surrounding the violation. ocr explains that where multiple individuals are affected by a hiPaa violation (e.g., a breach of unsecured Phi), it is anticipated that the number of identical hiPaa violations would be counted by the number of individuals affected. ocr also explained that, with respect to continuing violations (e.g., a lack of appropriate safeguards for a period of time), it is anticipated that the number of identical hiPaa violations would be counted on a per day basis (i.e., the number of days the covered entity or business associate did not have appropriate safeguards in place to protect the Phi). ocr notes that in many hiPaa breach cases, there would be an impermissible use or disclosure as well as a safeguards violation, for each of which ocr would be entitled to calculate a separate civil monetary penalty. needless to say, the amount of civil monetary penalties that could be imposed against a billing company or one of its subcontractors for a hiPaa violation can be quite substantial. Factors Used to Determine a Penalty the final rule lists the following five factors that ocr will consider in determining the amount of a civil monetary penalty. 1. the nature and extent of the hiPaa violation, including the number of individuals affected and the duration of the violation 2. the nature and extent of the harm resulting from the violation, including physical, financial, and reputational harm, and any hindrance to an individual’s ability to obtain healthcare 3. the history of prior compliance with hiPaa, including whether the current violation is the same/similar to prior indications of noncompliance by the covered entity or business associate and their attempts to correct that noncompliance 4. the financial condition of the covered entity or business associate, including any financial difficulties that could have affected compliance and whether a civil monetary penalty could jeopardize the future provision of healthcare 5. such other matters as justice may require WHEN IT COMES TO REIMBURSEMENT ACCURACY MATTERS Clean Claims. Accurate AccuratAccurate Reimbursements. It’s that simple. alphaii.com | 800.476.8477 the journal of the healthcare billing and management association 15
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