THIS NOTICE DESCRIBES HOW
MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU
CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Notice of Privacy Practices is
being provided to you as a requirement of the Health Insurance
Portability and Accountability Act (HIPAA). HealthBackSM must abide by
the terms of the notice currently in effect, but HealthBackSM reserves
the right to change the terms. If there is a change, HealthBackSM will
provide you with a written, revised notice as soon as practicable by
mail or hand delivery.
As a client of HealthBackSM, HealthBackSM may use your
protected health information for purposes of providing treatment,
obtaining payment for treatment, and conducting health care
operations. For example, we may share your health information with a
laboratory that performs a test. We may use and disclose health
information about you to get your health plan to authorize services
or referrals. We may use and disclose your health information to
review and improve the quality of care we provide, or the competence
and qualifications of our professional staff. We may also share your
health information with our business associates, such as a billing
service, that perform administrative services for us. We have a
written contract with each business associate that contains terms
requiring them to protect the confidentiality of your health
information.
Such information may include your medical records,
psychological, drug abuse or chemical dependency, laboratory tests,
and any other related financial or medical information about you. By
Oklahoma law we are required to notify you that your medical
information used or disclosed as described in this Notice of Privacy
Practices may include records which may indicate the presence of a
communicable or venereal disease which may include, but are not
limited to, diseases such as hepatitis, syphilis, gonorrhea and the
human immunodeficiency virus, also known as Acquired Immune
Deficiency Syndrome (AIDS). Specifically when needed, your health
information may be disclosed to:
1.Your insurance company, self-funded or third party health
plan, Medicare,
Medicaid, or any other person or
entity that may be responsible for paying or processing for payment
any portion of your bill for services;
2.Any person or entity affiliated with or representing for
purposes of administration, billing, and quality and risk
management;
3.Any hospital, nursing home, or other health care facility to
which you may be admitted;
4.Any assisted living or personal care facility of which you
are a resident;
5.Any physician providing you care;
6.Family members and other caregivers who are part of your home
care plan for service;
7.Licensing and accrediting bodies, including the information
contained in the OASIS Data Set to the state agency acting as a
representative of the Medicare/Medicaid program;
8.Contact you to provide appointment reminders or information
about other health activities we provide.
HealthBackSM is permitted to use or
disclose information about you without consent or authorization in
the following circumstances;
1.In emergency treatment situations, if HealthBackSM attempts to
obtain consent as soon as practicable after treatment;
2.Where substantial barriers to communicating with you exist
and HealthBackSM determines that the consent is clearly inferred from
the circumstances;
3.Where HealthBackSM is required by law to provide treatment and
we are unable to obtain consent;
4.Where the use or disclosure is required by law;
5.For certain public health activities;
6.Where HealthBackSM reasonably believes you are a victim of
abuse, neglect, or domestic violence to a government authority
authorized to receive abuse, neglect or domestic violence;
7.Health care oversight activities;
8.Certain judicial administrative proceedings;
9.Certain law enforcement purposes;
10.To coroners, medical examiners and funeral directors, in
certain circumstances;
11.For cadaveric organ, eye or tissue donation purposes;
12.For certain research purposes;
13.To avert a serious threat to health and safety;
14.For specialized government functions, including military and
veterans’ activities, national security and intelligence activities,
protective services for the President and others, medical
suitability determinations, correctional institution and custodial
situations;
15.For Workers’ Compensation purposes.
HealthBackSM is permitted to use or
disclose information about you without consent or authorization
provided you are informed in advance and given the opportunity to
agree to or prohibit or restrict the disclosure in the following
circumstances:
1.The use of a directory of individuals served by HealthBackSM;
2.To a family member, relative, friend, or other identified
person, the information relevant to such persons involvement in your
care or payment for care.
Other uses and disclosures will be
made only with your written authorization.
That
authorization may be revoked, in writing, at any time, except in
limited situations.
YOUR RIGHTS
You have the right, subject to certain conditions, to:
1.Request restrictions on certain uses and disclosures of
information about you. However, HealthBackSM is not required to agree
to the requested restriction;
2.Receive confidential communication of protected health
information;
3.Inspect and copy protected health information;
4.Amend protected health information;
5.Receive an accounting of disclosures
6.Obtain a paper copy of this notice, if you had agreed to
receive this notice electronically.
COMPLAINTS
You may complain to HealthBackSM and
the Secretary of the U.S. Department of Health and Human Services if
you believe that your privacy rights have been violated. Complaints
about this Notice of Privacy Practices or how HealthBackSM handles
your protected health information should be directed to:
HealthBackSM Privacy Officer
Address: 7504 N. Broadway Ext., Oklahoma City, OK 73116
Phone #: (405) 842-1700
Please state
the specific incident(s) in terms of subject, date and other
relevant matters. If you are not satisfied with the manner in
which this office handles a complaint, you may submit a formal
complaint to:
The Department of
Health and Human Services
Office of Civil Rights
Herbert H. Humphrey Building, Room 509 F
200 Independence Avenue, S.W.
Washington, D.C. 20201
You
will not be penalized for filing a complaint.
This Notice is
effective beginning April 14, 2003.
BILLING AND CODING COMPLIANCE
We have in place policies, procedures and systems to facilitate accurate billing to government payers, commerical insurance payers, and patients. These policies, procedures, and systems conform to pertinent Federal and State laws and regulations. We prohibit any colleague or agent of HealthBackSM from knowingly presenting or causing to be presented claims for payment or approval which are false, ficticious, or fraudulent.
Effective January 1, 2007, the Deficient Reduction Act of 2005 requires all Medicaid recipient entities (HealthBackSM) to develop and distribute policies, outlining federal and state false claims acts, as well as information regardng whistleblower protections and the entities policies to reduce fraud and abuse.
