Corporate Compliance

*Privacy issues, incapacity, and minors
*To round or not to round: How does Medicare want fractional anesthesia time billed?
*OCR may not be the only HIPAA police

Compliance Monitor, September 19, 2003

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September 19, 2003
Vol. 6, No. 75

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Sample compliance policies and procedures. (For subscribers to Strategies for Health Care Compliance only)

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The OIG Work Plan for Fiscal Year 2003

Ask the Expert

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 Kate Alvarez at kalvarez@hcpro.com. We hope you enjoy this service and we welcome your feedback.

This week's questions

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Questions and Answers

Privacy issues, incapacity, and minors

Q: When a behavioral health facility (BHF) admits a minor and ward of the court on a 72-hour involuntary hold, who signs the notice of privacy practice (NPP)? If any patient on a 72-hour hold refuses to sign the acknowledgement form for the NPP, does the Health Insurance Portability and Accountability Act of 1996 (HIPAA) require the BHF to make another attempt to have the patient sign once the hold is up, or is the documented attempt upon admission sufficient?

A: HIPAA defers to state or other laws (including relevant case law) in determining how to handle health information and responsibility between minors and legal guardians. When a court maintains the right to make health decisions for a minor, the court has stepped in as a guardian and is responsible as the 'personal representative' for signing the NPP.

The best course of action is to either include the NPP and acknowledgement when the court first approves treatment for the minor, or to include the NPP in the first reports the courts receive concerning treatment. In either case, document your actions.

It may be wise to deliver the NPP to older minors and seek their acknowledgement. Although HIPAA does not require the minor's acknowledgement, it may help reduce future exposure to litigation.

HIPAA expects a later attempt for acknowledgement of receipt of the NPP in cases of emergency treatment or patient incapacity when service delivery began. However, if the patient simply refused to sign, there is no reason to ask him or her to sign again later but be sure to document the refusal.

Remember, as a direct treatment provider, you must post your NPP at the front desk or reception area, and keep copies available for patients.

This question was answered by Marion Neal, President of HIPAASimple.com.
800-279-3668

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Tell us about your financial policies!

Click here to take our quick survey on your financial policies and procedures!

The long awaited EMTALA rule is finally here!

EMTALA governs the way hospitals manage patients coming into the emergency department, and how and when those patients can be transferred. The government has finally released the final EMTALA rule, and it takes effect November 10. Join us for a very important 90-minute audioconference, "EMTALA Final Rule: New Strategies for Compliance" on September 30 beginning at 1 p.m. Eastern and learn everything you need to know to get ready. 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 EZ23288B.

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JOIN THE COMPLIANCE MONITOR TEAM!

Are you a compliance expert? We're looking for compliance experts in coding, billing, documentation, HIPAA, EMTALA, Stark, laboratories, and many other areas of compliance. If you are interested in answering questions from your peers, please e-mail Compliance Monitor editor Kate Alvarez.

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Pay-Per-View article: OCR may not be the only HIPAA police

If you ask a privacy official what agency enforces the HIPAA privacy rule, the answer you will most likely get is the Office of Civil Rights. This answer is correct, but it's not complete. The OCR isn't the only agency that can impose penalties for privacy violations. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has had confidentiality and security requirements in its information management standards for many years, as has the American Osteopathic Association (AOA). It is a little known fact that CMS also has standards on medical record privacy and confidentiality.

When Congress passed the federal law establishing the Medicare program in 1965, it wanted to establish an agency that could oversee hospitals and other health care institutions and establish rules to ensure that patients would receive quality care. This became the job of a federal regulatory agency known then as the Health Care Financing Administration, which changed its name to CMS in April 2001.

To find out more about CMS' enforcement of the privacy rule, order the pay-per-view article "OCR may not be the only HIPAA police." The cost is $10. Subscribers to the online version of Briefings on HIPAA have free access to this article. Subscribers to the print edition can find it in their September issues.

A $30 steal!
You can read this article and much more in the September issue of Briefings on HIPAA. Your cost: Five stories for only $30! You'll also learn how not to mistake CMS' recent transactions guidance for a free ride, how CMS' patient-rights standards relate to privacy rule requirements, how to focus on 'good-faith efforts' when preparing for HIPAA transactions, how to train you personnel to provide patients proper access to protected health information, and how PacificSource Health Plans make staff training engaging, and memorable.

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FIVE RESOURCES to help you build an effective and sustainable HIPAA compliance program

Give your HIPAA security and privacy compliance program a boost with the "HIPAA Security and Privacy Reminder Toolkit." Take a look at what's inside:

  • The video training tool, "Protecting Patient Privacy: Your Role in Patient Rights under HIPAA"
  • The CD-ROM Q&A resource, "H-Mail, Second Edition: HIPAA Privacy and Security Training Reminders for the Healthcare Staff"
  • The CD-ROM, "HIPAA Compliance Cartoons," for use in your staff education program
  • "HIPAA Security and Privacy Posters" to reach large numbers of staff repeatedly
  • "HIPAA Security Reminder Screensaver" to promote HIPAA awareness and protect PHI

    To order, or learn more, Click Here. Or, call 800/650-6787 and mention source code EB23246G.

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    To round or not to round: How does Medicare want fractional anesthesia time billed?

    Q: When billing for anesthesia time, are we supposed to round incomplete units of anesthesia time up or down, or leave them as fractional time units? What is the proper way to bill?

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

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    Quick survey: Does your organization train employees on Medicaid compliance issues?

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

    Here are the answers to the last survey:

    When will your organization begin auditing its HIPAA compliance program?

    • Within the next six months: 68%
    • In 7-12 months: 17%
    • In 12+ months: 9%
    • We do not plan to audit: 6%

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    Network with your audit colleagues

    "Audit Talk" is a new, moderated chat forum that members can use to post messages or questions for their peers 24-hours-a-day. "Audit Talk" offers a free forum to network, share ideas, and solve problems for those in the audit industry. Getting involved is easy. To subscribe, just send your request to this e-mail: owner-audit_talk@hcpro.com.

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    Share the news!

    You've been benefiting from our informative e-mail newsletter, so why not pass on this resource to your peers? Sign up a colleague and get $20 off your next purchase on HCPro's Healthcare Marketplace!

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

    Kate Alvarez
    Editorial Assistant
    kalvarez@hcpro.com


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