Providing high-quality and cost-effective healthcare requires exchanging health information where data must be accurate and timely for the intended use. Although this may seem rather simple, it is sometimes difficult to accomplish in the medical and legal environment in which the healthcare industry functions. ROI solutions can make or break a patient’s quality of care when it comes to healthcare. Also, billing, reporting, research, and other functions rely heavily on it.
Protected health information (PHI) is subject to several laws and regulations that dictate when, how, what, and to whom it can be disclosed. Plus, individual confidentiality is protected by the HIPAA privacy rule, which further stipulates particular regulations for health information administration. The law aims to balance the need for rapid and informed healthcare delivery and the need to protect the individual.
When state laws are thrown into the equation, chaos ensues. All 50 states and the District of Columbia do not use the same state privacy laws. The focus of state laws (e.g., HIV or genetic information) and the degree of rigor with which patient privacy is protected differ. A patient authorization form may be required in some states, while it isn’t necessary for other states. Healthcare organizations must establish, execute, and maintain comprehensive policies and procedures related to release of information (ROI).
Confidentiality, security, and regulatory compliance in the release of protected health information depend on the entire management of those HIM operations. Management strategies that support and oversee the disclosure process must be included in the organization’s policies and procedures. HIM quality control, productivity, turnaround time, and backlog management are all addressed in this practice brief.
A request for information can be monitored to see if the following activities were taken by the staff:
The following activities are also helpful in keeping track of the receipt of requests:
Any dissemination of information should be subject to stringent quality control procedures. Accordingly, any request should be prioritized as soon as it is received as a general best practice.
Continuity of care releases is incorporated into the overall policy effectively. Releases for reasons of continuity of care or otherwise should be subject to quality control procedures that look at:
Compliance with all state and federal rules that may relate to the disclosure of health information is one of these functions that should be defined in department or organization policy.
Some of the crucial actions listed below can be audited concurrently or retrospectively over a long period. While a retrospective audit can reveal training gaps, new hires may necessitate ongoing monitoring. A random sample of requests can be audited to see if the following processes were completed:
A wide variety of logs helps keep track of and monitor request activity, from simple binders to specialist software. Information release software is created to enable tracking requests throughout their lifecycle. Management can use the program to track employee performance, response times by request type, and other metrics.
However, the tracking log mentioned above is used for business process management rather than HIPAA’s accounting of disclosures function. Using simple database or spreadsheet programs, records can easily be made. For monitoring, electronic systems make it possible to examine data readily; for example, they can determine turnaround time by deducting the date of receipt from the date of actual completion.
Even at facilities with minimal leakage of information, manual logs are appropriate. Dividers in records make locating a specific request for status updates more accessible, and a patient’s last name or the date the request was submitted can be used as dividers.
There are pros and disadvantages to both setups. Alphabetical listings are easy to find, but they take longer to enter, and older requests are harder to detect. All submissions are entered sequentially on the same day when categorized by the month they were received.
The date of receipt can be noted on the request itself to serve as a quick point of reference when it comes time to update the request’s status. This new format makes it much easier to spot any outstanding open requests.
When a request is made, all relevant data must be included. To identify recommendations for continuous care from other sorts of inquiries, such as third-party payer, legal, and research inquiries, staff can use flags.
As soon as a request is received, staff should prioritize it based on the needed day and time. To place requests for continuity of care in the proper priority queue, they must be thoroughly examined. Having this information in the request’s body makes it easier for staff to keep track of their tasks.
Critical quality control measures include ensuring that the request is accurate, comprehensive, and authorized and checking to see if a patient’s identity has been verified.
The first step for staff is to confirm that requests for information comply with organizational policies and state and federal laws. A documented request for medical information release may be required in all but emergencies. An essential piece of information may be clear and complete:
Individuals and organizations must have the legal authority to request information. Witness signature or notary seal on the request form, evidence that the requester and patient have a mutually beneficial arrangement, or other proof of legal power may be required.
In other cases, this may necessitate direct patient contact when the care provider or asking entity is unknown to the healthcare organization that processes the request.
It is necessary to check the patient’s identity in the release request against the master patient index of the organization before processing the request. These include the patient’s legal name, date of birth, and gender, as well as their Social Security number, address, phone number, and a guarantor, subscriber, or next-of-kin.
Additional inquiry, such as verifying the patient’s signature on the consent with the consents in the medical record, should be carried out when there are many individuals with similar demographics.
The content of the information released should be reviewed by staff to ensure that:
Behavioral health and drug addiction care information is subject to stricter state and federal requirements and needs careful assessment of the request, authorization for release, and distribution of the information to the intended recipient.
According to the circumstances and the person’s skill level preparing the release, a reviewer may or may not be involved. Inexperienced workers should double-check their work before releasing it, while fresh employees may need supervision from a supervisor.
Eventually, the final step in the quality control procedure is to evaluate the request’s completion. The following are crucial considerations:
A comprehensive analysis of the request and the various questions raised is required to comply with a request for information.
The main challenge for an HIM professional is balancing privacy protection, legal compliance, and the ability to improve patient care through information exchange. The HIM professional is responsible for maintaining the delicate symbiotic relationship between the two.
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