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Seniors and Asthma
What Patient Rights Are Provided by Health Insurance Portability
and Accountability Act (HIPAA)?
By Jan Tippett, RN
June 2003
The U.S. Department of Health and Human Services (HHS), privacy
regulations became final on April 14, 2001 and become mandatory April
14, 2003. These regulations create national standards to protect
individuals’ personal health information and give patients increased
rights relative to their medical records whether those records exist in
paper or electronic form. “Protected health information” is defined as
that which is “individually identifiable and maintained by a covered
entity”.
Covered entities are defined in HIPAA as 1. health plans, 2. healthcare
clearing houses 3. health care providers that transmit any health
information in electronic form for healthcare claims, payment and
remittance advice; benefits coordination; health plan eligibility,
enrollment, disenrollment or premium payments; referral certification
and authorization.
Each time you visit a physician, health care provider or hospital, a
record of your visit is made. Typically, this record contains a
description of your symptoms, medical history, examination and test
results, diagnoses, treatment and a plan for future care. This protected
health information, often referred to as your medical record, serves as
a:
- Basis for planning your care and treatment
- Means of communication among the health professionals who
contribute to your care
- Legal documents of the care you receive
- Means by which you or a third-party payer (e.g. health insurance
company) can verify that services you received were appropriately
billed
- A data source for medical research and public health
- A tool for educating health professionals
- A tool with which we can assess and work to improve the care we
provide
Understanding what is in your record and how your health information
is used helps the patient to ensure its accuracy; better understand how
others may access and use your health information; and make more
informed decisions when authorizing disclosures to others.
Patient Health Information Rights Under HIPAA
Increased patient rights will allow patients to do the following:
- Receive a written notice from their health care provider
explaining how the provider will use and disclose patient information.
- Access and copy their own protected healthcare information.
- Request that an amendment be made to their own protected health
care information.
- Request that certain information be restricted from uses or
disclosures that would otherwise be allowed.
- Request that their own protected health information be
communicated in a way that ensures confidentiality (e.g., a request
that billing notices be sent to an address other than a home address).
- Authorize the release of their own information for purposes not
related to treatment, payment or healthcare operations.
- Receive an accounting of those disclosures of protected health
information that are not related to treatment, payment or healthcare
operations.
- Right to file a complaint about privacy practices or about a
privacy violation of their protected health information.
In summary, the three basic goals provided to patients by HIPAA:
1. Protect medical privacy
2. Maintain patient information and billing process in compliance with
national standards.
3. Provide appropriate security of patient records.
HIPAA Glossary of Terms
|
Term |
Definition |
|
HIPAA
|
Health Insurance Portability and Accountability Act |
|
HHS
|
U.S. Dept. of Health and Human Services |
|
Covered Entity
|
1. Health Plan
2. A clearinghouse
3. A health care provider who transmits any health information in
electronic form in connection with your health care. |
|
Protected Health Information |
Any information about a patient that has been received, created, or
stored by Covered Entity
|
|
Treatment
|
Provision, coordination or management of a patient’s care, including
consultation between providers and referrals. |
|
Payment
|
Activities related to paying or being paid for services rendered,
including eligibility and coverage determinations, billing, claims
management and utilization review |
|
Healthcare operations |
Broad range of activities, including: quality assessment, education
and training of patients and healthcare professionals, contracting
for health services, medical review, business management and
administrative activities.
|
|
Business Associates |
Example: Transcribers of your medical records, copy service |
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