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Provider Update Newsletter

August 2003, Volume 130
 

All Providers

HIPAA Happenings
2003 HIPAA Implementation Timeline for RI Medical Assistance Billing
TPL (Third Party Liability) Information Card
Recipient Eligibility Verification System (REVS)

Pharmacy Providers

Scheduled Database Maintenance & POS

HIPAA Happenings

Incidental Uses and Disclosures

Many customary health care communications and practices play an important or even essential role in ensuring that individuals receive prompt and effective health care.  Due to the nature of these communications and practices, as well as the various environments in which individuals receive health care or other services from covered entities, the potential exists for an individual’s health information to be disclosed incidentally. For example, a hospital visitor may overhear a provider’s confidential conversation with another provider or a patient, or may glimpse a patient’s information on a sign-in sheet or nursing station whiteboard.  The HIPAA Privacy Rule is not intended to impede these customary and essential communications and practices and, thus, does not require that all risk of incidental use or disclosure be eliminated to satisfy its standards.  Rather, the Privacy Rule permits certain incidental uses and disclosures of protected health information to occur when the covered entity has in place reasonable safeguards and minimum necessary policies and procedures to protect an individual’s privacy.

Quick Examples of Incidental Uses and Disclosures that do not violate the Approved HIPAA Privacy Ruling:

·    Waiting Room Sign-in sheets

·    Calling out patient names in waiting room

·    Patient charts in clear file holders outside of examination rooms provided the chart is turned to make the written portions of the chart less readable to passers-by

·      Appointment reminder post cards / Telephone and Answering Machine reminders

·    Picking up prescriptions (e.g., friends, relatives)

·    Provider having surgery or treatment conversations with family and relatives in a    semi-private hospital room

Reasonable Safeguards

Many health care providers and professionals have long made it a practice to ensure reasonable safeguards for individuals’ health information; for instance:

·     By speaking quietly when discussing a patient’s condition with family members in a waiting room or other public area;

·     By avoiding using patients’ names in public hallways and elevators, and posting signs to remind employees to protect patient confidentiality;

·     By isolating or locking file cabinets or records rooms; or

·     By providing additional security, such as passwords, on computers maintaining personal information.                                       

Minimum Necessary

Covered entities also must implement reasonable minimum necessary policies and procedures that limit how much protected health information is used, disclosed, and requested for certain purposes.  These minimum necessary policies and procedures also   reasonably must limit who within the entity has access to protected health information, and under what conditions, based on job responsibilities and the nature of the business.  The minimum necessary standard does not apply to disclosures, including oral disclosures, among health care providers for treatment purposes.  For example, a physician is not  required to apply the minimum necessary standard when discussing a patient’s medical chart information with a specialist at another hospital.

Need more information or have more questions?

Additional information and further explanations of what the Privacy Rule requires in the area of incidental uses and disclosures can be found at the U.S. Department of Health and Human Services (HHS) website, Office for Civil Rights (OCR) guidance document on Incidental Uses and Disclosures 

Answers to frequently asked questions can be found at the U.S. Department of Health and Human Services web site “Questions and Answers”. In the Category drop down box, select “Privacy of Health Information/HIPAA”, then in the drop down box below, select the sub-category titled, “Incidental Uses and Disclosures”.

2003 HIPAA Implementation Timeline for RI Medical Assistance Billing

May	June	July/August	September/October
TPA Available on WEB	Informational Mailing	Provider Specific Mailings	Phased Implementation by
Companion Guides Available	TPA Mailing	WEB Interface Instructions	Provider Type
	Selected PES Testing	PES Delivery	Enhanced transactions available
	Non-PES Testing	Provider Educational   Seminars	through the DHS web site

The Rhode Island Medical Assistance Program is prepared to test with your Vendor or Clearinghouse now.   A Trading Partner Agreement (TPA) is required for billing electronically through your vendor, clearinghouse or with Provider Electronic Solutions (PES).  A TPA was sent to you with the June informational mailing.  If you did not receive a TPA, you can obtain one at the RI Department of Human Services Web site –  or by calling the Customer Service Help Desk at EDS – (401) 784-8100, or in state toll free at (800) 964-6211.

RI Medicaid Companion Guides are intended for business and technical areas responsible for the testing and set up of electronic submissions to EDS.  The guides are specific to the exchange of electronic claims (837), remittances (835), unsolicited claim response (277) and the functional acknowledgement (997) and are to be used in conjunction with the National     Electronic Data Interchange Transaction Set Implementation Guides for supplemental information specific to RI Medical Assistance. 

Providers that are utilizing PES to submit and receive HIPAA electronic transactions will not require the information provided in the RI Medicaid Companion Guides.

Training Workshops

The Rhode Island Department of Human Services, in conjunction with Blue Cross Blue Shield Medicare, Centers for Medicare & Medicaid (CMS), and EDS, are hosting several HIPAA awareness training sessions to prepare for implementation on October 16, 2003.  Training will include information on the following:

Ø   Transaction testing

Ø   PES usage & Availability

Ø   “Local Code” usage and extension to December 31, 2003

Ø   Companion Guides

Ø   Implementation timelines

July 23, 2003 – 8:00 – 5:00 – (2 sessions) Provider HIPAA Training – Crowne Plaza Hotel, Warwick:  More information to follow on your DHS/EDS Remittance Advices and additional communication from BC/BS.  We will also post details on the DHS Web site HIPAA page, or, you may call the EDS Customer Service help Desk at the telephone numbers listed above.

July 25, 2003 – 9:00 – 12:00 – Nursing Home/Group Home Providers – CCRI Warwick – 4^th Floor Presentation Room:  RSVP to EDS, Jean-Philippe Moceto at 401-784-3861

July 25, 2003 – 1:00 – 4:00 – General Health Care Providers – CCRI Warwick, 4^th Floor Presentation Room:  RSVP to EDS, Jean-Philippe Moceto at 401-784-386

August 8, 2003 – 9:00 – 12:00 – Nursing Home/Group Home Providers – CCRI Warwick – 4^th Floor Presentation Room:  RSVP to EDS, Jean-Philippe Moceto at 401-784-386

August 8, 2003 – 1:00 – 4:00 – General Health Care Providers – CCRI Warwick – 4^th Floor Presentation Room:  RSVP to EDS, Jean-Philippe Moceto at 401-784-3861

August 22, 2003 – 9:00 – 12:00 – General Health Care Providers – CCRI Warwick – 4^th Floor Presentation Room:  RSVP to EDS, Jean-Philippe Moceto at 401-784-3861

August 22, 2003 – 1:00 – 4:00 – General Health Care Providers – CCRI Warwick – 4^th Floor Presentation Room:  RSVP to EDS, Jean-Philippe Moceto at 401- 784-3861

TPL (Third Party Liability) Information Card

The TPL (Third Party Liability) Information Card has been developed for providers to notify EDS if their patients' Medicare or private insurance information is different from the recipient ID card or REVS. Send in this card or call the CSHD whenever you are rendering services to a Medicaid recipient and you are made aware of any other insurance coverage which is different from EDS’ records. As soon as the completed TPL card or a phone call is received and researched, EDS will update the appropriate information.

SAMPLE:                              TPL INFORMATION CARD

If you are rendering service to Medicaid recipients and you are made aware of Medicare or Private Insurance Information that does not appear on their Medical Assistance ID Card or appears on their card in error, please complete as much of the following information as  possible:

1)_______________________2)________________ 3)_________________

         Patient’s Name                     MID Number                Insurance Name/Medicare 

4)_________________ 5)____________ 6) ____________ 7)______________

     Policy # or Group #        Effective Date           End Date             Policy Holder Name   

8) ____Self , ____Spouse, ____ Child , _____Other Relationship to Insured

Does this information appear on the

9) ____Yes ____No  Does this information appear on the patient’s current   

                                                Medical Asst.ID Card?

10) If Yes, explain nature of problem: 

11)________________________________ 12)_____________________

    Provider Name                                                     Provider MID Number

 13)________________________________ 14)______________________

      Contact Person                                                     Telephone Number

To obtain TPL Cards or have further questions please contact the Customer Service Help Desk at (401) 784-8100 and we mail them to you.  Thank You.