If a patient comes into your office with a post cataract op rx and wants to bill the glasses to medicare, (and this is not a previous patient of yours that had been referred from you) do you have to have the patient sign a records release form to get dates of surgery and any other pertinent info (like which eye, what dr.) from the opthalmologist to be able to file the glasses, or are you able to just call the other office and get the info?
Technically, you always need the records release.
However, in practice, it depends on the MD's staff. Typically, I call with the patient's DOB and address, which they verify, and they tell me the dates of surgery.
I don't recall that the Privacy Rule speaks to obtaining personally-identifiable health-related information at all. It's all about the circumstances under which such information can be disclosed to others; and it includes an exception for treatment. That is, you can disclose information to a third party who is providing treatment services of some kind (like making lenses).
The M.D. from whom you seek the necessary information may believe that some kind of permission is necessary for him to release the information (even for treatment purposes, though I believe that's incorrect - but hey, that's just my reading, and recollection, of the Rule). She probably had the patient sign something that allows her to release information for treatment purposes in any case. Whether to release the information is her (the M.D.'s) problem.
States may have more rigid requirements, but these usually cover information of a more sensitive nature than spectacle Rx's.
Originally Posted by EyeFitWell
From what I read under Section 2:Common uses and disclosures it states:
Under the HIPAA Privacy Rule, covered entities are allowed to disclose PHI without a signed authorization for treatment, payment, or health care operations reasons. From what I can gather, it would come down to whether you consider making and dispensing glasses is a Health Care Operation or treatment for payment?
Under these circumstances, if you are unable to bill glasses without the info and if the patient clearly knows that and they are handing you an rx (which I woudl assume is PHI in the first place)from an entity that doesn't even have the means to fill the rx (doesn't sell glasses) wouldn't you think that it's a bit overkill to have them have to sign it?
What is your opinion on this matter?
Last edited by Ladyoptician; 12-01-2006 at 09:22 AM. Reason: left something out
Shanbaum,
I agree with your point about a release being unnecessary for treatment purposes. However, if that were the case in practice, why would you need a record's release for an office to fax you a prescription or fax you a patient's exam sheets?
In my opinion, the decision is made by the office disclosing such information. I've delt with local offices who were happy to tell me everything I ever wanted to know about a person w/o even verifying a DOB or address! On the other hand, I've had offices request a record's release before they'd even let me know if a patient had been seen there. At the end of the day, if they want a record's release, you'll have to give it to them or you won't get your information.
My opinion is, making and fitting eyeglasses is treatment.
I'm not sure you grasped my point, Ladyoptician; the "release" issue is the M.D.'s, not yours. As EyeFitWell correctly suggested, you can't force the M.D. to release information. And if the M.D. insisted on you getting the patient to provide you with written permission to seek the records before they would release them, I guess you'd have to do it, but it wouldn't have anything to do with HIPAA. And if they thought they needed permission to release the information, they should obtain it, not you.
Yes, I am very clear on the point that I am at the mercy of the doc holding the info and I am in no position to force the info, but my issue with this whole thing is this:
If a patient is post op and the opthalmologist does not sell glasses and knows full well a patient has to have the date of surg, which eye, and the doc that performed the surgery to bill the glasses to medicare, why would they not go ahead and explain this to the patient and get them to sign a release right then and there to prevent any delay in payment or receiving the glasses? Or even better yet, put the info on the rx itself?? What patient would decline this info being released??
If the Dr didn't write the surgery info on the Rx, I would always try to see if the patients had their implant cards in their wallet. Surprisingly, a lot of patients to carry this with them ~ hope that helps
Are you having a problem with an M.D. actually refusing to release information?
I can't explain why an M.D. wouldn't do as you suggest, other than the fact that the actual, as opposed to imagined, requirements of HIPAA are generally misunderstood.
I agree with Lady, and I'm guessing it's more the principal of the thing and the time delay/pita. The MD who send tons of patients to us does put this on the Rx. We appreciate that. I think it makes sense, but I wouldn't know how to go about asking local MD's to do so if they don't already.
Yes, I absolutely did! This was a patient that had great difficulty getting here in the first place and I couldn't see dragging her all the way in here to get the stupid form signed. It took me several days to even contact her to tell her about the situation. After a couple of days of debate on the issue, they finally decided if I could get her to call or a family member, they would give them the info over the phone. She is also a bit disoriented as well and to get the info third hand from her, was a reach. After much debate and going to the top of the heap, I finally got the info. This whole process took a total of TEN DAYS! It was a ridiculous waste of time in my eyes.
My office put together a short form to be sure we had all our info before the patient left the office in cases when we'd file medicare.
If you guys worked up something like that, you could call the MD office while she was in your store and put her on the phone to give permission. I'd suggest that if you get any more Rxs from that doctor, you try to get the dates while your customer is still present to provide any permission they require!:cheers:
Oh, if you only knew who we are dealing with!!LOL! That is a joke for this office. It normally takes at least 2 or 3 DAYS to get any info from them with a release form signed!!! Whether the patient is standing there or not! And the really bad thing is, they are the only place within about a 75 mile radius that does cat surgery. It is a factory and all they care about is moving them in and out as fast as possible.
Awe man...that sucks.
If the patient signed the hippa release at the Md's office to allow records to be released then you do not have to have them sign another. If the patient did this, the MD cannot refuse the release unless treatment hasn't been completed for some reason.
Really? What regulation requires the MD to release anything (other than the FTC's Release Rule, which doesn't extend beyond the Rx)?
No guarantee the patient will still have this, or be coherent enough to know what it is. But unless the ruled have changed I think it's required with IOL's to give the patient a card (many have these in thier wallet unbenonest to thelm) that identifies the IOL, the surgeon and the date of surgery.
Chip
Why not have the patient provide you with that info. They surely know which dr, which eye, and somewhere they have the surgery date written down, if they don't carry the IOL card. I usually get the order and have them call me with the info. You can't bill m/c until the glasses are delivered anyway.
Tried that. Most of them don't remember and will guess at the date and which eye. They usually have them done within 2 weeks of each other and won't remember which one was done last. If we don't file the exact date and eye, it won't be approved. I have never seen or heard of an IOL card, been doing this over 9 years.....what is it?
I may be going out on a limb here but I am sure that IOL cards are required to be given to patients, esp now that bi focal IOLs are around. They are the size of credit cards and list the Dr ID number (soon to be NPI) date of surgury, which eye, and the info about the actual implant. Just ask for the card the Dr gave them, prod them a bit like they should have it and if they do not have them call the Dr all upset. You will get it then. ;)
The MD will give the patient a card to carry with them. The card indicates that they have a foreign body implanted in their body. The card will tell you the surgery date, which eye was operated, and the IOL manufacuter.
Is this required of the MD? If so, who enforces it?
I meant the rx.
HIPAA violations are enforced by the US Justice Department. Additionally, many states have rules regarding disclosure or failure to secure private medical records. These are enforced by the various state attorney general's offices. One of the more recent federal rules is the requirement for all payroll records to be kept in a locked cabinet. The rules just keep coming.
Last edited by LKahn; 12-04-2006 at 02:04 PM. Reason: typo
I don't know the answer to that. I just know that all of the doctors here provide the card to their patients. Maybe you should call one of your doctors and find out.
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