Complying With Laws and Regulations in the Ethical Management of Health Information. Distinguish between quality, quality improvement, risk management, and patient safety.
- Summarize the federal regulations and government initiatives in support of quality and patient safety.
- Differentiate between the voluntary quality and patient safety reporting programs.
- Identify the major statutes, rules, and regulations that relate to compliance and fraud and abuse issues.
- Explain corporate compliance programs.
Course Outcomes assessed in this assignment:
HI135-5: Analyze state and federal regulations which govern the release of health information.
BSHIM: I.3 Evaluate policies and strategies to achieve data integrity.
BSHIM: I.4 Recommend compliance of health record content across the health system.
AAS-HIT: II.3 Identify compliance requirements throughout the health information life cycle.
AAS-HIT: V.2 Demonstrate compliance with external forces.
As a compliance officer, you are required to manage and monitor security, integrity, and quality of medical information. You will demonstrate competence in information governance by completing both of the scenarios in this assignment.
Scenario 1: A patient has requested an amendment to their medical record. They also want their medical record released to a physician in a different healthcare system. You recognize there is no policy in place to help facilitate requests such as this. For this portion of the assignment, you should:
- Review and interpret the HIPAA guidelines regarding patient amendments as well as release of information (ROI) regulations applicable to your home state. A resource to assist in reviewing HIPAA guidelines can be found at: HIPAA Rights and Privacy Rights Clearinghouse. Release of information applicable to each state can be found at the following site: https://www.findlaw.com/state.html
- Develop an institutional policy for ensuring data security, integrity, and quality of health information. Your policy should include the following:
- Timelines for responding to a requested patient amendment or release of information (ROI) request.
- Procedural compliance with HIPAA relating to the patient amendment and ROI processes.
- Your policy should be created as a 1- to 2-page Microsoft Word document.
Scenario 2: You have been tasked with recommending strategies to maintain compliance of health record content across the health system. To accomplish this, you must do the following:
- Visit the following links pertaining to documentation guidelines relating to patient care, reimbursement, quality improvement, and research. Use the information from these links to complete the assignment.Behavioral Health Documentation Requirements
Documentation Requirements for Acute Care
National Committee for Quality Assurance Documentation Requirements
Home Health Documentation Requirements
CDI and Research
- Evaluate the importance of compliance with documentation guidelines across the health system as they relate to patient care, reimbursement, quality improvement, and research.
- Based on your interpretation and evaluation of the documentation guidelines provided, create a 1- to 2-page report for your facility’s administration. Your report should identify one facility setting, such as a hospital, home health agency, or behavioral health institution. Recommend and justify one initiative in each of the following areas: patient care, reimbursement, quality improvement, and research, that is important in meeting the compliance standards across the health system.
American Professional Agency. (2019). Documentation in behavioral health. https://www.apa.org/members/your-membership/benefits/insurance-documentation.pdf
Combs, T. (2021). The importance of high-quality clinical documentation across the healthcare continuum. Journal of AHIMA. https://journal.ahima.org/the-importance-of-high-quality-clinical-documentation-across-the-healthcare-continuum
FindLaw. (n.d.). State laws. https://www.findlaw.com/state.html
Individuals’ Right Under HIPAA to Access Their Health Information, 45 CFR § 164.524 (2020).
Privacy Rights Clearinghouse. (2014). The HIPAA privacy rule: Patients’ rights. https://privacyrights.org/consumer-guides/hipaa-privacy-rule-patients-rights
Medicare Learning Network (MLN). (2021). Complying with medical record documentation requirements. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/CERTMedRecDoc-FactSheet-ICN909160.pdf
National Committee for Quality Assurance (NCQA). (2018). Guidelines for medical record documentation. https://www.ncqa.org/wp-content/uploads/2018/07/20180110_Guidelines_Medical_Record_Documentation.pdf
Novitas Solutions. (2021). Physician and allowed practitioner certification and recertification of home health. https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00081587
Samaritan Health Plans. (2021). Medical record documentation standards. https://providers.samhealthplans.org/-/media/SHP/Documents/Providers/Medical-Record-Documentation-Standards-Guidelines.pdf?la=en&hash=A3C77D83C9B392E1B569F30C50121C5DE72064CD
Tips for Success:
Evaluate the purpose of clinical documentation and how it is utilized in achieving quality patient care, ethical reimbursement, and research.
Written Assignment Requirements:
- For your written assignment, you will utilize your analysis of the research to write a policy and report as outlined in the scenarios above.
- Your assignment containing your responses to both scenarios, using the headings Scenario 1 and Scenario 2, should be a minimum of 2-4 pages in length, submitted as a single Microsoft Word document, double-spaced in 12-pt Times New Roman font.
- Include a title page and reference page. Be sure to use APA in-text citations in addition to the reference page to attribute each source.
- Include four or more credible resources.
- Your writing should follow APA format and follow the conventions of Standard English (correct grammar, punctuation, etc.).
- writing should be well ordered, logical, and unified, as well as original and insightful.
- Your work should display superior content, organization, style, and mechanics