00:00:04:07 – 00:00:33:08
Welcome to Shorr Solutions: The Podcast. I’m your host, Jay Shorr. I’m the CEO and founder of Shorr Solutions, a national and award-winning consulting firm, assisting aesthetic and surgical practices with their operational, administrative and financial success. I have an amazing team of practice management experts and clients across the U.S. and as an industry expert with firsthand experience owning a multimillion dollar cosmetic dermatology and plastic surgery practice.
Listen in as I’ll lend you my expertise and best tips to successfully manage and grow your esthetic practice. I will also be bringing in guests along the way, so get ready to be equipped to operate your esthetic practice strategically and profitably. Welcome to Shorr Solutions: The Podcast.
00:00:55:00 – 00:01:14:25
This episode of Shorr Solutions: The Podcast was originally recorded as a webinar sponsored by Weave. However, we thought the content was so important, we wanted to make sure, you, our loyal podcast listeners heard it as well. Thanks for listening and we hope you enjoy.
00:01:15:27 – 00:03:17:11
So before we begin, your guide to understanding HIPAA to prevent violations in your aesthetic practice, once again, I’m Jay Shorr. I am the founder and CEO of Shorr Solutions. So, let’s first start off with describing what is medicine? Medicine is a science. We all know you have anatomy of physiology. You have pharmacology. It’s aesthetic cosmetic medicine. It’s internal medicine, cardiology, orthopedics. We can go through all of the specialties.
It’s also a way to heal the sick and injured. That’s the traditional medicine. In the aesthetic world where I’m in. It’s a way to keep our patients looking young and beautiful. We’re in there for the actual neuromodulators, the fillers. I’m not going to mention any names, but medicine is still one of the most respected professions today.
And why is that? Because in order to be a physician, you have to end up going through your four years of traditional university college. Then you go to medical school, then you do an internship, then you do a residency, then you may do a fellowship, and then you come out and either work into institution, academia, you go out and work for an existing practice, or you just may decide to hang your shingle and open up your own practice.
But more importantly, medicine is a business, and we have to treat medicine like the business that it is, and people don’t do that. They figure it’s just a way to treat patients. However, they don’t understand all the nuances. They don’t understand all the ramifications behind the problematic issues that concern medicine today. HIPAA, being one of them. So let’s describe what are the most important priorities?
00:03:17:22 – 00:04:11:15
Well, the ten rules of the medical practice, number one, beyond all is safety of all of our patients and our medical staff. Safety by far trumps everything. We won’t have a practice. We won’t have a business if we don’t keep it safe, keep our patients safe, keep our staff safe. Secondly, we have to protect all of our practitioners licenses.
We have to comply with all local, state and federal regulatory issues. HIPAA, which is one of them. In our world, we have to commit not to doing anything that is either illegal, unethical or immoral. We have to promote the practice of medicine to our community. We have to be honest to ourselves, have fun and make money. Why do we need to make money?
Because medicine is and always will be a business.
So what are the do’s and don’ts? as we speak today, the most important dos and don’ts, especially today, is never comment on race, religion, ethnicity, gender, sexual orientation. These are the things that are going to get you in the most trouble. Do not comment on political assimilation or party lines, especially today.
We are in a polarized society. I’m not going to get into who’s right and who’s wrong because, number one, we don’t speak and we don’t end up indicating one party over another. You shouldn’t promote anything personal on a practice’s social media channels. This is pure, purely and strictly business. You have to assume that patients are aware of the current privacy practices.
Don’t ever assume. Don’t ever assume they were aware. You must be the one that has to be aware of it because most of the time your staff doesn’t even know. Because I don’t recall the last time many of you have actually gone through a HIPAA training course in your office. So what’s really most important about that is assume that because a patient arrives with another patient, that it’s okay to discuss with the patient’s permission.
Don’t ever assume that. You have to ask permission, even if the patient arrives with another patient or with a guest. You have to ask whether or not it is okay to speak to that other person with that patient there. Additionally, do not ever take pictures on personal devices that lead the premise of the Office. I can’t share with you enough how many of our practices end up taking pictures on their own personal iPhones.
They take their iPhones home. I have friends who are physicians and dentists, and they show me pictures of patients. That’s a no no. If anything ever happened and that phone was found and people were able to see, that is a number one HIPAA violation. And we will get to that. Do not ever send emails to patients on your personal device that are not HIPAA-compliant.
For example, AOL, Gmail, Yahoo, BellSouth.net, Horizon.net, whatever. A lot of you get free emails. They have to be HIPA compliant. Now, Microsoft Office 365 is HIPAA-compliant.
00:06:48:12 – 00:09:41:11
So let’s talk about HIPAA and what HIPAA really is, and we have to be aware of its compliance. HIPAA, the Health Insurance Portability and Accountability Act of 1996 is United States legislation that provides data privacy and security provisions for safeguarding medical information.
So the standards for privacy of individual identifiable health information, which is the privacy rule, actually, established that for the first time, a set of national standards for the protection of specific health information. So who controlled this? Initially, the U.S. Department of Health and Human Services issued the privacy rule to implement the requirement of the Health Insurance Portability and Accountability Act of 1996.
The Privacy Rule Standard addressed the use and disclosure of individual health information called protected Health Information. You may also see it listed as PHI, and that’s called covered entities, as well as standards for individual privacy rights to understand and control how their health information is used, because the patients have the right to determine how you disclose their health information.
And that’s why when you go into an office, you get a whole myriad of paperwork that asks you who, what and when and where Can your protected health information be disclosed to another doctor, to a family member? How do you want to be contacted? on your phone? by an email? Voicemail?
So within the Health and Human Services Office, the Office of Civil Rights, they’re the ones that have the responsibility for implementing and enforcing the privacy rule with respect to voluntary compliance activities for civil and monetary performance and fines.
So a major goal of the privacy rule is to ensure that the individual’s health information is properly protected, allowing the flow of health information needed to provide and promote high quality health care and to protect your health and well-being.
So HIPAA required the Secretary to issue privacy regulations governing individual identifiable health information and, I’d rather bore you with all the dates that went into effect, in March of 2022, the department proposed and released for public comment.
Modifications of this privacy rule. There’s a whole myriad that there has to be an advance notice of proposed rulemaking procedure. It goes to the public for comment. It comes back and the notice of then proposed rulemaking procedure gets established and then it gets enacted into legislation. Final modifications were published in its final form in August of 2002, and then the final regulations became part of the federal law.
00:09:41:21 – 00:11:42:28
So who’s covered under the privacy rule? Well, health plans, individual and group health plans that provide or pay the cost of medical care and covered entities. Who? Blue Cross, Blue Shield. Medicare. United. Aetna, Cigna. I’m not going to bore you with all of the different insurance payers out there. Also, health care providers.
Every health care provider, regardless of the size, who electronically transmit data. EMR, HER, clearinghouses for your insurance. If your insurance, in connection with certain transactions, is a covered entity. Now these transactions include claims, benefit eligibility, inquiries, referral authorization requests, and other transactions. Health care clearinghouses. So who were they? Now, I understand that when you if you’re an insurance based practice, submit insurance, you are not submitting directly through you from your EMR, HER, to the insurance companies.
You have to go through a clearinghouse. So these health care clearinghouses are entities that process the nonstandard information that they receive from another entity into a standard format or vice versa. And in most instances, health care clearinghouses will receive individually identifiable health information. Example: Social Security number, Medicare IDs, other information when they’re providing or processing services to a health plan.
Aetna, Cigna, Medicare and the like. Or the health care provider As a business associate, which we’re going to get into in a little bit. All right. Only certain provisions of this privacy rule are applicable.
00:11:42:28 – 00:13:20:27
Now, Health care providers with the direct treatment relationship have to do the following provide the notice no later than the first date of service of the delivery of the service.
Now, this is very, very important. The moment you walk into an office, they have to give you the paperwork. And when they give you that paperwork, that’s the first service and the date of the delivery. Have the notice available the same day, the delivery site for the visuals to request and to keep. If they don’t want a copy, they don’t have to have a copy.
But note on there that they refuse to have a copy. Post the notice in a clear and a prominent location where it’s reasonable that you can expect individuals seeking service from the provider to be able to read it and they may be emailed prominently post or make available to your website if you have one. There is a regulatory issue that states that you have to have a HIPAA on your website to where you can have it.
Maybe I would just say have a link to it. Health care providers with the direct treatment relationship have to properly revise and distribute its notice wherever there’s a material change. And a clearinghouse would need authorization from individuals to sell a patient mailing list, disclose information and disclose information for life insurance. So what are the patient’s rights? Ensure a patient has access to their medical records.
They must be able to see their records. They must be able to get copies of their records. They have to be able to request amendments to their records. And they have to have a history of six years of the most TPO disclosures that have to be made accessible to the patients. Now, what’s most important about that? Protecting printed information.
00:13:21:09 – 00:14:28:10
You have to funnel incoming correspondence through a direct channel. Do not copy documents indiscriminately. You have to have a clean desk protocol. What does that mean? So that patients can’t look over the desk, over the checking counter, and see other patients. Information. Shred papers containing protected information when it becomes obsolete. It’s not used, recycled and discarded. If your printer stores information, you have to delete that from its memory.
Now, let me share something with you for a second. You vmay not be aware that a copier, a printer has a hard drive in it. And if you are going to get rid of your printer and if you’re going to get rid of your copier, it may have specific information in it. And you have to destroy that because if you’re going to sell it back or you’re going to dispose of it, if you’re leasing it and you have to return it and turn it back, you have to be very careful that there isn’t any protected health information on there that really can get you in trouble.
00:14:29:00 – 00:15:02:21
Warehouse files routinely locked, though, during and after hours. If you store paper charts. Who has the keys to these? Because there may be people there that have access to it. And are they the right people? Those people that have those keys? And who else has that is permitted access or documents anywhere? Is there a policy? Is there a job description of what these people have?
Are they allowed into these areas or not? It is very, very important because a lot of protected health information can be stolen.
00:15:03:21 – 00:16:24:13
So now, let’s talk about protecting telephone calls. The first thing you have to do is train your people. It is very important. Everybody in your office has to be trained. Make sure that you take the steps to verify the identity of People on the phone. Don’t assume that if somebody says I am or I’m their husband on their wife and their listed, don’t assume that they are the people who they are. Beware of people nearby patients, or visitors that might be around in the office. Consider physical barriers. Physical barriers may be walls. They might be soundproof barriers in your office.
Avoid lab tests results on voicemail when you call a patient. Don’t be giving the results unless they tell you in that original HIPAA notice that it is okay because you don’t know who may be answering the voicemail for that patient unless they give you express permission.
You have to know how to leave a message if the family answers the patient’s phone. Just say that this is Jay from Dr. So-and-so’s office, please have X return my phone call. Without giving any information whatsoever because you can be called to attest for giving information out. Now, who and how should you control HIPAA in your office?
00:16:24:14 – 00:17:36:09
Well, you should have a privacy officer. In your office, name somebody that can be a privacy officer. Could be you, could be the office manager, It could be a HIPAA compliance officer.
Adopt written privacy policies, develop a notice of privacy practices, establish a grievance process, and have employee training each and every time. When you hire a new staff member, it is so important to train your staff on HIPAA policies, procedures, protocols that are clear, concise and consistent. Not everybody knows and not everybody really understands HIPAA in your office.
00:17:36:09 – 00:18:47:28
So let’s talk about business associates for a second. Who and what are business associates? What you see here is a business associate agreement. So a business associate in general is a person or organization other than a member of your workforce that performs certain functions or activities on behalf of or provide certain services to a covered entity that involves the use of protected health information.
So who could that be? Business Associates Service to cover entities are limited to legal actuarial accounting, consulting, data aggregation management, Administrative. Sounds like a lot. All right. But what’s most important as a business associate is anybody that can have protected health information about each and any one of your clients. So who might that be? All right. Those that have persistent access service providers, people that have agreement, signers, protected health information, subcontractors, direct vendors.
Who is it? People with limited access. Business associate delegates, specified people or entities. But what’s most important is insurance companies. People that have access to your EMR. People have access to your protected health information. Each one of you should have a business associate agreement with each and every vendor that you do business with.
00:18:47:29 – 00:20:29:15
Yes. We’re going to take a quick break and a slight intermission, because what kind of business would we be if we didn’t tell you about our own services?
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00:20:29:16 – 00:26:37:13
And what is the purpose of that business Associate Agreement? Well, it is a legal document and the purpose of it strictly states what happens in the event of a breach.
It’s a several page document that is individualized between you and the business associate. And it goes on to say that you are responsible and that you will hold all protected health information in the strictest of confidence. And if you don’t, this is what happens. Let me give you another example. I’m sure many of you have received emails, letters from entities who believe that your credit for example, or it may be a health insurance company or a clearinghouse, that your information may have been subject to a violation.
It may have been hacked. It doesn’t mean that they’ve gotten who whoever the perpetrator was. It doesn’t mean that they got your information. It means that the possibility exists that they did get your information and that the entity that is contacting you is doing the following. Many times, if it was the department store, if you recall a little while back, Target would hit very, very badly.
So what do they do? They offer you a year worth of credit monitoring. What would a protected health information do? They would offer you a year’s worth of or whatever it is, kind of credit monitoring to see whether or not any of your personal or protected health information was breached and whether or not, if it is, they will be able to protect you in any way, shape or form.
Now, I urge each and every one of you listening, if you don’t have a business associate agreement with even your biomedical transport waste provider, your cleaning crew, anybody that can come in, pharmaceutical reps. I know it seems a little bit on the protective side, but I am very risk averse and my role and goal in life and in our consulting company is to protect you from you in spite of you.
Now, as a special offer, each and every one of you that do not have a business associate agreement, if you will send us your email address, then we will send you a blank copy that will be, can be editable of a business associate agreement so that you can have it for your use. Please don’t keep it in your inbox.
Please download it, please use it. Now by accepting that I want you to understand that by you accepting that, you’re giving us your email address and to be very transparent, you will receive offers, you will receive information, you will receive podcast, you’re going to receive, we’re not trying to sell anything, our e-blast is basically an educational platform.
We partner with vendors like Weave to provide wonderful educational content to you, so we’re more than happy to give this to you. Compliments of Weave and The Best Medical Business Solutions, commonly known as Shorr Solutions. You know, Denise showed you who is and who is not a business associate agreement. So pull that slide back up, Denise. So we’re going to show you this is not an all inclusive list, but more a list of in detail.
These are business associates. It’s not all inclusive, but I am sure that you deal with a lot of these. Now, be very, very careful. As I spoke in the very beginning, many of you may have emails like Jayshorr@gmail.com. They are not HIPAA-compliant. AOL, Yahoo!, Your free internet that you get when you have Internet from your service provider, whatever.
They are not HIPAA-compliant you must have HIPAA-compliant software, an email that is protected, and every step of the way. Here are more business associates. I’m sure each and every one of you work with people like that. Now, if a vendor never has, never will, and currently does not have access to any PHI (protected health information), you don’t have to worry about it.
But the moment somebody does, whether it’s in an eyeball site, or electronically, social media or whatever, you must have protected health information. All right. And then you have to have a business associate agreement which covers you by HIPAA, because in the event, HIPAA is not a local, it’s not a state violation, it is a federal law. So it is very, very important because the fines are extremely egregious.
Why? Because you could have and should have prevented any perspective violation. So it’s very important. I urge each and every one of you, please do what is prudent in your life. You know, make sure that you do everything right. There is no substitute, all right. For not having this done correctly. So what’s the privacy rule? The No business associate agreement, if you have a substitute doctor working in your practice, mail or other delivery people coming into your office, a contracted insurance company, labs that are used.
All right. Third party discussions about the sale of your practice. They are waived from things like that. All right. Now, permitted use and disclosures, appropriate safeguards, requirements to report non permitted usage and response to any protected health information.
00:26:37:14 – 00:27:30:26
So there are administrative safeguards. Now, what are administrative safeguards? Number one, security management processes. Assigned security responsibility, workforce security, information access management, security awareness training, a contingency plan, an evaluation and business associate (contracts and other arrangements).
These are your eight standards of administrative safeguards. You have the unilateral authority to protect people and protect their protected health information. If you follow those eight steps. And it’s very important that you do so.
00:27:30:27 – 00:28:18:07
Now, let’s talk about passwords. What is the thing that bothers you most? Well, first of all, you have to have strong passwords. You have to have protected passwords and you have to have unique passwords.
I know when I go on to something that asks me to create a password, it tells me, no, it’s got to have a capital letter, a lowercase letter, a number. It has to have a hieroglyphic, an asterisk. It can’t be one of the last 365 passwords that I’ve used. And then I start getting angry. I don’t know what it was that I’ve used.
Do I have to have the password with the capital letter before or after? And then it gives me this option to use a strong password given by them. And it’s just the password that I will never remember. You have to write it down. But remember, use strong passwords, use strong passwords, use strong passwords.
00:28:18:04 – 00:30:35:24
in the last couple of minutes that we have left. What’s very important, let’s talk about fines. How egregious is it if you get caught, it can be anywhere between five and $25,000 per violation. This is a federal law. And if you get caught… and how do you get caught? Usually you’re never going to get caught unless somebody reports you because their protected health information was breached. How would you feel if your protected health information was breached?
I wouldn’t feel good about it at all. So we have to do everything in our power to make sure that we have good passwords, that we put strong enforcement methods in place, that we… to summarize that the moment the first encounter of a patient walks into your office, you give them the HIPAA paperwork that allows them to tell you who is eligible to receive that in what format and what protected health information can you disclose.
And they have to sign it, it becomes part of their permanent file. If they don’t want a copy, you check off that they refused a copy. If they want a copy of it, give that to them. But make sure that is what protects you and always have your business associate agreement filed so that if it is done by the party that signed the Business Associate Agreement, they are the ones that are liable.
I urge you, ladies and gentlemen, a final comment. Get cybersecurity insurance if you’re ever hacked and HIPAA is breached, you’re going to play havoc getting your data back, but you’re going to get sued. Have at least a million or $2 million worth of cyber coverage. I know you don’t like the extra fees.
It will protect you. I can share horror stories. Maybe we’ll do that in another webinar. I can share with you what other doctors problems they’ve had.
So we have one minute to go. I’ll be more than happy to answer any questions that anybody in the audience has. These webinars are for you.
00:30:35:24 – 00:31:44:23
Thanks, Jay. That was awesome. We do have a couple of questions here. I’ll go ahead and ask. So the first question is, I know you mentioned not to comment on race, religion, ethnicity, things like that, but my question is: How do you handle it when a patient brings that up in the office? Like, what is the best way to change the subject or kind of deal with that? I guess.
I don’t engage in any of those. I would politely smile. I am a formal practice owner of a very large dermatology facial body, plastic, cosmetic, plastic, gynecology and med spa. I will disclose I am not a physician, in the state of Florida, non physicians may own and be partners in medical practices, so I wanted to make that disclosure.
when I had that situation, I also trained my staff. Just say that in this office we don’t discuss politics, we don’t discuss religion. We want to respect each and everyone’s privacy. And then people will honestly, they’ll get the message very polarized society. I will be more than happy to engage in any dialogue about your health information. But at this moment we don’t discuss that in the office.
00:31:45:15 – 00:32:02:29
Great. Someone just asked, says the agreement need to be updated yearly or how long does that last?
The business associate agreement is in perpetuity. Once you sign it and date it, it is good forever for the lifetime of your association with that vendor. It never needs to be updated
00:32:04:16 – 00:33:49:12
Great. Thank you, Martha, for that question. Any others came in? One more. You kind of mentioned this at the end, but if a breach of information does occur, like what are the first steps to take? What do you recommend doing right off the bat?
It depends how it occurred. The first thing that I would do is determine HOW. Because if that happened, the first measure is prevention. All right. An ounce of prevention is worth a pound of cure. You know, I didn’t make that one up. Right? However, I have to ensure that we’re able to protect you, from you, in spite of you.
So somewhere there was a flaw in the system. If it was from the vendor, they are responsible. The first people I would call is my attorney. The second I would call is my malpractice coverage, and the third I would call is my insurance company. There’s three reasons why. I need to call my attorney to find out how I’m going to be protected.
I need to call my malpractice company in case part of my professional liability coverage incorporates that. And I need to call my insurance company, my general liability carrier, to see whether or not I have that clause in coverage within my general liability, cyber coverage, etc.. Because what you need to do is you’re going to get sued. Now you have to mitigate the losses.
That’s why the attorney is important. Next, malpractice and next the your general liability carrier, because that’s who is going to pay off. It’s not a thousand it’s not a $5,000 fine. It is egregious and it’s per occurrence.
00:33:49:12 – 00:35:58:22
Got it. That’s super helpful. I have one other question. It might be a clarification from a previous question, but does the HIPAA consent form for the patients need to be updated yearly or is that one long lasting as well?
It does not. I’m assuming that what we’re speaking about are the initial intake HIPAA forms that, you know, you’re given when a patient first walks in the door. I know it was crazy ten years ago or 20 years ago, everywhere you went, pharmacies, everywhere you went, you had to fill out all this HIPAA paperwork.
Now, it’s done electronically. But if, look, I don’t want to get to people’s personal lives. People separate, people get divorced, people get married, and there are people that are married that no longer want their spouse, all right, to have access. Do not ever that because a person walks in with somebody, as I said in the very beginning, that they really want that person to hear what’s going on.
A woman may walk in with another person not wanting them to know why they’re at the plastic surgeons office. They want to look natural. They don’t want somebody knowing what services they’ve had. And I’m not going to go into what services they are. All right. People can figure it out. Could be anywhere from a dermal filler to a neural modulator to a face and body procedure of any type.
Now, if you changed what you would like or you change the methodology and how you wish to be contacted… I don’t use my home phone so if you’re going to contact me on my home phone, you’re never going to get me. Because the only time I answer my home phone is for the gate, the guard gate to tell me somebody is here.
If you know me and you want me, you’re going to contact me on my cell phone. I may not want certain information. So the only time it needs to be updated is when any of those information choices change. If they don’t change and you contact somebody, let’s say Paige was on the list initially and that person no longer wanted Paige on there and they didn’t update it.
And we contacted Page. We as the provider are not liable because that change was never made.
00:35:59:13 – 00:38:36:13
So yeah, that makes a lot of sense. That’s a great advice. So that will wrap it up for today. Thank you so much, Jay. I think this is really useful information and everyone can find a lot of use out of it, so we really appreciate your time.
It is absolutely my pleasure. I love to educate. This is a three hour lecture I give at the University compounded into 30 minutes.
Yeah, you did great. You did really great.
Feel free. You can scan that barcode for a free 30 minute consult. Join our e-newsletter with that QR code. If you want our free offer, I promise we are not going to sell you anything. We’ll be more than happy to give you the free business associate agreement. You can compare it with yours, but we will put you on to our E-newsletter, your acceptance and request for that business associate Agreement is a voluntary opt in.
Great. Thank you so much for being here with us today and we will see you soon.
So that wraps up today’s episode of Short Solutions, the podcast. If we mentioned any website links, you can find them in our show notes to work directly with me and our award winning team of consultants to increase efficiency, increase revenue and decrease costs. And your esthetic practice schedule is free. Consult with us today. We will help you establish and refine your esthetic practices, protocols for maximum efficiency and productivity, decrease your expenses and increase your with an expert financial analysis of your business.
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