* Can our board view protected health information?
* Should internal auditors report to our HIM department?
* Strategies for examining diagnostic testing in the emergency room

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Compliance Hot Topics: Billing and Coding, EMTALA, Stark, HIPAA

Question of the Week

Welcome to Compliance Monitor Q&A!

Our mission is to answer your difficult compliance questions-and your simple ones, too. To submit a question, send it to Compliance Monitor Q & A editor Laura Motta at lmotta@hcpro.com. We hope you enjoy this service and we welcome your feedback.

This week's questions

• Can our board view protected health information?
• Should internal auditors report to our HIM department?

• Strategies for examining diagnostic testing in the emergency room

• Would you be interested in learning how other organizations structure their compliance, privacy, and risk management functions, set procedures, train new employees, and handle reporting and budgets?

Q: Under the new medical privacy regulations (within the HIPAA law), may governing boards have access to identifiable patient health information? If so, under what conditions?

A: Workforce members, including governing board members, may access protected health information (PHI) without patient authorization, as long as they do it to perform any health care operation for your covered entity. Board members may access only the minimum PHI necessary to perform the function.

The definition of "health care operations" under the Health Insurance Portability and Accountability Act (HIPAA) is extensive. The following are some of the major activities:

1. Conducting quality assessment and improvement, including outcomes evaluation and clinical guidelines; improving health or reducing costs; protocol development; case management and care coordination; and communicating treatment alternatives
2. Reviewing the competence or qualifications of health care professionals, and evaluating practitioners or health plans; conducting training programs; and doing accreditation, certification, licensing, or credentialing activities
3. Doing underwriting, premium rating, and other activities related to health insurance or health benefits
4. Conducting or arranging for medical review, legal services, and auditing
5. Handling business planning and development, such as cost-management and planning-related analyses
6. Overseeing management and general administration, including, but not limited to
   • compliance with HIPAA
   • customer service
   • resolution of internal grievances
   • sale, transfer, merger, or consolidation
   • fundraising

TIP: Make sure each governing board request complies with one of these definitions. To find out, ask board members what they plan to do with the PHI. Your privacy officer or compliance director should determine the exact amount of "minimum necessary" information.

Do not give the board PHI when it only needs a summary, or general statistics. Do not, for instance, give a copy of a detailed accounts receivable report with patient names and amounts, when the board only needs categorized totals to perform its function. Realistically, board members vary rarely need to access individual patient information to carry out their duties.

Also remember, board members are bound by the same privacy policies and procedures as all other workforce members. Train them to protect patient privacy, and sanction those who don't comply with your rules.

This question was answered by Marion Neal, President of HIPAASimple.com.

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Here are the answers to the last survey:

Are you concerned that the new outliers rule will have a negative impact on your organization's reimbursement?

• Yes: 41%
• No: 38%
• I'm not sure what impact the rule will have on our reimbursement: 21%

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