Under the definition of "health care operations", found in section 164.501, item (4) of that definition includes, "Conducting or arranging for medical review, legal services, and auditing functions, including fraud and abuse detection and compliance programs".
I would take this to mean that the audit is part of TPO, and there for not a disclosure that needs to be accounted for. As a footnote, I'm not sure I agree with your implication that by mentioning the possibility of a type of disclsoure in your NPP you can relieve yourself of the obligations to account for such disclosures. The disclosures that should and should not be accounted for are ennumerated clearly in section 164.528(a)(1). I am not aware of any relief from these requirements through your NPP. Noel Chang -- Open WebMail Project (http://openwebmail.org) ---------- Original Message ----------- From: "Jim Moores" <[EMAIL PROTECTED]> To: "WEDI SNIP Privacy Workgroup List" <[EMAIL PROTECTED]> Sent: Wed, 05 Feb 2003 08:11:02 -0500 Subject: Recording Disclosures (was BA Agreement Questions) > Hi All, > > I agree with Noel's interpretation.... > > But, I would like to confirm a related Privacy implication: When you > disclose PHI to either the state or an auditing group that the state > hired, must you record that as a disclosure? Do you have to record the > disclosure at the individual level or can you just put a statement into > your NPP that this kind of disclosure could happen to the person's PHI? > > The main reason I ask the question really centers on what TPO consists > of. If the state audits, say an insurance company as a part of it's > oversight of all insurance companies, is that disclosure of PHI to > the state a part of TPO, since the insurance company doesn't have > any choice in the matter? Can the same be said for all regulatory > types of disclosures? > > All opinions expressed are my own and should not be construed to be > Medical Mutual or Antares Management Solutions official policy. > > Jim Moores - HIPAA Team Leader - Privacy > Antares Management Solutions > 23700 Commerce Park Road > Beachwood, Ohio 44122-5832 > > [EMAIL PROTECTED] > Phone: (216)292-1605 > Fax: (216)292-1619 > > > >>> "Noel Chang" <[EMAIL PROTECTED]> 02/04/03 10:36PM >>> > Is the audit being done at your request or are you required to > submit to the audit by the state? > > If you are initiating the audit then I'd say you should have a BA > agreement. > If the audit is being imposed on you by the state then I'd say no BA > is required. > > If the billing information you submit to the schools/nursing > homes/welfare > departments are for services you delivered to them, I don't see why > a BA > > agreement would be necessary. You are making a disclosure to obtain > payment. Such disclosures are specifically permitted, even if the > disclosure > is to the financially responsible party who is not the same person as > the > subject of the PHI. > > BA agreements are only necessary when you have a third party performing > a > covered function on your behalf. > > Noel Chang > > -- > Open WebMail Project (http://openwebmail.org) > > ---------- Original Message ----------- > From: "Teri Baskett" <[EMAIL PROTECTED]> > To: "WEDI SNIP Privacy Workgroup List" <[EMAIL PROTECTED]> > Sent: Tue, 4 Feb 2003 17:42:31 -0500 > Subject: BA Agreement Questions > > > I've met with my CFO and our Purchasing Mgr and we've figured out > > most of our vendor list. But we had a couple of questions I hoped > > someone could help with: > > > > 1. What do we do about auditors that come on-site to review records > > for payment/compliance. If i read this right, if the auditor is a > > govt agency (Medicaid or Medicare) then we don't need an agreement. > > But our state contracts with another company to audit our state > > contract funds. Do we have to have the BA with that company for that? > > > > 2. We have service contract agreements with several schools/nursing > > homes/welfare depts. In addition to the treatment piece, we also > > (of course) submit bills that include patient identifiers (name, SSN, > > address). Do we need BA's for those relationships? > > > > Teri Baskett > > Information Officer > > LifeSpring Mental Health Services > > > > --- > > The WEDI SNIP listserv to which you are subscribed is not moderated. > > The discussions on this listserv therefore represent the views of > > the individual participants, and do not necessarily represent the > > views of the WEDI Board of Directors nor WEDI SNIP. 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These listservs > should not be used for commercial marketing purposes or discussion > of specific vendor products and services. They also are not > intended to be used as a forum for personal disagreements or > unprofessional communication at any time. > > You are currently subscribed to wedi-privacy as: > [EMAIL PROTECTED] To unsubscribe from this list, go to the > Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a > blank email to [EMAIL PROTECTED] If you > need to unsubscribe but your current email address is not the same > as the address subscribed to the list, please use the > Subscribe/Unsubscribe form at http://subscribe.wedi.org ------- End of Original Message ------- --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-privacy as: [email protected] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org
