* Dueling privacy notices: Forming an OHCA
* Can we charge a fee for retrieving records under HIPAA?
* Watch for employee conflicts of interest in vendor gratuities

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Compliance Hot Topics: Billing and Coding, EMTALA, Stark, HIPAA

Question of the Week

Welcome to Compliance Monitor Q&A!

Our mission is to answer your difficult compliance questions-and your simple ones, too. To submit a question, send it to Compliance Monitor Q & A editor Laura Motta at lmotta@hcpro.com. We hope you enjoy this service and we welcome your feedback.

This week's questions

• Dueling privacy notices: Forming an OHCA
• Can we charge a fee for retrieving records under HIPAA?

• Watch for employee conflicts of interest in vendor gratuities

• Are you concerned that the new outliers rule will have a negative impact on your organization's reimbursement?

Q: We have a medical staff with more than 200 physicians, over half of whom are not employed by our medical center. These physicians have privileges only. They have raised the question of whether they must give their own notice of privacy practices to patients they treat inside the medical center. These patients have already received our center's notice. This notice clearly states that our center may share a patient's protected health information with all health care professionals involved in treatment This is a complicated issue for our organization because physicians cover for other physicians, or only perform consults on some patients. We do not believe that the intent of the Health Insurance Portability and Accountability Act (HIPAA) is for every physician to carry around his or her own privacy notice, but we could not find any specific reference to this in the regulation.

A: Many hospitals have chosen to form what is called an Organized Health Care Arrangement (OHCA) to address this very issue.

An OHCA is a clinically integrated health care system in which patients receive care from multiple providers. An OHCA consists of two or more covered entities that share protected health information for purposes of treatment, payment, and healthcare operations. Hospital physicians with staff privileges meet the requirements of an OHCA. In an OHCA, the hospital gives patients its notice of privacy practices, and that's the only one they get. All physicians who participate in the OHCA won't need to provide copies of their own notice to patients they treat in the hospital.

If your facility chooses to form an OHCA with the members of your medical staff, you must inform them of the arrangement and must provide them with the choice to "opt-out" of it. If physicians choose to opt-out, they are responsible for providing their own notice to the patients they treat.

Of note: Physicians participating in the OHCA must abide by the terms of the notice of privacy practices. Furthermore, the notice must clearly describe all covered entities to which it applies, as well as how the covered entities will share protected health information.

This question was answered by Stacie Buck, RHIA, LHRM, president, Health Information Management Associates, Inc.

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Are you documenting appropriately for diagnostic tests?

The Office of Inspector General is putting diagnostic tests ordered through the emergency room under the microscope. The government places a great deal of emphasis on whether diagnostic tests billed to Medicare are medically necessary. Coders need records from physicians and ancillary departments that are documented correctly and in compliance with Medicare medical necessity rules. Does your work measure up?

Join us for an intermediate/advance-level 90-minute live audioconference, "Diagnostic Testing and Medical Necessity in the ER: How to Comply and Get Full Reimbursement" on Wednesday, June 25, beginning at 1 p.m. Eastern.

For more information or to register, CLICK HERE, or call our customer service department at 800-650-6787. Be sure to mention source code EZ9609E.

Go to "Watch for employee conflicts of interest in vendor gratuities" for the rest of this article. The cost is $10. Subscribers to the online version of Health Care Auditing Strategies have free access to this article. Subscribers to the print edition can find it in their June issues.

A $30 steal!

You can read this article-and much more-in the June issue of Health Care Auditing Strategies. Your cost: Four stories for only $30! You'll learn tips for preparing your sample selection, and why now is a good time to start auditing your rehab claims. Choose between a PDF or HTML version for just $30. Online subscribers have free access to this issue. Print newsletter subscribers can find it in their mailboxes.

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Hotly debated and long awaited

The final EMTALA rule is due out within weeks. It's going to have significant implications for hospitals. In short, EMTALA governs the way hospitals have to manage patients coming into the emergency department, and how and when those patients can be transferred. Join us for a live 90-minute audioconference, "EMTALA Final Rule: New Strategies for Compliance" on July 14 beginning at 1 p.m. Eastern. Our speakers will dedicate half the program time to answering your questions.

For information or to register, CLICK HERE, or call our customer service department at 800-650-6787. Be sure to mention Source Code EZ1401B.

A: To read the answer to this question, click here.

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To submit your answer, go to the Question of the Week at Complianceinfo.com.

Here are the answers to the last survey:

How big a challenge is it to effectively and efficiently respond to patient complaints at your facility?

• Major challenge: 15%
• Somewhat of a challenge: 41%
• Minor challenge: 44%

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Send your comments and questions about Compliance Monitor Q&A to:

Laura Motta
Editorial Assistant
lmotta@hcpro.com