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I would say that the largest potential impact of offshore keying is two
fold:  1) Loss of Medicare billing privilege once the lack of support for
and auditing of the offshore business associate compliance is made known.
2) Severe public backlash, including significant liability.  I suspect that
most patients would be very unhappy to be told their US Insurance company
was shipping jobs overseas, where their privacy was not being protected.
How can anyone comply with the privacy and security requirements shipping
paper overseas, or even scanned images of the paper.  That's not to say that
they may not be compliance, but without the ability to validate that
compliance, for all intents it would be the same as being non-existent.
Further more, this would have to be explicitly disclosed to the patients in
plain language.  Remember that Accountability is a key component.

I wonder how many state Insurance Commissioners, elected officials, in this
labor market, would find this an interested issue!

Tim McGuinness, Ph.D.

-----Original Message-----
From: Hazelrigs, Jim [mailto:[EMAIL PROTECTED]]
Sent: Tuesday, September 03, 2002 5:00 PM
To: [EMAIL PROTECTED]
Subject: Privacy Issue - Data entry of paper claims outside the US


One of the recent trends is to send paper claims offshore (outside of the
US) for data entry.  This is often done by sending scanned files of paper
claims.  This practice may even increase in the future due to the "paper
backlash" some expect  from providers who were electronic submitters and who
decide to switch to paper due to HIPAA compliance expense or complications
and other issues.

I am interested in hearing some viewpoints on how HIPAA Privacy will affect
this off shore keying practice.  It seems that since HIPAA is a US law only,
there will be no ability to enforce its' provisions outside of the US.
Therefore no foreign company can be held to task for not protecting PHI or
using it in a manner not allowed under HIPAA.

I also have read of some off these off shore data entry companies (or their
employees) selling social security numbers (they dealt with credit card
data) to members of the Russian mafia who  used it in identify theft and who
knows what else.

Does anyone know of a specific requirement in HIPAA or via other federal
rules that claims can not be keyed off shore?  For the lawyers in the
audience - any commentary would be appreciated.  Should a best practice be
not to allow keying of PHI off shore?

Jim Hazelrigs
[EMAIL PROTECTED]
4905 Waters Edge Drive, Raleigh, NC  27606
tel: 919 233 6820





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