and enforce privacy rules that will include voluntary compliance with financial penalties.

Goals of HIPAA

An individuals’ health information is highly private. There should be no dissemination of information to outside parties unless written permission is expressively given by the patient. This rule strives to provide a balance that permits information to be sent to necessary parties while at the same time promoting protection and security of the public’s health and safety. The rule is flexible yet comprehensive and gives specific details as to what information can be sent to third parties.

HIPAA requires that entities (those who use health information) comply with the applicable requirements and rules. The summary of the HIPAA law is not a source of legal information, but the entire law or act needs to be read and studies to ensure that specific laws are followed.

HIPAA Coverage

HIPAA rules cover health plans or insurance companies and clearinghouses that move heath information to different third party providers. HIPAA definitely applies to the health care provider and other providers to meet the information needed treat a patient. Take note that HIPAA privacy coverage also covers health plans that are implemented by employment, government and church sponsored plans.

All individual and group plans that pay the cost of medical care are regulated by HIPAA rules and procedures. These include health and dental as well as vision and prescription drugs. Those organizations that are HMO, Medicare and Medicaid are also liable. In other words, every entity that handles private medical information is subject to HIPAA.

HIPAA is designed to protect individual medical records when entities use electronic technology to transmit medical records. Healthcare clearinghouses are those businesses that process nonstandard information and they are highly regulated under HIPAA rules. Clearinghouses are billing services, community health management systems and value-added systems that provide services to hospitals and clinics.

One very important medical entity is psychotherapy. The notes taken by a health care provider in regards to mental health are highly regulated. All professional documenting or analyzing during conversations with patients, family or groups are private and not to be disseminated unless specific permission is granted. All medications and monitoring plus counseling sessions and their start and stop times, the modalities of treatments that are furnished plus the results of clinical tests and the summary are not to be given to third parties. The only exception to this rule may be in the case of court ordered release to substantial a legal matter.

HIPAA does retain the right to modify the existing rules and procedures at any given time. There are updates issued on a regular basis. Currently there are a number of provisions of the HITECH Act that are designed to strengthen security issues for health information that are established in HIPAA.

How the Red Flag Rules Affect Your Practice – A Medical Practitioner’s Safeguard For Fraud

The Red Flag Rules is a regulation issued by the Federal Trade Commission (FTC) under the Fair and Accurate Credit Transactions Act (FACTA). It contains guidelines which require institutions, utilities, and other creditors to set up programs aimed at preventing identity theft.

Identity theft is a form of con in which someone pretends to be someone else by supposing that person’s identity, typically in order to access resources or obtain credit and other benefits in that person’s name. In the case of medical practitioners, the primary concern is the theft of one’s medical identity. Medical identity theft occurs when someone claims to be another person without the knowledge of that person to obtain or make false demands for medical services, therefore leading to fictitious and erroneous medical records.

The FTC released RFR (Red Flag Rules) on November 2007. However, the RFR did not specify whether medical practitioners were included in the Red Flag requirements. The American Medical Association (AMA), who is committed in guarding the patients and physicians, delayed the implementation of the RFR until June 1, 2010 due to its response to the appeal of the FTC staff regarding the intentions of applying it to physician practices. The AMA continues to insist that physicians should not be included in the Red Flag Rules because they are not “creditors”.

Conforming With the Red Flag Rules

The Red Flag Rules relate to any institution that is regarded as a creditor. A creditor is defined as “any person who regularly extends, renews, or continues credit; an entity (person or institution) that extends credit by giving another entity permission to borrow money if it is paid back at a later date.” However, physicians who submit insurance claims or permit payment plans are considered to be creditors by the FTC and therefore are bound by the Red Flag Rules.

The Red Flag Rules cover doctors who accept insurance or allow payment plans and must have sufficient policies and procedures in place by June 1, 2010 or they may face a penalty up to $2,500 per known violation. Without quoting the entire definition from the Final Rules, here’s the simple version: If the product or service you sell or provide is not paid in full at the time of purchase, you must comply.

Differentiating RFR and HIPAA privacy and security rules

The Health Insurance Portability and Accountability Act (HIPAA) protects health insurance (PHI) coverage for workers and their families when they change or lose their jobs. PHI as defined by HIPAA is swathed by the RFR but the Rule extends to different sensitive information:

· Credit card information;

· Tax identification numbers: social security numbers, business identification numbers, and employer identification numbers;

· Insurance claims;

· Background checks for employees and service providers.

What is a “Red Flag”?

A red flag is a model, exercise or specific account activity that indicates the probability of identity theft. The FTC identifies the following as red flags:

  • Alerts, notifications or warnings from a consumer reporting agency;
  • Suspicious documents;
  • Suspicious personally identifying information, such as a suspicious address;
  • Unusual use of – or suspicious activity relating to – a covered account;
  • Notices from customers, victims of identity theft, law enforcement authorities, other businesses about possible identity theft in connection with covered accounts.

How can Health Practitioners Comply with The Red Flag Rules?

In the majority of medical practices, the Red Flag Rules will apply because accepting insurance generally results in deferring payment from a patient until payment is received from the insurance carrier. This determination is important because the Red Flag Rules require creditors with accounts that are covered to identity those accounts that are at risk, and to define, detect, and respond to the Red Flags in order to prevent or at least mitigate identity theft. In short, a primary goal of a physician is to recognize suspicious circumstances that would prompt your office to be alert for possible theft of a patient’s identity and to respond accordingly.

Obligations Under the Red Flags Rule

The Red Flag Rules requires a creditor that maintains covered accounts to develop and implement a written identity theft program that has reasonable policies and procedures to:

1.) Identify Relevant Red Flags;

2.) Detect Red Flags;

3.) Respond appropriately to any Red Flags that are detected;

4.) Oversee the Program;

5.) Train Employees;

6.) Oversee Service Provider Arrangements;

7.) Ensure the Program is Updated Periodically and Provide Reports.

Identify Relevant Red Flags

Health care providers should identify specific activities or practices that indicate the possibility of identity theft. This could include the use of suspicious documents, which could include: documents (e.g. drivers license) that appear to be altered; the photograph on the identification does not resemble the appearance of the individual; and other information on the identification is not consistent with information provided by the person. Also, suspicious changes of address and fictitious addresses or phone numbers are signs of identity theft. Mail sent to the person that is returned repeatedly as undeliverable is also a red flag. Other red flags could include: a complaint of question from a patient based on the patient’s receipt of a bill for another individual; a bill for a service or item that the patient claims he/she did not receive; or an Explanation of Benefits or other notice for health care services never received.

Detect Red Flags

The Identity Theft Program should include reasonable approaches for detecting the identified Red Flags that have been incorporated into the program. This could include verifying the identity of the patients being treated, and verifying the validity of any change of address requests. Providers should implement registration procedures that could detect red flags. For example, the provider could request and in some cases (e.g. driver’s license) make a copy of the following information and documents at the time of registration:

– Driver’s license, passport, state identification, or other photo identification;

– Date of birth

– Physical address and telephone number

– Insurance card (if available)

– Other verification of identity (such as voter’s registration card or credit card)

– If there is no photo identification, the provider should ask for two forms of non-photo identification (e.g. social security card, school identification, utility bill, birth certificate, etc.)

The person registering the patient should be alert for any conflicting information (e.g. the photo on a driver’s license does not match the patient, insurance card appears to be altered or forged, signature does not match driver’s license). If during the admission process, a “red flag” is detected, the person in the office who is designated as the officer should be contacted to investigate and take any necessary action. This could involve stopping the admissions process and requesting additional documents/information to verify the identity or interviewing other individuals.

Respond to Red Flags

A health care provider should takes steps to prevent and mitigate identity theft by taking the following actions: monitoring covered accounts for evidence of identity theft, contacting the patient if necessary, changing passwords/security codes; not attempting to collect on an account when the individual has been a victim of identity theft; and notifying law enforcement officials.

A health care provider should have policies and procedures in effect that ensure the integrity of the medical record. When an individual’s identity is stolen to obtain health care services, this can potentially have significant harm for the patient. For example, inaccurate information in the medical record could result in the patient receiving inappropriate services. A provider should immediately correct any errors in medical records resulting from identity theft.

Oversee the Program

The practice should identify someone to oversee, develop, implement and administer the Identity Theft Prevention Program. It could be overseen by the board of directors or a designated member of staff.

Train Employees

It is imperative to train your staff regarding the Identity Theft Prevention Program. This could include general training of all employees and more specific training for employees who are responsible for patient registration and patient accounts.

Oversee Service Provider Arrangements

For any third party who provides services to a health care provider (e.g. coding, billing, or accounting activities) and has access to the covered accounts; the health care provider must take steps to ensure that the activity is in compliance with its Identity Theft Program. A business associate contract or other service agreement should include provisions obligating the service provider to comply with the Identity Theft Prevention requirements.

Ensure the Program is Updated Periodically and Provide Reports On an annual basis, the practice should provide a written report that addresses matters concerning identity theft, such as the effectiveness of the policies and procedures, significant incidents that have occurred and response to those incidents, and recommendations for changes to the program.

How to Lose Flab – The Golden Rules to Lose That Annoying Flab Fast

If you are looking for ways on how to lose flab, then read on to learn the golden rules to that annoying flab fast.

Rule #1 – Nutrition – If you don’t eat right, then say good night! Guys, nothing, and I mean nothing will work without proper nutrition. If you are not implementing proper nutrition into your daily life, results will be minimal to none. You can’t expect to lose flab by doing a bunch of ab crunches, take a walk around the block, and then go home and eat a freaking cheeseburger! It just doesn’t work that way. Here are the rules of nutrition to lose flab fast…

– What to eat? Protein, complex carbs, fiber, healthy fats, foods rich in vitamins and minerals.

– How much to eat? Eat the amount of calories you are supposed to get based off of your current weight. DO NOT reduce calories. Reducing your caloric intake is a sure fire way to cause a plethora of health problems…including yo-yo dieting.

– When to eat? To boost your metabolism, I recommend for you to eat 6 small healthy meals daily instead of the usual big 3.

Rule #2 – Water – Drinking plenty of water daily is highly essential to not just lose flab fast, but also for your overall health.

Rule #3 – Sleep – Often underestimated, sleep is very important for weight loss, and obviously your overall health. I recommend for you to get 7-8 hours of sleep every night.

Rule #4 – Exercise – Do cardio AND weight training. Not one or the other. Both types of exercises have their own benefits and both are highly important if you want to lose flab and weight fast.

Now, understanding those rules are important, BUT, making sure you stay consistent in following those rules are just as important. Consistency is key if you want to lose that annoying, stubborn flab fast!

The 5 Ultimate, No-Nonsense Rules to Permanent Weight Loss

Introduction

There is perhaps no other area of debate that has as many disparate and conflicting views as the topic of “Weight Loss”.

Today, hundreds, if not thousands of different dietary approaches exist, all attempting to provide dieters with the solution to permanent weight loss. Interestingly, most of these dietary approaches are authored by highly trained medical professionals, qualified doctors who lay claim to empirical research and related “science” to substantiate their particular approach to weight loss.

And yet, in spite of the abundance of medical supported, dietary advice currently available, obesity remains a fast-growing global epidemic, and one that is showing little sign of slowing. Also, the medical fraternity is still unable to reach absolute consensus on that elusive “ideal diet”. We just need to look at the “Diet” section of any book store, to see that within the medical dietary community, there are as many advocates for a “High Protein” approach, as there are for a “High Carbohydrate” dietary approach…as there are for a “Low fat” approach…not to mention numerous other approaches

The USA, Australia, South Africa and UK continue to experience increases in obesity, as well as similar increases in diabetes and cardiovascular disease, both also related to poor nutrition.

With all these conflicting dietary views, anyone attempting to lose weight can be forgiven for being at a complete loss as to which diet to follow or which approach is indeed best.

Clearly, a “back to basics” approach is needed – a common-sense, no-nonsense approach to weight loss. A set of simple, practical “rules” designed to provide direction for those trying to lose weight.

The following 5 “rules” are the result of 20 years experience in dietary and weight-loss counseling. They are rooted in logic and positive experience, and will benefit most dieters who have, and perhaps still are, struggling to lose weight.

The 5 Rules

Rule 1: Don’t Diet – Understanding Why Diets Don’t Work

The statistics prove it.

Dieters seldom remain on any diet for sustained periods of time and it is common for dieters to try one diet after another, only to fail consistently to maintain a diet for the long term (i.e. “Yo Yo dieting).

Q: The reason for this?

A: Patterning.

For most people, taste and food preferences are already well established, or patterned, by the time they reach adulthood due to eating patterns that are established from early childhood. “Parties”, “Sweet Treats”, “Fun Foods”, “Social occasions”. “Special Occasions”, “Reward Foods” – all contribute to formulating specific food choice patterns, patterns that are extremely difficult to adjust the older we get.

Because most diets are restrictive in some way – promoting the restriction or limiting of certain foods or food groups – to restrict a food that has been patterned from a young age is usually not sustainable, and this is why many dieters invariably find themselves “cheating” – or craving a restricted food.

Dieters need to accept that most restrictive diets are simply not practical or sustainable.

The solution is to develop a diet that provides a sound nutritional foundation…for the long term. And, that does not restrict favourite foods that have been firmly patterned.

Rule 2: Use Common Sense: Natural Vs Man-Made

All foods fall into 2 categories:

1) Foods that are natural or are as close to their natural state – i.e. have had little to no processing

2) Foods that have been processed, adjusted or synthesized by man in some way or form

If you want to lose weight, and improve your health, try to ensure that most food consumed each day is natural or close to natural.

This doesn’t mean creating a diet base purely on raw foods. What it does mean is to aim to base 70% (or two thirds) of total daily food intake on foods that are as close to their natural state as possible – such as:

All Fruits in their whole state, Fruit smoothies (fruits blended with a little juice), Vegetables – raw or cooked; Eggs (Cooked); Meats (cooked); Fish (Cooked or raw, as in sushi); Nuts (raw and unsalted), Milk, or yoghurt.

Logically, for most, these foods are easier for the body to utilize, unlike packaged and processed foods (naturally food intolerances/allergies must be considered too).

By ensuring that most foods that are consumed each day are as close to their natural state as possible, is an easy and practical approach to maintaining good health. The remaining 30% (or one third) of foods consumed should still be healthier choices, but can also include processed and packaged foods, as well as those indulgences and treats that typically lead to weight gain and poor health

Rule 3: Limit Starch – It’s Not Natural

Starch occurs very seldom in nature.

For a starch to exist requires heating or processing of a natural or raw food.

For example, vegetables such as butternut squash, potatoes and pumpkin – which are usually not eaten raw – are transformed into starches once heated.

Starch foods, are difficult for many people to metabolise and often lead to excess levels of the hormone insulin to be released in the bloodstream. Excess insulin in the body encourages fat storage and weight gain, as well as cravings.

The more processed the starch – i.e. the further it is removed from its natural state – the greater the potential impact on insulin release, and weight gain.

Examples of “Starch Offenders”:

Chips and crisps – Derived from potatoes

Pasta, rice, cereals – Derived from grains

Cakes, Breads, Biscuits, Pastries – Derived from milled grains

Naturally it makes sense to choose starches that are less processed – i.e. vegetable starches – and are as close to their natural state. For example, steamed pumpkin is a better choice than pumpkin pie or pumpkin fritters.

Refined grain, or flour-based starches are the worst choices. Even the now popular “Low GI” (Glycaemic Index) breads should be limited. Although these low GI grains are less refined, they are still difficult for many to metabolise.

Rule 4: Protein is Important

Protein is important.

But that does not mean dieters need to follow high-protein diets.

There are 2 reasons that high protein diets have gained popularity and achieved success:

1) They limit foods that create excess insulin (i.e. carbohydrate and starch foods)

2) They promote foods (i.e. protein foods) that keep blood sugar levels elevated and promote satiety.

Protein is important – however protein choices should ideally be low in saturated fat and eaten in moderation – and preferably during the day. Eating protein during the day keeps blood sugar levels elevated and limits cravings (cravings usually occur when blood sugar is low). Ensuring adequate protein intake during the day also maintains optimum mental functioning as amino acids found in protein foods stimulate brain functioning.

Rule 5: Don’t Exercise to Lose Weight

It has now been proven that exercise does little to reduce or prevent cardiovascular disease (refer to “The Exercise Myth” written by cardiologist Dr H Solomon).

A healthy diet is the best route to healthy weight loss and should make up at least 90% of a weight loss program. Exercise should be done to strengthen and condition the musculature system of the body.

Traditionally, dieters who embark on an exercise program usually take up aerobic activities such as running, cycling, rowing or walking in an attempt to lose weight through “burning fat”.

These activities are not effective at burning fat tissue and usually lead to a loss of muscle mass. The ratio of muscle on the body is the single greatest factor that determines metabolism – i.e. the rate at which the body utilizes energy and fat -, so by engaging in sustained aerobic activity almost ensures a slower metabolism by reducing the amount of active muscle tissue on the body.

The best exercise approach is any form of resistance exercise – such as Pilates, Weights, Circuits, Bodyweight exercises.

Activities such as running and cycling should be seen as recreational activities, done for enjoyment – not for weight loss.

These 5 rules are by no means finite, but are an attempt to help provide a starting point for those attempting to lose weight. Everyone is unique with individual dietary requirements, however, these practical rules will certainly help anyone trying to lose weight.

The 5 Rules at Work:

Here is an example of a day’s sample menu. Most of the options consist of foods that are closer to their natural state. However, options also allow for indulgences and dessert.

(It is assumed that alcohol is consumed in moderation: 5-6 drinks per week)

Breakfast:

Omelette with non-starch vegetables (e.g. broccoli, peppers, eggplant, zucchini)

Or

Mixed Fruits (lower sugar if possible: Berries, Apples, Pears, Peaches) and Yoghurt sprinkled with flaked raw almonds and a drizzle of honey

Or

Fruit Smoothie made with mixed fresh/frozen berries and yoghurt

Or

Traditional Breakfast made with poached eggs, grilled lean bacon, grilled tomato & mushroom (no toast!)

Snack:

Handful of Walnuts & Almonds and 1 Apple

Lunch:

Large Mixed Salad (mixed salad leaves, tomato, peppers, cucumber, celery, onions, – with Either:

“Greek” (added olives & Feta cheese),

“Chicken” (added grilled chicken – no mayo)

“Tuna” (added tuna chunks – no mayo)

Or

Any protein (fish, steak, chicken breast) with non-starch veg or salad

Afternoon Snack

Small Yoghurt

Or

Handful of Walnuts

Or

Pear or Apple

Or

Small bowl strawberries

Dinner

Thin base Pizza with veg toppings and less cheese & salad

Small bowl ice cream Or A Chocolate Or Chocolate Mouse

Or

Pasta Bolognese – reduced pasta (i.e. starch) portion, increased Bolognese sauce. Small Dessert of choice

Or

Lamb, Chicken or Vegetarian Curry & Rice – Reduced rice portion (starch), and generous topping portion
Small dessert of choice