IDENTITY COMPLIANCE PROGRAM
Effective May 1, 2009, Fox Valley Orthopedics must comply with the Fair and Accurate Credit Transactions Act of 2003 (FACTA) as amended in October 2007 to include Red Flag and Address Discrepancy Requirements. This Act is designed to protect your personal health and financial data.
Therefore, as of May 1, 2009, we are asking all of our patients to provide a government-issued photo ID or other proof of ID at registration.
Thank you for your cooperation.
Identity Compliance Policy.pdf
Frequntly Asked Questions on Identity Compliance.pdf
PRIVACY POLICY
NOTICE OF PRIVACY PRACTICES
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.
EFFECTIVE DATE: April 14, 2003
BACKGROUND
The Health Insurance Portability & Accountability Act of 1996 (HIPAA) requires all health care records and other individually identifiable health information (protected health information) used or disclosed to Fox Valley Orthopaedic Institute (FVOI) in any form, whether electronically, on paper, or orally, be kept confidential. This federal law gives you, the patient, significant new rights to understand and control how your health information is used. HIPAA provides penalties for covered entities that misuse personal health information. As required by HIPAA, we have prepared this explanation of how we are required to maintain the privacy of you health information and how we may use and disclose your health information. Contact information is included at the end of this Notice should you have any questions about its contents.
USES AND DISCLOSURES
OF PROTECTED HEALTH INFORMATION
FVOI reasonably ensures that the protected health information it requests, uses, and discloses for any purpose is the minimum amount of protected health information necessary for that purpose.
We treat all qualified individuals as personal representatives of patients and we generally allow individuals to act as personal representatives of patients. The two general exceptions to allowing individuals to act as personal representatives relate to unemancipated minors and abuse, neglect, or endangerment situations.
We make reasonable efforts to ensure that protected health information is only used by and disclosed to individuals that have a right to the protected health information. Toward that end, we make reasonable efforts to verify the identity of those using or receiving protected health information.
Uses and Disclosures – Treatment, Payment, and Health Care Operations
We use and disclose protected health information for payment, treatment, and health care operations. Treatment includes those activities related to providing services to the patient, including releasing information to other health care providers involved in the patient’s care. Examples of treatment would include surgery, physical therapy, supplies relating to such services, etc. Payment relates to all activities associated with getting reimbursed for services provided, including submission of claims to insurance companies and any additional information requested by the insurance company so they can determine if they should pay the claim. Health care operations includes a number of areas, including quality assurance and peer review activities. Examples of health care operations would include periodic assessment of our documentation protocols, etc.
Uses and Disclosures – Not Requiring Authorization
Disclosure to Those Involved in Individual’s Care:
We disclose protected health information to those involved in a patient’s care when the patient approves or, when the patient is not present or not able to approve, when such disclosure is deemed appropriate in our professional judgment.
When the patient is not present, we determine whether the disclosure of the patient’s protected health information is authorized by law and if so, disclose only the information directly relevant to the person’s involvement with the patient’s health care.
We do not disclose protected health information to a suspected abuser, if, in our professional judgment, there is reason to believe that such a disclosure could cause the patient serious harm.
Uses and Disclosures Regarding Abuse and Neglect Situations:
We use and disclose protected health information to appropriate individuals as required by law regarding victims of abuse, neglect, or domestic violence. We disclose information about a minor, nursing home resident, or person over 60 years of age whom we reasonably believe to be a victim of abuse or neglect to the appropriate authorities as required by law or, if not required by law, if the individual agrees to the disclosure. This includes child abuse and neglect, elder abuse and exploitation, abused and neglected nursing home residents.
We inform the individual (or, as the case may be, the individual’s personal representative) of the reporting unless we, in the exercise of professional judgment, believe informing the individual (or, as the case may be, the individual’s personal representative) would place the individual at risk of serious harm or would otherwise not be in the best interests of the individual.
Uses and Disclosures for Health Oversight Activities:
We use and disclose protected health information as required by law for health oversight activities. The information may be used and released for audits, investigations, licensure issues, and other health oversight activities, including, but not limited to, hospital peer review, managed care peer review, or Medicaid or Medicare peer review.
Disclosures for Judicial and Administrative Proceedings:
In general, we disclose information for judicial and administrative proceedings in response to an order of a court or an administrative tribunal, as well as a subpoena, discovery request, or other lawful process not accompanied by a court order or an order from an administrative tribunal.
Disclosures for Law Enforcement Purposes:
We disclose protected health information for law enforcement purposes to law enforcement officials.
Uses and Disclosures Related to Decedents:
We use and disclose protected health information as required to a coroner or medical examiner and funeral directors as required by law. The attending physician is required to sign the death certificate and provide the coroner with a copy of the decedent’s protected health information.
Uses and Disclosures Related to Cadaveric Organ, Eye or Tissue Donations:
We use and disclose protected health information to facilitate organ, eye or tissue donations.
Uses and Disclosures to Avert a Serious Threat to Health or Safety; Public Health:
We use and disclose protected health information to public health and other authorities as required by law, including, but not limited to, in order to avert a serious threat to health or safety.
Uses and Disclosures for Specialized Government Functions:
We use and disclose protected health information for military and veterans activities, national security and intelligence activities, and other activities as required by law.
Uses and Disclosures in Emergency Situations:
We use and disclose protected health information as appropriate to provide treatment in emergency situations. In those instances where we have not previously provided our Notice of Privacy Practices to a patient who receives direct treatment in an emergency situation, we provide the Notice to the individual as soon as practicable following the provision of the emergency situation.
Marketing Purposes:
We do not use or disclose any protected health information
for marketing purposes. We do engage in communications about services that encourage recipients of the communication to purchase or use the services for treatment, or recommend alternative treatments, therapies, health care providers, or settings of care to the individual. These activities are not considered marketing. In addition, we may contact you with appointment reminders or information about treatment alternatives or other heath-related benefits and services that may be of interest to you.
Uses and Disclosures – Do Not Apply to Practice
Research:
We do not engage in any research activities that require us to use or disclose protected health information.
Other Uses and Disclosures:
We do not use or disclose protected health information to an employer or health plan sponsor, for underwriting and related purposes, for facility directories, to brokers and agents, or for fundraising. If you want us to release your protected health information to employers or health plan sponsors, for underwriting and related purposes, for facility directories, or to brokers and agents, then you need to contact us and complete an appropriate written authorization.
INDIVIDUAL RIGHTS
You May Request an Accounting for Disclosures of Protected Health Information
We track all disclosures of your protected health information that occur for other than the purposes of treatment, payment, and health care operations, that are not made to you or to a person involved in your care, that are not made as a result of your authorization, and that are not made for national security or intelligence purposes or to correctional institutions or law enforcement officials.
We allow you to request one accounting of such disclosures within a 12-month period free of charge. We charge a reasonable fee for more frequent accounting requests. You can request an accounting of disclosures for a period of up to six years prior to the date of your request. Requests for shorter accounting periods will be accepted. Note, however, that you may only request an accounting of disclosures made on or after April 14, 2003 (the date the HIPAA requirements went into effect).
We respond to all requests for an accounting of disclosures within 60 days of receipt of the request. If we intend to provide the accounting for disclosures and cannot do so within 60 days, we will inform you of such and provide a reason for the delay and the date the request is expected to be fulfilled.
A request for an accounting for disclosures must be made in writing and mailed or sent to us at the address listed at the end of this Notice.
You May Inspect and Copy Protected Health Information
We allow you to inspect and have us copy your protected health information (on paper or electronically on CD-ROM or jump drive), document all such requests, respond to those requests in a timely fashion, inform you of your appeal rights when a request is rejected in whole or in part, and charge a reasonable fee for the copying of records.
As is the case with other medical practices, we often receive protected health information from outside sources (e.g., medical records from other practices, lab reports, and x-rays). This so-called “secondary record” is incorporated into our medical records, becomes part of your medical record that we maintain, and is not treated any differently from other protected health information contain in your record. Accordingly, protected health information received from outside sources is available for inspection and copying in the same manner as the rest of your medical record.
We review your request in a timely fashion and act on a request for access generally within 30 days. Each request will be accepted or denied and you will be notified of such in writing. If a request is denied, you will be informed if the denial is “reviewable” or not. You have the right to have any denial reviewed by a licensed health care professional who is designated by us as a reviewing official and who did not participate in the original decision to deny. We inform you of the decision of the reviewing official and adhere to that decision.
We charge a reasonable fee based on actual cost of fulfilling your request. We will determine the appropriate charge for providing the requested records and inform you in advance of providing the records. If you agree to pay the fee in advance, the records will be provided. Otherwise, the records will not be provided, unless our Privacy Officer determines that the charge is burdensome to you.
Requests for the inspection and copying of records must be sent to us in writing at the address listed at the end of this Notice.
You May Request Amendments to Protected Health Information
We allow you to request that we amend the protected health information maintained in your medical record or your billing record. We document all requests, respond to those requests in a timely fashion, and inform you of your appeal rights when a request is denied in whole or in part.
Generally, we will act on a request for amendment no later than 60 days after receipt of such a request.
If we deny your request, in whole or in part, we will provide you with a written denial in a timely fashion. We allow you to submit a written statement disagreeing with the denial of all or part of the initial request. The statement must include the basis of the disagreement.
Requests to amend your protected health information must be made in writing and mailed or sent to us at the address listed at the end of this Notice.
You May Request Confidential Modes of Communications
We accommodate all reasonable requests to keep communications confidential. We determine the reasonableness based on the administrative difficulty of complying with the request.
A request for confidential communications must be in writing, must specify an alternative address or other method of contact, and must provide information about how payment will be handled. The request must be mailed or sent to us at the address listed at the end of this Notice. No reason for the request needs to be stated.
We will reject a request due to administrative difficulty, if no independently verifiable method of communication such as a mailing address or published telephone number is provided for communications, including billing, or if you have not provided information as to how payment will be handled.
We will not refuse a request if you indicate that the communication will cause endangerment, nor will we refuse a request based on any perception of the merits of your request.
You May Request Restriction of Disclosures
We accept all requests for restrictions of disclosures of protected health information. We do not agree to restrictions in the use or disclosure of protected health information except in the case of a self-pay patient who has health plan coverage. In this case, you can request that we not provide protected health information to your health plan.
All requests for restrictions of disclosures must be submitted in writing. They must be mailed or sent to us at the address listed at the end of this Notice. Our Privacy Officer will notify you in writing that we do not accept restrictions of disclosure, except as noted above, in which case the notification will confirm the restriction.
Authorizations
We obtain a written authorization from you or your representative for the use or disclosure of protected health information for other than treatment, payment, or health care operations; however, we will not get an authorization for the use or disclosure of protected health information specifically allowed under the Privacy Rule in the absence of an authorization. We will provide you, upon request, a copy of any authorization we initiate (as opposed to requested by you) and signed by you.
We do not condition treatment of a patient on the signing of an authorization, except disclosure necessary to determine payment of claim (excluding authorization for use or disclosure of psychotherapy notes), or provision of health care solely for purpose of creating protected health information for disclosure to a third party (e.g., pre-employment or life insurance physicals).
In Illinois, a specific written authorization is required to disclose or release of mental health treatment, alcoholism treatment, drug abuse treatment or HIV/Acquired Immune Deficiency Syndrome (AIDS) information, even for treatment. This is an exception to the general rule that authorization is not needed to release protected health information for treatment purposes.
You should be aware that automobile insurance, homeowner’s insurance, and similar policies that provide coverage for health care expenditures in most circumstances are not covered under HIPAA; a signed authorization is required prior to releasing protected health information to such entities. Additionally, worker’s compensation is not covered under HIPAA; however, a signed authorization usually is not required for release of protected health information in worker’s compensation cases because release of such information is required by law.
We allow you to revoke an authorization at any time. The revocation must be in writing and must be mailed or sent to us at the address listed at the end of this Notice; however, in any case we will be able to use or disclose the protected health information to the extent we have taken action in reliance on the authorization.
Waiver of Rights
We never require you to waive any of your individual rights as a condition for the provision of treatment, except under very limited circumstances allowed under law.
CONTACT AND OTHER INFORMATION
Provision of Notice:
FVOI provides its Notice of Privacy Practices to every patient with whom it has a direct treatment relationship. The Notice is provided no later than the date of the first treatment to the patient after April 13, 2003. The practice makes its Notice available to any member of the public to enable prospective patients to evaluate our privacy practices when making his or her decision regarding whether to seek treatment from the practice. We provide our Notice via our web site (www.fvortho.com) to any patient or other individual who so requests the Notice.
Documentation of Provision of Notice:
When a direct treatment patient receives the Notice from us, we ask the patient to sign our “Receipt of Notice of Privacy Practices” form. The form is filed with the patient’s medical record. If the patient refuses to sign the form, it is noted in the medical record that the patient was given the Notice and refused to sign the form.
Changes to Notice:
We reserve the right to revise this Notice whenever there is a material change to our uses or disclosures of protected health information, your rights, our legal duties, or other privacy practices stated in the Notice. Except when required by law, a material change to any term of the Notice will not be implemented prior to the effective date of the notice in which such material change is reflected.
If the Notice is revised, we will make the revised Notice available upon request beginning upon the revision’s effective date. The revised Notice is posted in our reception area and made available to all patients, including those who have received a previous Notice.
Complaints:
We allow all patients and their agents to file complaints with us and with the Secretary of the Federal Department of Health and Human Services (DHHS). A patient or his or her agent may file a complaint with the practice whenever he or she believes that we have violated their rights.
Complaints to us relating to the subject matter of this Notice must be in writing, must describe the acts or omissions that are the subject of the complaint, and must be filed within 180 days of the time the patient became aware or should have become aware of the violation. Complaints must be addressed to the attention of our Privacy Officer at the address set forth at the end of this Notice. We investigate each complaint and may, at our discretion, reply to the patient or the patient’s agent.
Complaints to the DHHS must be in writing, must name us, must describe the acts or omissions that are the subject of the complaint, and must be filed within 180 days of the time the patient became aware or should have become aware of the violation. Complaints must be addressed to:
Department of Health and Human Services
Office of Civil Rights
233 N. Michigan Avenue, Suite 240
Chicago, Illinois 60601
Voice Tel. 312-886-2359
Fax 312-886-1807
TDD 312-353-5693
We do not take any adverse action against any patient who files a complaint (either directly or through an agent) against us.
FVOI Contact Person:
The following individual serves as our Privacy Officer for all issues related to the Privacy Rule. All communications, questions, and/or complaints related to the subject matter of this Notice or the Privacy Rule should be directed as follows:
Privacy Officer
Fox Valley Orthopaedic Institute
2525 Kaneville Road
Geneva, Illinois 60134
Tel. 630-584-1400
��