Medicare regs require new privacy procedures
Medicare regs require new privacy procedures
Hospitals' roles in aiding compliance unclear
Medicare+Choice program beneficiaries now have more protections through regulations ordered by the Clinton administration and published in the June 26, 1998, Federal Register.1 The rules were scheduled to take effect 30 days after publication date.
Included in these regulations are rules governing the confidentiality and accuracy of enrollee medical records. According to the rules, a health plan providing care as a Medicare+Choice (M+C) organization must establish procedures to do the following:
r Safeguard the privacy of any information that identifies a particular enrollee. Information from, or copies of, records may be released only to authorized individuals, and the M+C organization must ensure that unauthorized individuals cannot gain access to or alter patient records. Original medical records must be released only in accordance with federal or state laws, court orders, or subpoenas.
r Maintain the records and information in an accurate and timely manner.
r Ensure timely access by enrollees to the records and information that pertain to them.
r Abide by all federal and state laws regarding confidentiality and disclosure for mental health records, medical records, other health information, and enrollee information.
The rules give little guidance on how health plans should establish these procedures nor do they explain what an accurate and timely manner is. For the most part, experts are still wading through the 165,000 words of rules before making an evaluation of their content.
When details of the regulations were published in The New York Times and other media, the American Health Information Management Association (AHIMA) in Chicago issued a statement from Linda L. Kloss, RRA, AHIMA vice president and CEO.
"On behalf of its 38,000 members, the American Health Information Management Association thanks the Administration in advance for establishing rules that would protect the confidentiality of senior citizens' and other Medicare enrollees' health information. We are especially pleased with reports that the Administration's rules include limits on the redisclosure of health information by insurers. If that's the case, the unchecked flow of Medicare patients' information from health plans to unauthorized third parties would be stemmed," she says.
"AHIMA also is pleased with reports that the rules would give patients the ability to gain access to their medical records. This would allow patients to play a role in ensuring that their health information is timely and accurate. AHIMA urges Congress to follow the Administration's lead and pass legislation extending these kinds of protections to all Americans," Kloss notes.
"We pledge our association's continuing support and expertise to the Administration and to Congress in this endeavor as we have for the past several years," she adds.
In future issues, Hospital Payment & Information Management will continue to follow up on these developing rules and find out what role hospitals will play in aiding health plan compliance.
Reference
1. 63 Fed Reg 34,968 (June 26, 1998).
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