Protected Health Information Policies and Procedures
A. Privacy Rules.
II. Privacy Rules - Definitions
The Health Insurance Portability and Accountability Act (HIPAA) mandated that the Department of Health and Human Services create federal regulations to set standards for the use, disclosure, safeguarding, tracking and disposal of Protected Health Information (PHI). In order to assure adherence to those regulations Metro Medical Billing, Inc. has adopted the following policies and procedures.
B. Privacy Rules Summary
1. Identify what information and entities are covered
C. Metro Medical Billing, Inc. has adopted the following policies and procedures to assure compliance with the federal privacy rules.
2. Define which health information may be used and disclosed with and without the patients consent
3. Requires providing written notice to the patient describing the covered entity’s privacy policies
4. Requires a good faith effort to secure the patient signature on the privacy rights notice
5. Authorizes patients to request a restricted use and disclosure of certain health information
6. Gives patients the rights to review their health records
7. Requires covered entities to track and log certain disclosures of health information
8. Requires the appointment of a privacy officer
9. Requires covered entities to establish written agreement with their business associates
10. Mandates reasonable safeguards for the handling of patients records
11. Allows the states to adopt and enforce privacy rules if they are more stringent that federal rules
A. Covered Entity - Defined. The Privacy Rules apply to all covered entities and their business associates. A covered entity is defined as a health care provider, and health plan or a health care clearing House.
1. A health care provider is "…a provider of medical or health services…or any other person or organization who furnishes, bills, or is paid for health care in the normal course of business."
B. Protected Health Information (PHI) defined. PHI is defined by the Privacy rules as information (including demographics) collected from an individual by a health care provider, employer or health plan which relates to past, present, or future physical or mental health care or conditions of an individual or the provision of health care to an individual and which identifies the individual or could be reasonably believed to allow the identification of the individual.
2. A health plan is - "…an individual or group plan that provides, or pays the cost of medical care…"
3. A health plan clearing house is -"…a public or private entity including a billing service…that processes or facilitates the processing of health information."
C. Business Associate - defined. A business associate, a “…person who…performs, or assists in the performance of…A function or activity involving the use or disclosure of individually identifiable health information, including claims processing or administration, data analysis, processing or administration, utilization review, quality assurance, billing or benefits management.
III. Permitted Uses of PHI
A. Uses of PHI - Without patient authorization. A covered entity may use PHI without the prior consent of the patient for: (1) the treatment of the patient; (2) to obtain payment for the care; (3) or for certain health care operations.
B. Uses of PHI - With patient authorization. PHI may also be used for any purpose authorized in writing in advance by the patient. If Metro Medical Billing, Inc. intends to use the PHI for any purpose other that described in above, a written authorization, signed by the patient is required. The authorization must identify all uses to which Metro Medical Billing, Inc. intends or expects the PHI may be used and for whom the PHI may be disclosed. A signed copy of the authorization will be kept in the patient medical record.
C. Minors. The federal privacy rules permit the disclosure of PHI to the parents of a minor patient, with or without the consent of the patient unless specific state laws restrict such disclosures.
IV. Authorization Policies and Procedures
A. General Policy.
1. Uses. It is Metro Medical Billing, Inc. policy that a signed authorization must be obtained before any PHI is used for any purpose other than that permitted by the privacy regulations. 2. Conditional Authorizations. Metro Medical Billing, Inc. will not require a patient to sign any authorization as a condition of health care billing.
B. Authorizations - Content. As required by the privacy regulations, All authorizations will contain (1) description and reason for the PHI Authorization (2) entity to which the PHI is to be released by Metro Medical Billing, Inc. (3) Signature and date line for the authorizing patient.
C. Authorizations - Reliance on Third Parties. If a third party provides Metro Medical Billing, Inc. any PHI for the purposes other than permitted in The privacy rule, Metro Medical Billing, Inc. shall require that third party to Provide it with a current valid authorization signed by the patient which expressly permit’s the intended use of the PHI.
V. Safeguarding PHI
A. Metro Medical Billing, Inc. employees.
Employees are not permitted to access or attempt to access PHI unless required as a part of their employment duties and only if expressly informed of their right to access the PHI by management. The privacy officer shall maintain a list of all employees authorized to have such access and the dates that access began and ended.
1. Disclosure to Third Parties. No Employee is permitted to disclose PHI to any third party unless such disclosures are required in order to carry out the employee’s job and only in accordance with these policies.
B. On-site Access by others. Any subcontractors, consultants, auditors, counsel, temporary employees, custodians or others with authorized access to Metro Medical Billing, Inc. property will be permitted access to PHI only as required to carry out their duties and only after signing either a confidentiality agreement, business associated agreement or similar agreement, which ever is most appropriate.
C. Electronic PHI (EPHI overview- see the full policy covering EPHI)
1. Storage. Access to all PHI created or stored in electronic format, shall be protected by commercially appropriate anti-hacker and anti-virus software. The data shall be backed up per Metro Medical Billing, Inc. policy and stored in a secure off site location. All archived PHI shall be maintained at a site with appropriate security to prevent unauthorized access.
D. Non-electric PHI
2. Access. All PHI access shall be exclusively through the use of Pre-assigned controls solely to authorized employees. Temporary access may be granted to consultants and others as deemed necessary. Unique passwords will be given and then removed after completion of assigned work.
1. Storage of all PHI shall be in locked file cabinets or locked Rooms which are secured to prevent access by unauthorized Access.
E. Copying and or Removal of PHI. No one is permitted to copy or remove PHI unless such copying is permitted disclosure to a third party or patient in accordance with the privacy rule. No one is permitted to remove any PHI from the premises unless to make a permitted disclosure.
F. Destruction and Disposal. When Metro Medical Billing, Inc. no longer requires PHI in whatever form, it shall be returned to the appropriate party as may be called for in a written agreement. Otherwise, all PHI whether paper or electronic or copies shall be destroyed in a commercially reasonable fashion designed to assure that it cannot be read or accessed.
VI. Disclosing PHI
A. General Policy. Metro Medical Billing, Inc. shall disclose PHI to third parties in accordance with the privacy rule.
1. Reporting Disclosures to patients. By regulation, each patient is permitted a single accounting of PHI disclosures once a year. All accountings to patient shall be made in writing and only if the request is received in writing and signed by the patient.
VII. Amending PHI
A. General Policy. Metro Medical Billing, Inc. will not alter, correct or delete PHI unless fully satisfied that the change is warranted and will result in the correction of a material error in the PHI.
B. Patient Request. Patients have a right to request their PHI be corrected. However, Metro Medical Billing, Inc. is required to make corrections requested by a patient only if the request is necessary to correct a material error in the PHI.
1. In Writing. Any patient request to change PHI shall be in writing, signed and dated by the patient and must state with clarity the reason for the reason for the requested changed. If Metro Medical Billing, Inc. declines to make the requested change, the patient will be informed of the decision and the reason for the action.
2. Decisions. Any decision to approve or refuse a patient's request shall be made to the security officer. The patient shall also be advised that Metro Medical Billing, Inc. reserves the right to inform all third parties to whom the inaccurate PHI was previously provided.
VIII. Effect of the State Privacy Laws
A. In General. The federal Privacy Rules create certain authorized Uses and restrictions on the use of PHI. The federal rules expressly Defer to the state privacy laws where those laws are more stringent Than the federal privacy rules.
IX. Privacy Officer
A. Appointment. The privacy rules require that all covered entities appoint a privacy officer responsible for assuring that the entity’s privacy policies are kept current and are being followed. Metro Medical Billing, Inc. has appointed Dan Devou to serve as its privacy officer.
X. Violation of Privacy Policies
A. General. The privacy rules impose substantial civil and criminal Penalties, including fines and imprisonment, on individuals and Entities which make uses or disclosures of PHI in violation of the rules.
B. Metro Medical Billing, Inc. Policy. Under some circumstances, Metro Medical Billing, Inc. can be held liable for the actions of its employees which violate the privacy rules. Metro Medical Billing, Inc. has therefore established specific internal discipline for employees.
XII. Metro Medical Billing, Inc. Discipline for Privacy Violations
Metro Medical Billing has adopted the above policies and procedures regarding the uses and safeguarding of PHI and EPHI. In order to increase the likelihood of adherence to these policies and procedures, Metro Medical Billing, Inc. has included the following specific forms of discipline for employees who violate those policies.
A. Employees - Non Disclosure. A violation of an internal policy or procedure which does not result in a prohibited use or disclosure of PHI. First Offense - Letter of reprimand. Second Offense - punishment up to but not including termination. Third Offense - Termination
B. Disclosure. A violation of an internal policy or procedure which does result in a disclosure of PHI:
Negligent disclosure - first offense: up to suspension
Second offense: Termination
Reckless or intentional disclosure - First offense: up to and including
Termination. Second offense: Termination
Disclosure for profit. First offense: Termination
Disclosure that results in embarrassment or ridicule to the patient or
Was intended to have such a result - First offense: Termination
Disclosure to the Media with the intent or expectation that it would Be published - First offense: Termination.
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