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HIPPA

What is HIPAA Compliance?

The U.S. Department of Health and Human Services is responsible for creating and issuing new standards regarding the use or exchange of Protected Health Information (PHI). The basic premise is any healthcare provider or business associate must be HIPAA-compliant which means that he must be able to show due diligence in their attempt to comply with the HIPAA Security and/or Privacy Rule. The and/or for Privacy is for Business Associates who may only have to comply with the Security Rule and only parts of the Privacy based on the job they are performing for the Covered Entity.

Multiple rule changes and expanded regulations has made it much more complex to become HIPAA-compliant. Recent developments that have aided to the difficulty to comply are The American Recovery and Reinvestment Act 2009 and the 2013 HIPAA Omnibus Rule. The ARRA has gained prominence owing to the presence of the Health Information Technology for Economic and Clinical Health or the HITECH Act within it. These law changes including the recently approved Omnibus rule will require Covered Entities to perform audits and track more and more HIPAA compliance information to be able to say that they are HIPAA Compliant.

The HIPAA Act of 1996 has set strict standards regarding a patient’s Protected Health Information (PHI) as a part of its Privacy Rule regulations.

HIPAA Compliance for Covered Entities

This part of the rule addresses all issues concerned with saving/accessing/sharing medical & personal information of an individual. The concept of a Covered Entity is at the core of Privacy Rule regulations. All Healthcare Providers and Health Plans are called Covered Entities.

However, this is a very basic definition, as the realm of a Covered Entity implies to all Business Associates that are involved in accessing/sharing an individual’s medical health information. A Business Associate represents all persons or organizations that are involved in the direct functioning of a Covered Entity or act on behalf on a Covered Entity.However, it does not involve the employees of a covered entity. For example, the clerical staff at a healthcare center is not regarded as a Business Associate. However, an outsourcing firm that is handling medical billing on behalf of the medical facility is a Business Associate, i.e. it is bound to follow HIPAA compliance guidelines.

This includes covered entities (CE), anyone who provides treatment, payment and operations in healthcare, and Business Associates (BA), anyone with access to patient information and provides support in treatment, payment or operations. Subcontractors, or business associates of business associates, must also be in HIPAA compliance.

The HIPAA Privacy Rule addresses the saving, accessing and sharing of medical and personal information of any individual, while the HIPAA Security Rule more specifically outlines national security standards to protect health data created, received, maintained or transmitted electronically, also known as electronic protected health information (ePHI).

The physical and technical safeguards are the road map to successful HIPAA compliance

• Physical safeguards include limited facility access and control, with authorized access in place. All covered entities, or companies that must be HIPAA compliant, must have policies about use and access to workstations and electronic media. This includes transferring, removing, disposing and re-using electronic media and electronic protected health information (ePHI).

• Technical safeguards require access control to allow only the authorized to access electronic protected health data. Access control includes using unique user IDs, an emergency access procedure, automatic log off and encryption and decryption.

• Audit reports, or tracking logs, must be implemented to keep records of activity on hardware and software. This is especially useful to pinpoint the source or cause of any security violations.

• Technical policies should also cover integrity controls, or measures put in place to confirm that ePHI hasn’t been altered or destroyed. IT disaster recovery and offsite backup are key to ensure that any electronic media errors or failures can be quickly remedied and patient health information can be recovered accurately and intact.

• Network, or transmission, security is the last technical safeguard required of HIPAA compliant hosts to protect against unauthorized public access of ePHI. This concerns all methods of transmitting data, whether it be email, Internet, or even over a private network, such as a private cloud.

We utilize "The Guard" from Compliancy Group LLC to Achieve, Illustrate, and Maintain our HIPAA compliance, covering the Administrative side of HIPAA Privacy, Security, HITECH Breach Notification, Technical side with HIPAA IT Risk Analysis, Device Audit, and Physical side with our Physical Site Audit.

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Insurance & Billing

Suburban Orthopaedic Medical Center is centered on patient care and treatment, most insurances are accepted, but different providers allow for different plans and benefits. We participate with Medicare and with many state commercial policies such as Horizon Blue Cross Blue Shield and Aetna.

Suburban Orthopaedic Medical Center offers a free financial consultation to determine your coverage and benefits your policy entitles you to. We also offer a free Insurance verification by phone.

To receive your free financial consultation & insurance verification as well as any additional questions regarding payments or bills/statements contact us at (973) 483-2277.

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Personal Injury Protection (PIP)

Have you been involved in an auto accident recently?

Most states have programs that help pay for medically necessary and reasonable care due to an auto accident. This protection is called Personal Injury Protection and is provided by your insurance company. Seeing a doctor after a car accident is one of the most important things you can do to retain your personal injury case, because only a doctor can document and validate your injuries after an accident.

Why is it important to see a personal injury doctor right after your accident?

In order to open a personal injury case you must have documented proof from medical personnel proving your injuries. Our physicians here at Suburban Orthopaedic Medical Center will document your conditions and provide your personal injury lawyer the proper documentation so they may build a strong case to get you the settlement you deserve!

Why see a doctor even if you don’t feel hurt?

Most injuries that are caused from an auto accident differ from your standard everyday injuries. Majority of the time these injuries are seen to be musculoskeletal and may not show immediately after your accident for reason such as your body being in shock. Waiting to see a doctor may only extend your recovery process while making your case decrease in value. Common injuries such as whiplash can be treated by personal injury doctors and given the proper care so they may heal without lasting effects.

Why see a personal injury doctor even if you have gone to the ER after an auto accident?

When you visit the ER after a car accident the most common procedure is to check the patient for life threatening or immediate health threats, their objectives usually do not include diagnosing your injuries sustained from the wreck. Even if they have prescribed you medication for the pain you should still see a personal injury physician to assess your body and determine any other injuries that may have lasting effects on your daily routines.

Call Suburban Orthopaedic Medical Center’s healthcare staff to speak about possible treatment options after you have experienced a car accident: (973) 483-2277.

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