Fam Pract Manag. 2004 Feb;11(2):67.

HIPAA authorizations


To make our office compliant with the Health Insurance Portability and Accountability Act (HIPAA), are patients required to sign a separate authorization for the release of health information related to HIV, drug abuse or domestic violence?


The HIPAA privacy rule doesn’t treat information about HIV, drug abuse or domestic violence differently from any other type of health information; therefore, whether you need an authorization depends on the nature of the disclosure. Disclosures for treatment, payment or operational purposes, with the exception of psychotherapy records, generally do not require an authorization, even for the type of information you’re asking about. Disclosures to public oversight agencies (e.g., a public health department) or to those required by law also do not usually require an authorization. However, most other disclosures not expressly permitted by the privacy rule will require one.

Keep in mind that the federal Public Health Service Act restricts disclosure of alcohol and drug abuse records maintained in connection with a federally assisted alcohol and drug abuse program. In addition, your state may have specific laws on these kinds of disclosures, which, if more stringent than HIPAA, would dictate an authorization.

Documenting sick-leave excuses


Should physicians make copies of the excuses they write for patients to stay home from work or school due to an illness? If so, should they keep the excuses in the patient chart or filed separately? What are the legal aspects of not documenting sick-leave excuses?


While there are no federal rules requiring you to retain work or school excuses, it is good practice to keep copies of them to answer future inquiries by the patients or by others legally authorized to obtain that information. Many physicians find it convenient to file them in the patients’ charts so that all documents related to the patients’ conditions remain together. However, you could also file them separately in a location where their confidentiality will be maintained.

Complete records are helpful in circumstances involving legal or administrative actions or even allegations of civil or criminal liability. Should a patient attempt to use an excuse to establish eligibility for workers’ compensation or another benefit program, you may be requested to produce the original copy of the excuse, along with the underlying documentation supporting your medical decision-making and conclusions. If a patient alters an excuse in an attempt to obtain benefits fraudulently, producing the original excuse will help you to avoid any implication of conspiracy.

As with all legal issues, it is possible that individual states have their own unique requirements, and you should pose specific questions to your local attorney.

Credentialing delays


I am a foreign medical graduate currently completing my residency. Under state law, I cannot be licensed until my graduation. I have been offered a job, but I have recently discovered that credentialing could take up to six months. I cannot be without income for that length of time. What are my options?


Unfortunately, credentialing takes time, especially when you can’t obtain your license until graduation. While some payers will not allow physicians to bill for services until the date they are credentialed with the payer, many practices understand this delay and have factored it into their budget for the new associate.

The practice should complete the credentialing applications as quickly as possible so that they may be submitted as soon as you obtain your license. Once you have received the license and have been credentialed with Medicare and added to the assignment account of your group, the group can bill Medicare directly for the services that you rendered since the effective date listed on the enrollment application. Of course, such billing cannot take place until you have received your provider numbers from Medicare. Other payers that the practice contracts with may have a similar policy.

In general, whether the payer is Medicare or a private third-party payer, your services should not be billed in the name of another physician as if he or she provided them. The information you submit on the CMS-1500 claim form must be accurate.

I would recommend that you and your future practice obtain qualified health care legal counsel to make sure the enrollment application is completed accurately so that it may be processed as soon as possible.

* Denotes member of FP Assist, the AAFP’s online clearinghouse for consultants and attorneys.


Copyright © 2004 by the American Academy of Family Physicians.
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