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Jennifer,
I believe you are right, and the ICS is wrong.
The HIPAA acknowledgment of receipt of NPP is
independant of the Illiniois-required Authorizations
to Treat and File Insurance. You can not refuse to treat denial of
that acknowledgment.
There is also nothing in HIPAA that applies a different
privacy requirement on the Physician as opposed to the Physician's staff (ecxept
for psychotherapy notes). A Provider's office may bill and file insurance
if the NPP receipt acknowledgement is not signed. It does need to document
the good-faith attempt to deliver a copy of the NPP, and the refusal to
acknowledge receipt.
You can't treat if the patient was able to authorize
treatment, and didn't authorize you to treat.
If the patient refused to allow you to file insurance, I
believe that you could refuse to treat until a satisfactory method of payment
had been establised.
It does get confusing, since there so many things that require
a signature (either allowing these or explicitly denying them):
- Acknowledgement of receipt of NPP
- Authorization to Treat
- Authorization to Release information for Billing and
Insurance
- Authorization to release directory information
- Authorization to use PHI for Operations
- Authorization to release PHI to certain individuals or groups
or indviduals
- Authorization for payer to send payment directly to
Provider
- Authorization for Assignment of Benefits
- etc (there's probably something I overlooked)
The first one is the only one required by HIPAA. The
pateint can explicitly deny most uses of PHI. In many cases, the provider
does not have to accept the denial, but then must document why.
The opinions expressed here are my own and not necessarily the opinion of
LCMH.
Douglas M. Webb Computer System Engineer Little Company of Mary
Hospital & Health Care Centers [EMAIL PROTECTED]
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----- Original Message -----
Sent: Monday, September 22, 2003 09:46
AM
Subject: Re: Refusal to sign consent
form
State law does prevail, however, that was not my
question. The question is: If a patient refuses to sign the acknowledgement of
the providers attempt to comply with Hipaa, you then document the
patients refusal to sign; can you then deny patient treatment based on the
refusal and your documentation? Nothing about signing for benefits. That's
another circumstance. I was told the Illinois Chiropractic Society is
giving the message to its providers that they must refuse service to patients
who do not sign the acknowledgement. Their interpretation is the Dr.
would then be the only one who could generate/transmit claims, do patient
billing, etc. No other office personnel could touch the patient records. I
said that the documentation of the refusal is in alliance with the
interpretation of the Hipaa laws. It in no way would affect whether treatment
should or should not be provided. What do you think?
Jennifer
----- Original Message -----
Sent: Monday, September 22, 2003 7:49
AM
Subject: Re: Refusal to sign consent
form
Andy,
Quite right. We all need to remember that a
more-restrictive State Law trumps HIPAA
With these state law requirements, technically, can a
provider do anything other than hand the patient a bill without those
authorizing signatures? But again, in an emergency, treat first, and
do the paperwork later.
The opinions expressed here are my own and not necessarily the opinion
of LCMH.
Douglas M. Webb Computer System Engineer Little Company of Mary
Hospital & Health Care Centers [EMAIL PROTECTED]
"This electronic message may contain information that is confidential
and/or legally privileged. It is intended only for the use of the
individual(s) and entity(s) named as recipients in the message. If you
are not an intended recipient of the message, please notify the sender
immediately, delete the material from any computer, do not deliver,
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----- Original Message -----
Sent: Friday, September 19, 2003
04:43 PM
Subject: RE: Refusal to sign consent
form
Illinois law requires you to get patient consent -- not
HIPAA consent, but Illinois law -- for treatment, payment, and health care
operations. You can assume the patient wants treatment, as they are
sitting in your office. Can you assume, without a signature, that
they allow you to bill or conduct health care operations? Absolutely
not. If they do not consent for you to use their information for
billing, then technically you cannot bill. If they do not consent to
allow you to conduct health care operations, then again you technically
cannot do such. This is NOT a HIPAA requirement. This is an
Illinois state law requirement. And it is intended to make sure
patients are informed and understand their rights.
Of course, you
should always treat in urgent and emergent situations and worry about the
paperwork later. And you must never abandon a patient (as defined in
law).
Hope this helps.
And please, look at state laws before
you slam the advice being offered
locally.
===============================================
The
opinions expressed in this message are mine only, and do not reflect the
opinion or position of my
employer.
-------------------------------------------------------------------------------------
Andrew
H. Melczer, Ph.D.
Vice President, Health Policy Research
Illinois
State Medical Society
20 N. Michigan, Suite 700
Chicago, IL
60602
312-580-2468
FAX: 312-782-1654
E-mail: mailto:[EMAIL PROTECTED]
-----Original
Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED]
Sent: Thursday, September 18, 2003 3:32
PM
To: WEDI SNIP State & Government Agencies Subworkgroup
List
Cc: WEDI SNIP State & Government Agencies Subworkgroup
List
Subject: Re: Refusal to sign consent form
Okay, this is
it. We are all in the healthcare business serving people in
some
way - through technology, services, etc. Why in the world would
anyone
ever refuse treatment to a person in this situation? Not
only does that not
make sense; it is bordering on unethical and
certainly is not within any part
of the spirit of HIPAA.
Rarely
do I comment on these listserves, but I feel I must go on record as
saying that we must be wary of advice that goes against all areas of
common
sense and personal integrity.
> Jenifer,
> That
state association is wrong.
>
> If the patient refuses to
acknowledge recipt of your NPP, you document the
> refusal, and
proceed to treat the patient (assuming that you have the proper
>
authorizations to treat, which are totally independant from the privacy
> authorizations). In an emergency situation, remember the
maxim, "treat first,
> ask questions later".
>
> You
may also file insurance claims (but don't have to unless some other law
> requires you to [usually referring to Medicare or
Medicaid]). The closest field
> in the claim that refers to
the recepit is the "Release of Information" Code in
> CLM09.
The various claim signature indicators need to be reworked to indicate
> what has been signed properly (the CLM09 definition is not the
same as the NPP
> acknowledgment), but your NPP (whether it is
acknowledged or not) allows you to
> issue claims unless there is
an explicit signed statement forbidding it. I
> would assume
that your form for such a statement would also state "Cash in
>
Advance".
>
> The opinions expressed here are my own and not
necessarily the opinion of LCMH.
>
> Douglas M. Webb
>
Computer System Engineer
> Little Company of Mary Hospital &
Health Care Centers
> [EMAIL PROTECTED]
>
> "This
electronic message may contain information that is confidential and/or
> legally privileged. It is intended only for the use of the
individual(s) and
> entity(s) named as recipients in the
message. If you are not an intended
> recipient of the message,
please notify the sender immediately, delete the
> material
from any computer, do not deliver, distribute, or copy this message,
> and do not disclose its contents or take action in reliance on
the information
> it contains. Thank you."
>
>
>
> ----- Original Message -----
> From: Jennifer Graf
> To: WEDI
SNIP State & Government Agencies Subworkgroup List
> Sent: Thursday, September 18, 2003 11:51
AM
> Subject: Refusal to sign consent form
>
>
> Question: What if you have a patient that
refuses to sign a consent form to
> protect their patient health
information? Example: The clinic has a cover sheet
> designed to
inform the patient of the clinics' compliance with the Hipaa
>
regulations and ask that the patient sign the form. If patient refuses to
sign
> this acknowledgement - patient can still receive treatment,
can't they? My
> understanding of the rule is we are only required
to make the reasonable effort
> and if the patient refuses, are we
to kick them to the curb? There is a state
> association in
Illinois offering classes on Hipaa telling offices they must do
>
exactly that. Kick the patient to the curb.
> What does
the group say?
> Jennifer Graf, CMIS
>
HIPAA Compliance/Security Officer
>
EC&PMS
> 2100 So 21st St STE B
>
Clinton IA 52732
> 563-242-1170
> FAX:
563-243-0574
>
> CONFIDENTIALITY NOTICE:
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