Was ist das eigentlich? Cyberrisiken verständlich erklärt

Es wird viel über Cyberrisiken gesprochen. Oftmals fehlt aber das grundsätzliche Verständnis, was Cyberrisiken überhaupt sind. Ohne diese zu verstehen, lässt sich aber auch kein Versicherungsschutz gestalten.

Beinahe alle Aktivitäten des täglichen Lebens können heute über das Internet abgewickelt werden. Online-Shopping und Online-Banking sind im Alltag angekommen. Diese Entwicklung trifft längst nicht nur auf Privatleute, sondern auch auf Firmen zu. Das Schlagwort Industrie 4.0 verheißt bereits eine zunehmende Vernetzung diverser geschäftlicher Vorgänge über das Internet.

Anbieter von Cyberversicherungen für kleinere und mittelständische Unternehmen (KMU) haben Versicherungen die Erfahrung gemacht, dass trotz dieser eindeutigen Entwicklung Cyberrisiken immer noch unterschätzt werden, da sie als etwas Abstraktes wahrgenommen werden. Für KMU kann dies ein gefährlicher Trugschluss sein, da gerade hier Cyberattacken existenzbedrohende Ausmaße annehmen können. So wird noch häufig gefragt, was Cyberrisiken eigentlich sind. Diese Frage ist mehr als verständlich, denn ohne (Cyber-)Risiken bestünde auch kein Bedarf für eine (Cyber-)Versicherung.

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Exam Number : AHIMA-CCS
Exam Name : Certified Coding Specialist (ICD-10-CM / ICD-10-PCS / CPT)
Vendor Name : Medical
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AHIMA-CCS exam Format | AHIMA-CCS Course Contents | AHIMA-CCS Course Outline | AHIMA-CCS exam Syllabus | AHIMA-CCS exam Objectives


Number of Questions on exam:

 97 multiple-choice questions (79 scored/18 pretest)

 8 medical scenarios (6 scored/2 pretest)

Exam Time: 4 hours – no breaks

Domain 1 – Health Information Documentation (8-10%)

Tasks:

1. Interpret health record documentation using knowledge of anatomy, physiology, clinical indicators and disease processes, pharmacology and medical terminology to identify codeable diagnoses and/or procedures

2. Determine when additional clinical documentation is needed to assign the diagnosis and/or procedure code(s)

3. Consult with physicians and other healthcare providersto obtain further clinical documentation to assist with code assignment

4. Compose a compliant physician query

5. Consult reference materialsto facilitate code assignment

6. Identify patient encounter type

7. Identify and post chargesfor healthcare services based on documentation



Domain 2 – Diagnosis & Procedure Coding (64-68%)

Tasks:

Diagnosis:

1. Select the diagnosesthat require coding according to current coding and reporting requirementsfor acute care (inpatient) services

2. Select the diagnosesthat require coding according to current coding and reporting requirementsfor outpatient services

3. Interpret conventions, formats, instructional notations, tables, and definitions of the classification system to select diagnoses, conditions, problems, or other reasonsfor the encounter that require coding

4. Sequence diagnoses and other reasons for encounter according to notations and conventions of the classification system and standard data set definitions(such as Uniform Hospital Discharge Data Set [UHDDS])

5. Apply the official ICD-10-CM coding guidelines

Procedure:

1. Select the proceduresthat require coding according to current coding and reporting requirementsfor acute care (inpatient) services

2. Select the proceduresthat require coding according to current coding and reporting requirementsfor outpatient services

3. Interpret conventions, formats, instructional notations, and definitions of the classification system and/ornomenclature to select procedures/servicesthat require coding

4. Sequence procedures according to notations and conventions of the classification system/nomenclature and standard data set definitions(such as UHDDS)

5. Apply the official ICD-10-PCS procedure coding guidelines

6. Apply the official CPT/HCPCS Level II coding guidelines



Domain 3 – Regulatory Guidelines and Reporting Requirements for Acute Care (Inpatient) Service (6-8%)

Tasks:

1. Select the principal diagnosis, principal procedure, complications, comorbid conditions, other diagnoses and proceduresthat require coding according to UHDDS definitions and Coding Clinic

2. Assign the present on admission (POA) indicators

3. Evaluate the impact of code selection on Diagnosis Related Group (DRG) assignment

4. Verify DRG assignment based on Inpatient Prospective Payment System (IPPS) definitions

5. Assign and/or validate the discharge disposition



DOMAIN 4. Regulatory Guidelines and Reporting Requirements for Outpatient Services (6-8%)

Tasks:

1. Select the reason for encounter, pertinentsecondary conditions, primary procedure, and other proceduresthat require coding according to UHDDS definitions, CPT Assistant, Coding Clinic, and HCPCS

2. Apply Outpatient Prospective Payment System (OPPS) reporting requirements:

a. Modifiers

b. CPT/ HCPCS Level II

c. Medical necessity

d. Evaluation and Management code assignment (facility reporting)

3. Apply clinical laboratory service requirements



DOMAIN 5. Data Quality and Management (2-4%)

Tasks:

1. Assess the quality of coded data

2. Communicate with healthcare providersregarding reimbursementmethodologies, documentation rules, and regulationsrelated to coding

3. Analyze health record documentation for quality and completeness of coding

4. Review the accuracy of abstracted data elementsfor database integrity and claims processing

5. Review and resolve coding edits such as Correct Coding Initiative (CCI), Medicare Code

Editor (MCE) and Outpatient Code Editor (OCE)



DOMAIN 6. Information and Communication Technologies (1-3%)

Tasks:

1. Use computer to ensure data collection,storage, analysis, and reporting of information.

2. Use common software applications(for example, word processing,spreadsheets, and email) in the execution of work processes

3. Use specialized software in the completion of HIM processes



DOMAIN 7. Privacy, Confidentiality, Legal, and Ethical Issues (2-4%)

Tasks:

1. Apply policies and proceduresfor access and disclosure of personal health information

2. Apply AHIMA Code of Ethics/Standards of Ethical Coding

3. Recognize and report privacy and/or security concerns

4. Protect data integrity and validity using software or hardware technology



DOMAIN 8. Compliance (2-4%)

Tasks:

1. Evaluate the accuracy and completeness of the patient record as defined by organizational policy and external regulations and standards

2. Monitor compliance with organization-wide health record documentation and coding guidelines

3. Recognize and report compliance concerns



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Warum sind Cyberrisiken so schwer greifbar?

Als mehr oder weniger neuartiges Phänomen stellen Cyberrisiken Unternehmen und Versicherer vor besondere Herausforderungen. Nicht nur die neuen Schadenszenarien sind abstrakter oder noch nicht bekannt. Häufig sind immaterielle Werte durch Cyberrisiken in Gefahr. Diese wertvollen Vermögensgegenstände sind schwer bewertbar.

Obwohl die Gefahr durchaus wahrgenommen wird, unterschätzen viele Firmen ihr eigenes Risiko. Dies liegt unter anderem auch an den Veröffentlichungen zu Cyberrisiken. In der Presse finden sich unzählige Berichte von Cyberattacken auf namhafte und große Unternehmen. Den Weg in die Presse finden eben nur die spektakulären Fälle. Die dort genannten Schadenszenarien werden dann für das eigene Unternehmen als unrealistisch eingestuft. Die für die KMU nicht minder gefährlichen Cyber­attacken werden nur selten publiziert.

Aufgrund der fehlenden öffentlichen Meldungen von Sicherheitsvorfällen an Sicherheitsbehörden und wegen der fehlenden Presseberichte fällt es schwer, Fakten und Zahlen zur Risikolage zu erheben. Aber ohne diese Grundlage fällt es schwer, in entsprechende Sicherheitsmaßnahmen zu investieren.

Erklärungsleitfaden anhand eines Ursache-Wirkungs-Modells

Häufig nähert man sich dem Thema Cyberrisiko anlass- oder eventbezogen, also wenn sich neue Schaden­szenarien wie die weltweite WannaCry-Attacke entwickeln. Häufig wird auch akteursgebunden beleuchtet, wer Angreifer oder Opfer sein kann. Dadurch begrenzt man sich bei dem Thema häufig zu sehr nur auf die Cyberkriminalität. Um dem Thema Cyberrisiko jedoch gerecht zu werden, müssen auch weitere Ursachen hinzugezogen werden.

Mit einer Kategorisierung kann das Thema ganzheitlich und nachvollziehbar strukturiert werden. Ebenso hilft eine solche Kategorisierung dabei, eine Abgrenzung vorzunehmen, für welche Gefahren Versicherungsschutz über eine etwaige Cyberversicherung besteht und für welche nicht.

Die Ursachen sind dabei die Risiken, während finanzielle bzw. nicht finanzielle Verluste die Wirkungen sind. Cyberrisiken werden demnach in zwei Hauptursachen eingeteilt. Auf der einen Seite sind die nicht kriminellen Ursachen und auf der anderen Seite die kriminellen Ursachen zu nennen. Beide Ursachen können dabei in drei Untergruppen unterteilt werden.

Nicht kriminelle Ursachen

Höhere Gewalt

Häufig hat man bei dem Thema Cyberrisiko nur die kriminellen Ursachen vor Augen. Aber auch höhere Gewalt kann zu einem empfindlichen Datenverlust führen oder zumindest die Verfügbarkeit von Daten einschränken, indem Rechenzentren durch Naturkatastrophen wie beispielsweise Überschwemmungen oder Erdbeben zerstört werden. Ebenso sind Stromausfälle denkbar.

Menschliches Versagen/Fehlverhalten

Als Cyberrisiken sind auch unbeabsichtigtes und menschliches Fehlverhalten denkbar. Hierunter könnte das versehentliche Veröffentlichen von sensiblen Informationen fallen. Möglich sind eine falsche Adressierung, Wahl einer falschen Faxnummer oder das Hochladen sensibler Daten auf einen öffentlichen Bereich der Homepage.

Technisches Versagen

Auch Hardwaredefekte können zu einem herben Datenverlust führen. Neben einem Überhitzen von Rechnern sind Kurzschlüsse in Systemtechnik oder sogenannte Headcrashes von Festplatten denkbare Szenarien.

Kriminelle Ursachen

Hackerangriffe

Hackerangriffe oder Cyberattacken sind in der Regel die Szenarien, die die Presse dominieren. Häufig wird von spektakulären Datendiebstählen auf große Firmen oder von weltweiten Angriffen mit sogenannten Kryptotrojanern berichtet. Opfer kann am Ende aber jeder werden. Ziele, Methoden und auch das Interesse sind vielfältig. Neben dem finanziellen Interesse können Hackerangriffe auch zur Spionage oder Sabotage eingesetzt werden. Mögliche Hackermethoden sind unter anderem: Social Engineering, Trojaner, DoS-Attacken oder Viren.

Physischer Angriff

Die Zielsetzung eines physischen Angriffs ist ähnlich dem eines Hacker­angriffs. Dabei wird nicht auf die Tools eines Hackerangriffs zurückgegriffen, sondern durch das physische Eindringen in Unternehmensgebäude das Ziel erreicht. Häufig sind es Mitarbeiter, die vertrauliche Informationen stehlen, da sie bereits den notwendigen Zugang zu den Daten besitzen.

Erpressung

Obwohl die Erpressung aufgrund der eingesetzten Methoden auch als Hacker­angriff gewertet werden könnte, ergibt eine Differenzierung Sinn. Erpressungsfälle durch Kryptotrojaner sind eines der häufigsten Schadenszenarien für kleinere und mittelständische Unternehmen. Außerdem sind auch Erpressungsfälle denkbar, bei denen sensible Daten gestohlen wurden und ein Lösegeld gefordert wird, damit sie nicht veröffentlicht oder weiterverkauft werden.

Ihre Cyberversicherung sollte zumindet folgende Schäden abdecken:

Cyber-Kosten:

  • Soforthilfe und Forensik-Kosten (Kosten der Ursachenermittlung, Benachrichtigungskosten und Callcenter-Leistung)
  • Krisenkommunikation / PR-Maßnahmen
  • Systemverbesserungen nach einer Cyber-Attacke
  • Aufwendungen vor Eintritt des Versicherungsfalls

Cyber-Drittschäden (Haftpflicht):

  • Befriedigung oder Abwehr von Ansprüchen Dritter
  • Rechtswidrige elektronische Kommunikation
  • Ansprüche der E-Payment-Serviceprovider
  • Vertragsstrafe wegen der Verletzung von Geheimhaltungspflichten und Datenschutzvereinbarungen
  • Vertragliche Schadenersatzansprüche
  • Vertragliche Haftpflicht bei Datenverarbeitung durch Dritte
  • Rechtsverteidigungskosten

Cyber-Eigenschäden:

  • Betriebsunterbrechung
  • Betriebsunterbrechung durch Ausfall von Dienstleister (optional)
  • Mehrkosten
  • Wiederherstellung von Daten (auch Entfernen der Schadsoftware)
  • Cyber-Diebstahl: elektronischer Zahlungsverkehr, fehlerhafter Versand von Waren, Telefon-Mehrkosten/erhöhte Nutzungsentgelte
  • Cyber-Erpressung
  • Entschädigung mit Strafcharakter/Bußgeld
  • Ersatz-IT-Hardware
  • Cyber-Betrug