Software Solutions Can Save Healthcare Entities from Losing Millions in Penalties

Companies that fail to comply with the most updated HIPAA rules will be fined with civil and criminal penalties. The penalties for noncompliance are based on the level of negligence and can range from $100 to $50,000 per violation (or per record), with a maximum penalty of $1.5 million per year for violations of an identical provision. More serious violations can also carry criminal charges that can result in jail time.  HIPAA puts the focus on the general handling of patient medical information.

 

 

2018 HIPAA Fines Totalled $24,947,000.

Source: https://compliancy-group.com/hipaa-fines-directory-year/

 

The HIPAA Omnibus Rule introduced sweeping changes in terms of what organizations must now comply with HIPAA, among a host of other major changes. Note that HIPAA standards are mandatory, and the government (through the Department of Health and Human Services and Office of Civil Rights) is now enforcing stringent requirements and investigating breaches. HIPAA focuses more on the general handling of patient medical information.

 

Resultado de imagen para hipaa violation penalty tiers

 

Amongst those standards are the ISO 27001 and 9001 certifications. To be HIPAA compliant, many companies must now ensure and attest that they have implemented such international standards.

 

 

What constitutes a data breach according to HIPAA regulations?

According to the U.S. Department of Health and Human Services a breach is, generally, an impermissible use or disclosure under the Privacy Rule that compromises the security or privacy of the protected health information.  An impermissible use or disclosure of protected health information is presumed to be a breach unless the covered entity or business associate, as applicable, demonstrates that there is a low probability that the protected health information has been compromised based on a risk assessment.

In response, the best healthcare software solution companies adopted the ISO standards before mentioned.

 

Description of ISO Standards required by HIPAA – ISO 9001

ISO 9001 is the international standard that specifies requirements for a quality management system (QMS).  A quality management system (QMS) is a set of policies, processes and procedures required for planning and execution (production/development/service) in the core business area of an organization. (i.e. areas that can impact the organization’s ability to meet customer requirements).

 

This rule is used by organizations to demonstrate they consistently provide products and services that meet customer and regulatory requirements.

 

Achieving Certification to ISO 9001 is the first step of a process that will provide your organization with the necessary management tools to advance working practices throughout the entire organization. Conexia obtained the ISO 9001 certification in 2004.

 

With this designation, our services achieved higher quality and enhanced patient safety through the implementation of a QMS, the best way to provide patient-centered care. ISO 9001 provides with a model for a quality management system that is focused on the effectiveness of clinical, business and support processes to ensure high quality care is available.

 

ISO 9001 provides with a model for a quality management system that is focused on the effectiveness of clinical, business and support processes to ensure high quality care is available. The QMS integrates the various internal processes within the organization and intends to provide a process approach for project execution which ensures continual improvement through objective measurements.

 

A process-based QMS enables the organizations to identify, measure, control and improve the various core business processes that will ultimately add value and lead to improved business performance.

 

Completing Certification to ISO 9001 is the first step of a process that will provide your organization with the necessary management tools to advance working practices throughout the entire organization.

 

The ISO 9001 certification has the following benefits for our clients:

  • Improved quality and service
  • Delivery on time
  • Right first-time attitude
  • Saves costs and improves efficiency
  • Independent audit demonstrates commitment to quality
  • Ensure quality and safety in the treatment of patients
  • Identify and manage risk to patients, staff and the organization
  • Comply with relevant international and national legal requirements
  • Implement best practice routines and procedures
  • Guarantee to patients, authorities and other stakeholders that you have implemented well-functioning management that continues to improve

 

 

ISO 27001 to Avoid Data Breaches

Healthcare entities manage large amounts of both protected health information (PHI) and personally identifying information (PII) so healthcare entities leaders are concerned about preventing data breach.

 

According to the article published by Health IT SecurityHow Much Do Healthcare Data Breaches Cost Organizations?”, the three most recent Cost of a Data Breach Studies from Ponemon showed that stolen healthcare records cost the most. It also states that in two out of three of those years the cost of a healthcare record was over twice the cost of the global average.

 

  • 2015 results: $363 per stolen record, global average was $217
  • 2016 results: $355 per stolen record, global average was $158
  • 2017 results: $380 per stolen record, global average was $141

 

The 2018 study conducted between February 2017 and April 2018 demonstrated that data breach costs have risen once again. With a record in healthcare of having the highest data breach resolution which typically cost an average of $408 per record, it is no wonder why this is a major concern for healthcare leaders.

 

When we talk about the ISO 27001 standard, we may mistakenly assume that it is a means of complying with the legislation in force in the sector we are dealing with, but in this way, we only diminish its importance and undermine its objectives.

 

ISO 27001 is an international standard issued by the International Organization for Standardization (ISO) and describes how to manage information security in a company. This standard is written by the world’s leading specialists in the field and provides a methodology for implementing information security management in an organization.  The focus of ISO 27001 is to protect the confidentiality, integrity and availability of information in a company. It does so by investigating potential problems that could affect the information (i.e., risk assessment) and then defining what needs to be done to prevent these problems from occurring (i.e., risk mitigation or treatment).

 

We must understand that this standard is a valuable way to identify, mitigate and monitor your company’s information security risk. Additionally, it is designed to help you manage the security of your services, data, intellectual property or any information entrusted to you by a third party.

 

Resultado de imagen para iso 27001:2013 tuvThe security measures (or controls) to be implemented by this standard are usually in the form of policies, procedures, and technical implementation (e.g., software and equipment). In most cases, companies already have all the hardware and software but use it in an unsafe manner; therefore, most of the implementation of ISO 27001 will be related to determining the organizational rules (e.g., document writing) necessary to prevent security breaches.

 

Health information systems that store sensitive patient information must be managed rigorously from an information security point of view. The latter conforms an information security system (ISS) which purpose is to establish, implement, operate, monitor, revise, maintain and improve information security.

 

 

The ISO 27001 is internationally recognized and provides with a specification for information security management systems. Applying the precision of ISO 27001 has long been at the forefront in this sector since the healthcare industry is a particularly attractive data breach target. 

 

Conexia is proud to have been certified ISO 27001 and 9001, granting our clients that the healthcare software solutions we provide are up to the highest international standards.

To conclude, most of the activities that take place during the traditional billing process (fee schedule application, utilization review, coding validation, reconciliation with pre-authorization) have already been completed. Payment of invoices becomes prompt and simple avoiding potential billing mistakes.

 

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