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HIPAA regulations are well known for being somewhat arcane. That is especially so in regard to a healthcare provider’s relationship with law enforcement. When the authorities request information about a patient, the provider often feels unsure how to proceed.On the one hand, physicians, hospitals, and other providers have a duty to protect their patients’ privacy and to maintain confidentiality of any information obtained during the course of treatment. That is, after all, why the HIPAA regulations refer to such confidential information as protected health information (PHI). On the other hand, there is sometimes a responsibility to work for the common good and cooperate with law enforcement. To help deal with these situations, Martin Health System (MHS) in Stuart, Fla., has prepared a form that staff can use to document and respond to law enforcement PHI requests. Approved by MHS’ legal and health information departments, the document has been in use for a number of months and has proven quite successful. Access the form: Law Enforcement Request for Information Records Without Patient Authorization
The MHS form complies with HIPAA regulations, which permit disclosure of PHI without the patient’s consent under some circumstances:
Most of these permitted HIPAA disclosures can be handled routinely by a hospital’s health information management, legal, or compliance departments. However, law enforcement issues and threats to health or safety can arise at any time, and authorities may need the information outside of “normal business hours.” The requests often come to clinical areas, such as the emergency department, where staff members may not be familiar with the obscure nuances of federal regulations. In addition, state laws must be considered in addition to the federal HIPAA regulations. “This form really works,” says Linda Hake, MHS senior attorney. “It helps staff think through the issues and get the information they need for documentation purposes, and it makes life easier for both the hospital staff and the law enforcement personnel.” MHS has promoted the form to local police and sheriff departments, the state department of law enforcement, and the FBI. “They are aware of the form and have even been known to ask for it if the emergency department staff member is unaware,” she says.
In some situations, law enforcement personnel are entitled to PHI without the individual’s authorization. For example, disclosure of some limited identifying information is permitted when necessary to locate a suspect, fugitive, material witness, or missing person. At other times, such as when the patient is a crime victim, the individual must be given the option to agree to the disclosure. The MHS form addresses these nuances and guides the staff to make a proper decision without consulting the esoteric and complex HIPAA regulations.An occasional quandary relates to law enforcement requests made over the telephone. The legitimacy of such a request is obviously in question, yet there may be valid justification for it. Hake explains one such case in which a caller wanted information on a deceased patient who had been brought into the ED from another county. “I faxed the form to him, and he completed it and faxed it back. I verified the number and that he was, in fact, with the sheriff’s department, and I got him the information he needed.” She adds that this approach is much easier and quicker than having the officer write a request on official letterhead, which is the typical advice for handling such situations.
MHS modeled its form on one originally developed by Arizona attorney Kristen Rosati for the Arizona Hospital and Healthcare Association. Rosati says that developing this form and an associated FAQ have helped to reduce the tension between Arizona hospitals and law enforcement officials. “The documents were developed in collaboration with Arizona law enforcement, and they take into account HIPAA compliance and the practical needs of law enforcement," she says. The MHS form also includes reference to the Florida Department of Children and Families, which often needs information for investigation of possible abuse/neglect cases. Facilities that adopt a form like this should include any state agency authorized by law to investigate alleged abuse of vulnerable individuals. Legal counsel should be asked to review for state law principles that may apply, and instructions can be printed on the reverse of the form, if necessary.
J. Stuart Showalter, JD, MFS, is a contributing editor to HFMA’s Legal & Regulatory Forum.Quoted in this article: Linda Hake, senior attorney, Martin Health System, Stuart, Fla. (Linda.Hake@martinhealth.org). Kristen Rosati, partner, Coppersmith Schermer & Brockelman PLC, Phoenix, (firstname.lastname@example.org).
Forum members: Please add your insights, questions, and comments about this article on the Legal & Regulatory Forum’s LinkedIn discussion board.
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TriMedx helps health systems control costs and uncover savings opportunities by optimizing the clinical engineering function.
Patient financial engagement is more challenging than ever – and more critical. With patient responsibility as a percentage of revenue on the rise, providers have seen their billing-related costs and accounts receivable levels increase. If increasing collection yield and reducing costs are a priority for your organization, the metrics outlined in this presentation will provide the framework you need to understand what’s working and what’s not, in order to guide your overall patient financial engagement initiatives and optimize results.
A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow.
No two patients are the same. Each has a very personal healthcare experience, and each has distinct financial needs and preferences that have an impact on how, when and if they chose to pay their healthcare bill. It’s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients. The need to tailor financial conversations and payment options to individual needs and preferences is critical. This presentation provides 10 recommendations that will not only help you improve payment performance through a more tailored approach, but take control of rising collection costs.
Emad Rizk, MD, president and CEO of Accretive Health, discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management.
This white paper, written by Apex Vice President of Solutions and Services, Carrie Romandine, discusses the importance of patient segmentation and messaging specifically related to the patient revenue cycle. Applying strategic messaging that is tailored to each patient type will not only better educate consumers on payment options specific to their billing needs, but it will maximize the amount collected before sending to collections. Further, targeted messaging should be applied across all points of patient interaction (i.e. point of service, customer service, patient statements) and analyzed regularly for maximized results.
Jim Bohnsack, vice president, solution & corporate development for Conifer Health Solutions, explains how the company helps healthcare providers leverage data to deliver better outcomes while optimizing reimbursement for all payment arrangements.
This white paper, written by Apex President Patrick Maurer, discusses methods to increase patient adoption of online payments. Providers are now seeking ways to incrementally collect more payments due from patients as well as speeding up the rate of collections. This white paper shows why patient-centric approaches to online payment portals are important complements to traditional provider-centric approaches.
Steve Scibetta, senior director of channel sales for Ontario Systems' healthcare product line, shares insights into effectively managing receivables.
Increased electronic engagement between healthcare providers and patients provides significant opportunities for improving revenue cycle metrics and encouraging patients to access EHRs. This article, written by Apex Founder and CEO Brian Kueppers, explores a number of strategies to create synergy between patient billing, online payment portals and electronic health record (EHR) software to realize a high ROI in speed to payment, patient satisfaction and portal adoption for meaningful use.
Elena White, vice president of risk, quality, and network solutions for Optum, discusses how healthcare providers can leverage data and technology as they enable risk in their organization.
Faced with a rising tide of bad debt, a large Southeastern healthcare system was seeing a sharp decline in net patient revenues. The need to improve collections was dire. By integrating critical tools and processes, the health system was able to increase online payments and improve its financial position. Taking a holistic approach increased overall collection yield by 10% while costs came down because the number of statements sent to patients fell by 10%, which equated to a $1.3M annualized improvement in patient cash over a six-month period. This case study explains how.
Somnia President and CEO Marc Koch, MD, MBA, explains how hospitals can drive transformative change in the perioperative experience for outstanding clinical and financial outcomes.
With the ICD10 deadline quickly approaching and daily responsibilities not slowing down, final preparations for October 1 require strategic prioritization and laser focus.
PMMC President Roger L. Shaul discusses the effects of healthcare reform on revenue cycle management and how PMMC's products help clients adapt to a changing financial environment.
Read how Gwinnett Medical Center provides clear connections to financial information, offers multiple payment options for patients, and gives onsite staff the ability to collect payments at multiple points throughout the care process.
Greg Burgess, Founder and Chief Product Officer at Burgess Group shares insights and opportunities for payment integrity in the rapidly changing healthcare IT landscape.
Read how Orlando Health was able to perform deeper dives into claims data to help the health system see claim rejections more quickly–even on the front end–and reduce A/R days.
To maintain fiscal fitness and boost patient satisfaction and loyalty, healthcare providers need visibility into when and how much they will be paid–by whom–and the ability to better navigate obstacles to payment. They need payment clarity. This whitepaper illuminates this concept that is winning fans at forward-thinking hospitals.
Financial services staff are always looking for ways to improve the verification, billing and collections processes, and Munson Healthcare is no different. Read about how they streamlined the billing process to produce cleaner bills on the front end and helped financial services staff collect more than $1 million in additional upfront annual revenue in one year.
Effective revenue cycle management can be a challenge for any hospital, but for smaller providers it is even tougher. Read how Wallace Thomson identified unreimbursed procedures, streamlined claims management, and improved its ability to determine charity eligibility.
Before launching an energy-efficiency initiative, it’s important to build a solid business case and understand the funding options and potential incentives that are available. Healthcare leaders should consider taking the steps outlined in the whitepaper to ease the process of gaining approval, piloting, implementing, and supporting sustainability projects. You will find that investing in sustainability and energy efficiency helps hospitals add cash to their bottom line. Discover how hospitals and health systems have various options for funding energy-efficient and renewable-energy initiatives, depending on their current financial structure and strategy.
Health care is a dynamic mergers and acquisitions market with numerous hospitals and health systems contemplating or pursuing formal arrangements with other entities. These relationships often pose a strategic benefit, such as enhancing competencies across the continuum, facilitating economies of scale, or giving the participants a competitive advantage in a crowded market. Underpinning any profitable acquisition is a robust capital planning strategy that ensures an organization reserves sufficient funds and efficiently onboards partners that advance the enterprise mission and values.
The success of healthcare mergers, acquisitions, and other affiliations is predicated in part on available capital, and the need for and sources of funding are considerations present throughout the partnering process, from choosing a partner to evaluating an arrangement’s capital needs to selecting an integration model to finding the right money source to finance the deal. This whitepaper offers several strategies that health system leaders have used to assess and manage capital needs for their growing networks.
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