Health care is one of the most heavily regulated major industries in the United States. Leaders are challenged to stay current and to comply with federal, state, and local laws and their associated regulations. Health care organizations are also responsible to meet industry standards. In some cases, payers equate meeting industry standards with achieving and maintaining accreditation. In fact, many payers consider accreditation a minimum condition of participation. In addition, individual licensure and certification requirements establish basic expectations for health care leaders’ professional conduct.In summary, health care leaders are responsible to:
Meet ethical personal, professional conduct, certification and licensure expectations.
Comply with local, state and federal health care and human resources laws.
Provide evidence of compliance with existing regulations and scan the field for emerging regulations.
Identify and meet appropriate accrediting body standards (Example: Joint Commission’s National Patient Safety Goal standards.)
As an individual’s health care leadership career advances, so does the corresponding level of accountability. Not knowing the laws or regulations is not an excuse for not complying with them.This assessment allows you to demonstrate your knowledge of and skills relating to compliance concepts, governmental and regulatory agencies which oversee health care service delivery, billing, and general operations. You will also have the opportunity to apply the components necessary to initiate and maintain an effective compliance program. Finally, you will consider relevant human resources laws which may pertain to your compliance recommendations.
DEMONSTRATION OF PROFICIENCY
By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:
Competency 1: Analyze health care laws and regulations from a local, state, and federal level.
Summarize the relevant health care compliance concepts that apply to a HIPAA privacy breach.
Competency 3: Assess the importance of continuous readiness in the health care organization.
Apply the seven essential elements of an effective compliance program to a HIPAA privacy breach.
Recommend evidence-based actions to address a HIPAA privacy breach.
Describe a health care, industry-approved, ethical decision-making framework.
Competency 4: Explain how governing body and regulatory agency standards exercise oversight authority within a health care organizational setting.
Provide a synopsis of the consequences to individual leaders and other internal stakeholders of not addressing a HIPAA privacy breach.
Competency 5: Communicate in a manner that is scholarly, professional, and respectful of the diversity, dignity, and integrity of others and is consistent with health care professionals.
Write a clear, concise, well-organized, and generally error-free workplace brief addressing a HIPAA privacy breach that is reflective of professional communication in the health care field.
In this assessment, you are assuming the role of an early careerist in risk management and quality improvement at one of Vila Health’s community-based hospitals. Vila Health is a medium-sized system of health operating facilities in Minnesota and Wisconsin. You are working on a team-based initiative under the supervision of the Vila Health Chief Compliance Officer. Your role is to assist in addressing a specific compliance risk regarding a breach of privacy and potential HIPAA violation. A Vila Health employee has disclosed—without prior written authorization—a patient’s protected personal health information.Here is the information the team has collected about the privacy breach and potential HIPAA violation to date. A Vila Health supervisor instructed an employee to obtain pre-authorization for an upcoming surgical procedure for a patient. The Vila Health employee submitted confidential, protected health care information about the patient to the insurance company. The Member Services Representative at the insurance company contacted the Vila Health supervisor. The insurance company representative indicated that further discussion of the matter without prior written consent from the patient is prohibited.As part of the team exploring the privacy breach, you will prepare a workplace brief with authoritative, evidence-based references to support your work.