Submit your HIPAA questions to Associate Editor Nicole Votta at [email protected] and we will work with our experts to provide you with the information you need.

Q: My office manager at an outpatient practice revealed to two employees that I’m a recovering alcoholic. I’m a midlevel practitioner and a patient of one of the physicians in the practice. Is this a HIPAA violation?

A: It may be a HIPAA violation because you are a patient of the practice. If the office manager accessed your medical record or learned of your condition during a conversation with your physician, it would be a violation of the HIPAA Privacy Rule. On the other hand, if the office manager disclosed information about your medical condition and it did not relate to treatment at the clinic (say, the information came from a job interview with you or was documented in your personnel file), it would not be a HIPAA violation because the information was available to your office manager acting as the employer. It may still be a violation of state law or other federal law, but it would not be a HIPAA violation.

Editor’s note: Chris Apgar, CISSP, president of Apgar and Associates in Portland, Oregon, answered this question for HCPro’s Briefings on HIPAA newsletter. This information does not constitute legal advice. Consult legal counsel for answers to specific privacy and security questions.

HCPro.com – HIM-HIPAA Insider

Submit your HIPAA questions to Associate Editor Nicole Votta at [email protected] and we will work with our experts to provide you with the information you need.

Q: Can you self-deny a claim after you’ve already received Part A payment for it?

A: Yes. Even if you have already received payment, it is your responsibility to always ensure the services billed to Medicare were correctly paid and any overpayment refunded. If upon review you believe there is a case that did not meet medical necessity requirements, even though you had already billed it to Medicare and received payment under Part A, it is your responsibility to correct that overpayment. This would happen if the patient is here and nobody flags the stay as possibly not appropriate or medically necessary under Part A while the patient is here and then discharges the patient. The claim would be submitted as usual and paid. Then, subsequently, the utilization review committee may be looking at cases that were one-day stays or meet other criteria they have set up for review, and upon review they determine the case does not meet medical necessity requirements for payment under Part A. Once that determination is made, the hospital would have to refund the Part A payment to Medicare by submitting an adjustment claim on a Type of Bill (TOB) 110. When that processes, and the hospital refunds the patient any copay or deductible that may have been collected, they can then proceed with the inpatient Part B billing. This makes the process more complicated than if the original Part A claim is a no-pay claim (TOB 110), and it takes a little longer to get through, but in the end the result is the same: no Part A payment and instead payment under Part B through billing an inpatient Part B claim.

Editor’s note: Chris Simons, MS, RHIA, HIM director and privacy officer at Maine General Medical Center in Augusta, Maine, answered this question for HCPro’s HIM Briefings newsletter. This information does not constitute legal advice. Consult legal counsel for answers to specific privacy and security questions.

HCPro.com – HIM-HIPAA Insider

Submit your HIPAA questions to Associate Editor Nicole Votta at [email protected] and we will work with our experts to provide you with the information you need.

Q: What is the recommendation for retaining hard copies of medical records once they have been transferred to an EMR system?

A: This varies quite a bit depending on your storage capabilities and state retention laws. I am aware of some organizations that keep these records for 3–6 years (until the statute of limitations has run out), but this is a very conservative approach. I have also seen six months and one month. I would suggest ensuring you have a rigorous scanning quality control process to reassure yourself that you in fact have the scanned documents and they are readable. I would recommend that you keep the hard copies for at least one month after scanning. You might also want to consult legal counsel on this matter.

Editor’s note: Chris Simons, MS, RHIA, HIM director and privacy officer at Maine General Medical Center in Augusta, Maine, answered this question for HCPro’s HIM Briefings newsletter. This information does not constitute legal advice. Consult legal counsel for answers to specific privacy and security questions.

HCPro.com – HIM-HIPAA Insider