HIPAA POLICY REGARDING USE AND DISCLOSURE OF PHI FOR TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS INCLUDING SPECIAL HIPAA RULES REGARDING USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION (PHI) FOR MARKETING PURPOSES.
SCOPE OF POLICY:
All offices of Meagan Moore, MD are covered by this policy:
What Personnel Are Covered by this Policy? This policy applies to health care providers, clinical and all employees who assist these providers in performing tasks related to health care.
PURPOSE OF POLICY: The purpose of this policy is to set forth the standards for the use of a patient's or subject's (the "Individual") Protected Health Information (PHI) for treatment, payment, and health care purposes.
DEFINITIONS:
Covered Entity: health plan; healthcare clearinghouse; or a health care provider who transmits any Health Information in electronic form in connection with a transaction covered under the HIPAA regulations.
Health Information: Any information whether oral or recorded, in any form, that is created or received by Meagan Moore, MD that related to an Individual's past, present, or future physical health, or to the payment of such health care.
Health Care Operations: Any of the following activities of the Meagan Moore, MD Covered Component to the extent that the activities are related to the functions of the Meagan Moore, MD Covered component that make it a health plan, health care provider or a health care clearinghouse:
- (a) health care protocol development (excluding research protocol development)
- (b) case management and health care coordination;
- (c) contacting health care providers and patients with information about treatment alternatives;
- (d) accreditation, certification, licensing or credentialing activities;
- (e) conduction or arranging for medical review, legal services, and auditing functions, including fraud and abuse detection and compliance programs.
Individually Identifiable Information: Health Information, including demographic information, that identifies the Individual or with respect to which there is a reasonable basis to believe the information can be used to identify the Individual.
Marketing: Marketing is:
(1) An arrangement between a Covered Entity and any other entity pursuant to which the Covered Entity discloses PHI to the other entity, in exchange for direct or indirect remuneration, for the other entity or its affiliate to make a communication about its own services that encourages the recipient of the communication to use;
(2) Making a communication about a service that encourages the recipient of the communication to use the service unless the communication is made:
- (a) to describe a health related service (or payment for such service) that is provided by, or included in a plan of benefits provides by the Covered Entity that is making the communication (including communications about entities that are participating in a health care provider network or health plan network, or about replacement of or enhancement to a health plan; and health related services available only to a health plan enrollee that add value to, but are not part of a plan of benefits);
- (b) for treatment of the Individual;
- (c) for case management or care coordination for the Individual;
- (d) to direct or recommend alternative treatments, therapies, health care providers or setting of care to the Individual.
Protected Health Information (PHI): Individually Identifiable Health Information that is transmitted by electronic media or transmitted or maintained in any other form or medium.
POLICY:
General Rule: The Meagan Moore, MD Covered Component may use and disclose PHI for Treatment, Payment and Health Care Operations purposes without first obtaining a written authorization (that contains all HIPAA-required elements) from the Individual who is the subject of the PHI, provided that the use or disclosure falls within one of the following categories:
- (a) the Meagan Moore, MD Covered Component may use or disclose an Individ PHI for it own Treatment, Payment or Health Care Operations;
- (b) the Meagan Moore, MD Covered Component may disclose an Individual's for the treatment activities of a health care provider;
- (c) the Meagan Moore, MD Covered Component may disclose an Individual's PHI to another Covered Entity or a health care provider for the payment activities of the entity that receives the PHI;
- (d) the Meagan Moore, MD Covered Component may disclose an Individual's PHI to another covered entity for the Health Care Operations of the entity that receives the PHI if each entity either has, or had, a relationship with the Individual; the PHI pertains to the relationship; and the disclosure is for quality assessment, quality control or peer review purposes or for the purpose of health care fraud, and about detection or compliance.
Consent: Although the Meagan Moore, MD Covered Component is not required to obtain an Individual's authorization for the use of PHI for the treatment, payment and health care operations purposes in order to comply with HIPAA, it is permitted under HIPAA to obtain an individula's consent to such uses/disclosures.
PROCESS/PROCEDURE:
Consent for Treatment: The Meagan Moore, MD Covered Component should continue to obtain a signed consent for treatment for each Individual who receives health care services. This consent for treatment may contain a consent to the use and disclosure's of the individual's PHI for treatment, payment and health care operations purposes; however, for uses and disclosures of PHI for the HIPAA purposes outlined above under the General Rule, a HIPAA authorization is not required.
APPLICABILITY OF MINIMUM NECESSARY AND ACCOUNTING RULES:
Minimum Necessary Rule: The Minimum Necessary Rule does not apply to disclosures made for treatment purposes. The Minimum Necessary Rule does apply to any other uses and disclosures permitted under this policy that are not made to the Individual or made pursuant to the written authorization of the Individual.
Accounting Rule: The Meagan Moore, MD Covered Component is not required to keep records accounting for the disclosure of PHI used for Treatment, Payment and Health Care Operations purposes permitted under the policy, or for disclosures made to the Individual or pursuant to the written authorization of the Individual. Records of all other disclosures permitted hereunder must be maintained in order to provide an Individual with an accounting of such disclosures upon her request. These records must be maintained for a period of six years following the date of the disclosure.
HEALTH INFORMATION EXCHANGE:
This practice is participating in the Hoag Health Information Exchange (HIE), an electronic system through which it and other participating healthcare providers can share patient information according to nationally recognized standards and in compliance with federal and state law, that protects your privacy. Through the HIE, your participating providers will be able to access information about you that is necessary for your treatment, unless you choose to have your information withheld from the HIE by personally opting out from participation.
If you choose to opt out of the HIE (that is, if you feel that your medical information should not be shared through the HIE), We will continue to use your medical information in accordance with this Notice of Privacy Practices and the law, but will not make it available to others through the HIE.
To opt out of the HIE, please contact the Hoag Director of Health Information Exchange in writing at One Hoag Drive, Newport Beach, CA 92663, or by telephone at 949/764-8722.
I acknowledge receipt of HIPAA privacy policy: