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5062_Assessment2_R.pptx

5062_Assessment2_R

pptx

School

Capella University *

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Course

5062

Subject

Health Science

Date

Dec 6, 2023

Type

pptx

Pages

18

Uploaded by SuperOstrichMaster775

Rebecca Ojo MHA-5062: Health Care Delivery: New Environments in Health Informatics Dr. Suzanne Richins November 6, 2023 Laws, Regulations, and Oversight

Introduction Health care is everchanging. As a health care administrator, it is my duty to ensure we are operating in compliance with laws and regulations within the Managed Care Organization environment. The purpose of this assessment is to develop a plan to comply with regulatory requirements associated with health informatics systems. 2

Agenda • Regulatory agencies and laws that impact HIM • Roles and responsibilities of health care managers in meeting current HIM regulatory obligations • Plan to assist MCO’s to comply with current HIM regulations • Agencies relevant to MCO’s • Benefits of aligning with current HIM oversight organizations 3

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Regulatory agencies and laws that impact HIM 4

HIPAA Health Insurance Portability and Accountability Act 5 • Privacy Rule safeguards PHI • Protected Health Information (PHI) must be encrypted • Automatic shutdown after specific period • Secure messaging • Security Rule

HITECH Health Information Technology for Economic and Clinical Health Act 6 • HITECH Act requires that data breaches are required reported • Section 13410(d) of the HITECH Act enforces HIPAA rules • HITECH is a part of healthcare reform

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ACA Affordable Care Act 7 • Meaningful use program (adoption of the EHR) • Electronic Health Records • Funding to increase the use of technology • PHI rules and regulations

Laws Impact on HIM 8 • System requirements • Oversight • Operations • Reporting • Financial Impact

responsibilities of health care managers in meeting current HIM regulatory obligations

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HIM Stakeholders 10 Stakeholder Roles and Responsibilities C-Suite Level Executives (CEO, COO, CMO) Securing new business, maintaining existing business, ensuring regulatory compliance with state and federal requirements, communicating requirements to team members, securing funding to meet requirements Compliance Officer Staying up to date with new and changed regulatory requirements, communicating requirements to team members, reporting out compliance re: requirements HIM Managers, IT, IT Support, Claims, Business Technicians Implementing new regulatory requirements, ensuring systems meet requirements, reporting, system enhancements, IT support

Plan to assist MCO’s to comply with current HIM regulations

MCO Managed Care Organization 12 • Medicaid and CHIP state contracts • Federal Regulations • Reduce cost of care • Improve quality of care

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Agencies relevant to MCO’s

MCO Regulating Bodies 14 • CMS • State • Federal Government

Benefits of aligning with current HIM oversight organizations

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HIM Support Organizations 16 • Increases access to medical records • Allows collaboration between health care providers • Promotes use of electronic medical information • Improve whole person care

Summary As health care continues to evolve, we must be able to adapt to all rules and regulations to ensure compliance from an operational perspective. Our goal is to evaluate all internal processes against external regulations that affect our health informatics systems such as the HITECH (Health Information Technology for Economic and Clinical Health) Act, HIPAA (Health Insurance Portability and Accountability Act), and ACA (Affordable Care Act). 17

References • AHIMA. (2022). AHIMA Home - American Health Information Management Association . Ahima.org. https://www.ahima.org/ • Managed Care Organization HIE Policy | Medicaid . (n.d.). Www.medicaid.gov. https://www.medicaid.gov/medicaid/data-systems/health-information-exchange/ma naged-care-organization-hie-policy/index.html • HIPPA Journal. (2016). The Use of Technology and HIPAA Compliance. HIPAA Journal. https://www.hipaajournal.com/the-use-of-technology-and-hipaa-compliance/ • HHS.gov. (2017). HITECH Act Enforcement Interim Final Rule. HHS.gov. https://www.hhs.gov/hipaa/for-professionals/special-topics/hitech-act-enforcement- interim-final-rule/index.html • Snell, E. (2016, September 22). The Role of HIM Professionals in HIPAA Compliance . HealthITSecurity; HealthITSecurity. https://healthitsecurity.com/news/the-role-of-him-professionals-in-hipaa-complian ce • What is the HITECH Act? 2023 Update . (n.d.). HIPAA Journal. https://www.hipaajournal.com/what-is-the-hitech-act/#:~:text=The%20HITECH

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