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 : NCCT-ICS
Exam Name : NCCT Insurance and Coding Specialist
Vendor Name : P-and-C
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NCCT-ICS exam Format | NCCT-ICS Course Contents | NCCT-ICS Course Outline | NCCT-ICS exam Syllabus | NCCT-ICS exam Objectives


Test Detail:
The NCCT-ICS (NCCT Insurance and Coding Specialist) exam is a certification exam offered by the National Center for Competency Testing (NCCT). It is designed to assess the knowledge and skills of individuals in the field of medical insurance and coding. The exam evaluates the candidate's understanding of insurance regulations, coding systems, reimbursement processes, and medical documentation requirements.

Course Outline:
The NCCT-ICS course provides comprehensive training on medical insurance and coding. It covers a wide range of courses related to insurance procedures, coding guidelines, and reimbursement practices. While the specific course content may vary, the following is a general outline of the key courses covered:

1. Introduction to Medical Insurance:
- Overview of the healthcare insurance industry.
- Understanding insurance terminology and concepts.
- Introduction to healthcare reimbursement systems.
- Legal and ethical considerations in medical insurance.

2. Medical Coding Fundamentals:
- Introduction to medical coding systems (e.g., ICD-10, CPT, HCPCS).
- Coding guidelines and conventions for accurate code assignment.
- Coding for diagnoses, procedures, and services.
- Coding compliance and auditing processes.

3. Medical Insurance Claims Processing:
- Overview of the insurance claims process.
- Understanding different types of insurance plans (e.g., HMO, PPO).
- Completing insurance claim forms accurately and efficiently.
- Managing claim denials, appeals, and reimbursement issues.

4. Health Information Management:
- Medical record documentation and organization.
- Privacy and security of patient health information (HIPAA).
- Electronic health records (EHR) and health information exchange.
- Data quality and integrity in health information management.

5. Reimbursement and Billing Practices:
- Overview of healthcare reimbursement methodologies.
- Understanding fee schedules, billing codes, and charge capture.
- Insurance verification and pre-authorization processes.
- Managing accounts receivable and collections.

Exam Objectives:
The NCCT-ICS exam assesses candidates' knowledge and skills in medical insurance and coding. The exam objectives include, but are not limited to:

1. Medical Insurance Principles:
- Understanding insurance terminology, policies, and regulations.
- Demonstrating knowledge of insurance claim processing procedures.
- Applying legal and ethical standards in medical insurance practices.

2. Medical Coding and Documentation:
- Applying coding guidelines and conventions for accurate code assignment.
- Demonstrating proficiency in coding diagnoses, procedures, and services.
- Understanding medical record documentation requirements.

3. Insurance Claims Processing:
- Completing insurance claim forms accurately and efficiently.
- Demonstrating knowledge of insurance claim submission and processing.
- Managing claim denials, appeals, and reimbursement issues.

4. Health Information Management:
- Understanding the principles of health information management.
- Complying with privacy and security regulations (HIPAA).
- Demonstrating proficiency in electronic health records (EHR) usage.

5. Reimbursement and Billing Practices:
- Understanding healthcare reimbursement methodologies and fee schedules.
- Applying proper billing codes and charge capture processes.
- Managing insurance verification, pre-authorization, and accounts receivable.

Syllabus:
The NCCT-ICS course syllabus provides a detailed breakdown of the courses covered in the training program. It includes specific learning objectives, case studies, practical exercises, and hands-on coding practice. The syllabus may cover the following areas:

- Introduction to medical insurance and coding.
- Medical coding systems (ICD-10, CPT, HCPCS).
- Insurance claims processing and reimbursement.
- Health information management and documentation.
- Compliance and ethics in medical insurance.
- exam preparation and practice tests.
- Final NCCT-ICS Insurance and Coding Specialist Certification Exam.



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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