Thank you in advance. CASE STUDIES IN HEALTH INFORMATION MANAGEMENT 30 CASE 5-42
ID: 3913166 • Letter: T
Question
Thank you in advance.
CASE STUDIES IN HEALTH INFORMATION MANAGEMENT 30 CASE 5-42 Audit Triggers Since the HIPAA privacy rule was implemented, you have been drowning in your audit trail reviews. You have finally obtained permission from administration to develop and use triggers to help with the review. These triggers, although not eliminating review of the audit trail, can be used to identify poten- tial problems much more quickly and easily than using a manual review. Now that you finally have approval, you have to develop the triggers to be used. Administration wants to review your proposed triggers before they are implemented. Identify 10 triggers that you will present to administration for approval.Explanation / Answer
Answer:
HIPAA privacy rules deals with national standards to protect each person health information and medical records.
Some Transactions that canbe used as triggers:
1. Medical bill payments when payments against the medical bills are initiated
2. Enrolment in a health plan to determine insurance termination.
3. Medical bill payments - Information of remittance made against payments of bills.
4. First report of Injury - for patial workmen compensation claims or Insurance claims.
5. Eligibility for a health plan - Enquiries on eligibility and requirement for enrolling in a health plan.
6. Medical Reports and discharge summary - Reports and discharge ummary to insurance or health plan.
7. Refferal Letter - Refferal letter for patient for treatment to a particular health care provider.
8. Medical Claims status - ENquiry on status of claim submitted.
9. Enquiry on services - Enquiry to health care provider on services provided and facilitie available
10. Health care claims - for reimbursement of medical expenses incurred.
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