The Art of Practice Management's Dental Pearls
The Art of Practice Management
A dental practice management consulting company that focuses on revenue and collection systems, front desk systems and forms, dental insurance processing, medical/dental cross-coding systems and employment-law compliance.
  Article
Marianne Harper Release of Information
I was fortunate to attend a seminar this past week dealing with medical records law. This course was presented by Gail Bisbee of Confidential Records Management, Inc., of New Bern, N.C. Gail touched upon many areas dealing with medical records management but there was one area that I thought I would share with my newsletter readers.  Release of information (ROI) is that
area, and I believe that many practices are unsure about how to handle this as well as how to stay in compliance with the law.

According to Gail, release of information is the title of the process whereby a medical practice provides an individual or a covered entity access to a patient’s health information provided that the individual or covered entity is authorized to receive or view it. There are several aspects to ROI that must be considered in order to be compliant with the law. As you continue reading, I will give abbreviated information on the law.

Each practice must prepare in several ways. First we must realize that the entire staff needs to know and understand all the different levels of the law. Training is a must! New employees need to be trained within ninety days of employment. Secondly the practice must develop a plan for how to handle complaints and incident reporting. Thirdly, how will the practice respond? A system will need to be developed that deals with allegations and enforcement of the sanction policy. Lastly, the practice will need to create a plan to monitor and document compliance.

There are several regulations that govern ROI. One that we are all familiar with is HIPAA. However, the others are the Sarbanes Oxley Act, the Gramm Leach Billey Act, the Fifth and Fourteenth Amendments, and the Freedom of Information Act of 1966/Privacy Act of 1974. I will sum up these regulations below.

Minimum necessary – The law requires that covered entities (the dental practice) and business associates (those who have access to a practice’s PHI) need to limit the disclosure or access of PHI to the minimum necessary to accomplish the request.
Patients and other provider requests – This law does not apply to requests from other healthcare providers for treatment purposes or requests from the patient for access to their records.
Requests from any other source require authorizations from the patient or legal representative. The following are examples:
 
Attorneys
Disability determination departments
Friends or relatives who are not legally considered to be the patient’s representative
Medical researchers
Insurers that are not responsible for claim payment
 

These authorizations must include the following:

 
Patient name
Specific description of the information that will be disclosed
Identify who this information may be released to
Expiration date of the authorization
Signature of the patient or legal representative as well as the date
A statement that the signer has the right to revoke the authorization by written request
Any exceptions to the right to revoke along with a description of how the patient or legal representative can revoke the authorization and the extent of the process
The individual must be given a copy of the signed authorization

With regard to minors, parents or guardians may sign such authorizations provided that the following applies: patient is not emancipated or not emancipated by a court decree of emancipation, that the patient is not married, or that he/she is not serving in the military. Step parents are usually not allowed to authorize ROI unless the minor is legally adopted. Check with your state laws regarding this. Foster parents are allowed to authorize ROI if the government agency who they have been working with allows it. Areas where a minor has control over his/her ROI is when there is a situation involving STDs and communicable diseases, pregnancy, substance abuse, or physical abuse by a parent of guardian.

There are some situations where the patient cannot complete such an authorization. Therefore, guidelines must be in place on how to handle those situations. When the patient is not competent (either due to age or mental capacity), if there is a healthcare power of attorney in place, if the patient is deceased, or if the patient is incarcerated, then the practice needs to have guidelines in place to handle these situations.

There may be times when a law enforcement agency may request PHI. The rules regarding this type of situation are that ROI may occur when:

The patient agrees to the disclosure
It is required by law
There is a court order, warrant, summons, or subpoena
Limited information is needed for purposes of identifying or locating a suspect, fugitive, witness, or missing person
A death was caused by criminal activity
A crime occurred at the practice location
Emergency care was needed that may have been the result of a crime

There may be incidents where only a verbal authorization is possible. If this happens, it is acceptable provided that at least two staff members are present and they must sign a form that states that the consent was obtained verbally. The practice must obtain all of the information that the written authorization requires and the practice must be able to confirm the identity of the patient

Patients have rights regarding the content of their medical records. If they believe that any documentation is incorrect, they can request that the record be amended. Practices must create a plan to handle these types of situations. A copy of the amended documentation must be kept with the original portion of the patient’s record.

In addition, patients have rights to an accounting of the disclosures that have been made of their records. The law allows that they can obtain this information for a period of up to six years prior to the date of their request (except for disclosures prior to April 14, 2003).

That sums up the details on ROI for dental practices. It will be helpful to review all of this information with your entire staff so that everyone will be aware of what is required by the law and then develop your plan so that your practice is compliant with the law.

  Insurance Alert

Dental-Medical Cross Coding – For those practices that file with Medicare, there are new modifier requirements if you do or do not provide an ABN (Advance Beneficiary Notice of Non-coverage) form to your patient. This form establishes the patient’s financial liability for the service(s) when it is expected that Medicare will deny coverage due to a determination of not medically necessary or if it is known that Medicare will deny benefits. The modifiers are as listed:

  • GA - When a provider believes that Medicare will deny coverage based on the service not being medically necessary, a GA modifier needs to be appended to the CPT or HCPCS code. Any claim that is coded this way must have an assignment of benefits.
  • GZ - If no ABN is given to the patient or the patient refuses to sign an ABN, modifier GX needs to be appended to the procedure code.
  • GY - For services that are statutorily excluded from being a covered benefit by Medicare or do not meet the definition of a Medicare benefit, a GY modifier is required. Providers do not need to file a claim in this case, but if claim filing is requested by the patient and the provider volunteers to file the claim, then a modifier GY will need to be appended to the procedure code.

For more detailed information on this, go to:
www.med.nyu.edu/fgpcompliance/assets/ABN%20Modifier%20Chart.doc

  Time Line
Red Flag Rule – the latest deadline for compliance with the Red Flag Rule is June 1, 2010. Up till now there have been several postponements to this rule for dental practices but we have not heard yet if there will be another. June 1st is right around the corner, so be prepared. For more information on this rule and how to comply with it, please check the following site: www.sdds.org/RedFlagRule.htm
Dental-Medical Cross Coding – For those dental practices that file with Medicare, Congress has delayed the 21% Medicare cuts until May 31, 2010. Originally the delay would have been extended to September 30th but Congress only extended it for 30 days. There is no certainty as to whether the cuts will be delayed again.
BA Agreements – February 17, 2010 was the deadline for amending business associate agreements (HIPAA requirement)
HITECH – June 18, 2010 marks the deadline for HHS to issue guidance on certain aspects of the HITECH (Health Information Technology for Economic and Clinical Health Act), and one aspect deals with what constitutes “minimum necessary” (see reference to minimum necessary in the article above).

My Favorite Quotes:

“What lies behind us and what lies before us are tiny matters compared to what lies within us.”
Ralph Waldo Emerson

This insightful quote by Ralph Waldo Emerson should be posted for all dental staff to read. Both in our personal lives and within our teams, problems and mistakes have been made in the past, but we should never let these negative situations pull us down. We need to draw from what’s within us as individuals and as teams to learn and grow from these situations. And of course we need to concern ourselves with the future but the best way to do that is to prepare for the future by concentrating on the present and developing fully what is within us as teams. Team meetings, retreats and continuing education courses can aid us in developing what “lies within us.”


Tips

For our patients – We are aware of the damage that GERD (Gastroesophageal reflux disease) can cause orally. If your patient indicates that he/she suffers from GERD, you can make the following suggestions that can help them (reported in the August 23, 2009 issue of Parade):

  • Reduce caffeine and alcohol consumption
  • Eliminate late night eating because reclining with a full stomach increases the occurrences of GERD
  • Smaller more frequent meals reduces the amount of pressure in the stomach that aggravates reflux
  • Even modest weight loss reduces pressure on the stomach and can alleviate heartburn
  • Encourage reduction in the consumption of fatty foods and chocolate that can relax the lower esophageal sphincter and keep acid in the stomach and out of the esophagus

For staffIs your handwriting understandable?
Clear handwriting is a key to preventing several problems in those practices that are still using paper records. Whoever will be reading your patients’ dental records will need to be able to read them accurately. As an example, if your insurance coder is unable to read the record clearly, incorrect claims can be submitted resulting in a possible decrease in reimbursement or even a denial of benefits. In addition, if your practice is audited by an insurance carrier, they may determine that these services were not performed, resulting in a “false claim” for when documentation is not clearly readable.


Dental Humor for the quarter:

A little boy was taken to the dentist. It was discovered that he had a cavity that would have to be filled. "Now, young man," asked the dentist, "what kind of filling would you like for that tooth?" "Chocolate, please," replied the youngster.
http://www.medicallaughter.com/dental.php


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The Art of Practice Management
2217 Fox Horn Road  •  New Bern, NC 28562  •  Phone: 1-252-637-6259
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The contents of this publication reflect the opinion of the author only. This publication is for informational purposes only.
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