[healthcare, gov/law, US] HIPAA and Private Pay

[siderea]

Oh, huh. I just found this looking something up in HIPAA:

(a)
(1) Standard: Right of an individual to request restriction of uses and disclosures.

(i) A covered entity must permit an individual to request that the covered entity restrict:

(A) Uses or disclosures of protected health information about the individual to carry out treatment, payment

Comments

[rialian]

That is...rather interesting.

I am now wondering if a few of the rather right-wing folk with money that I know of are aware of this, and act accordingly.

(I know one Conspiracy Stealth Tea Party New Ager in particular who insists on negotiating with the doctors offices, and paying out of pocket.)

[siderea]

Well the hardcore tinfoil-hat people have been paying for everything with cash with years; those that care sufficiently about the privacy of their healthcare certainly wouldn't use insurance in the first place.

Your contacts may be interested to know that HIPAA's privacy provisions are just full of government/LEO exceptions. My fav is that a patient can request a report on who has viewed their medical record, but if the state is investigating the patient's records, the facility is (or can be?) forbidden to reveal that to the patient. Also, apparently these government/LEO exceptions don't involve needing a warrant.

[rialian]

===(Sigh) I believe it. And yes, they have been...but I have seen more of that with the money folk, not the folks that need services that are also tinfoilers.

===I am very glad to not be doing service work these days. It went rapidly downhill from the time I was working with Foster Care Reunification/Foster Care Prevention programs (Maryland)....then silliness in the various programs I worked with for work programs for the severely emotionally disturbed/autistic/mentally ill...and then...I worked in West Virginia (both types of services.)

===I have become convinced that we are trying to see how to make the safety nets fail.

===Thank you for posting on this!

[403]

I seem to recall you mentioning that one of the shifty things about a clinic (Antelope?) was that they wanted you to keep multiple charts for each patient. Might this have something to with it?

[siderea]

Wow, you have a great memory. That was my supervisor-from-hell back in 2011. Turns out the shiftiness goes all the way to HIPAA; he wasn't wrong, that's what HIPAA authorizes.

But not to solve this problem, to solve a different problem. And by "solve" I mean "almost perfectly fail to solve".

So now I'm being told to do this at my new clinic, and probably will. We've gone from "keeping two charts is illegal" to "keeping two charts is nigh-mandatory".

ETA: The keeping two charts thing requires that you put into the chart you show auditors (and use for other sharing purposes) exactly the sorts of things this here request is to keep out of the charts you show auditors.

[estelendur]

*waves from lurkerville*

I work for a company that builds software for home health agencies -- not quite the same thing, but we are still subject to HIPAA. And if one of our customers required us to do this separation, I am honestly not sure if it would be the work of a week, or the work of a year. Just about everything about a given client is kept in one place in the software, regardless of how many service types they use and how many different people are paying. Mmm, tasty software...!

[siderea]

Thanks for chiming in!

Out of professional curiosity, when you say "Just about everything about a given client is kept in one place in the software" does that mean in the user interface, or do you mean it's all in one row in a relational database, or a single doc in a noSQL document store, or...? (Sorry if I'm being nosey, I totes understand if you can't get into that sort of detail about your employer.)

[estelendur]

Ahaha I completely forgot to check back! So here is a weirdly late reply... It's all in one place in the user interface, and basically all linked from, but not directly contained in, one row in a relational database, I believe, with the distinct exception of documents uploaded by agency staff, which are in $CloudDocStorage. But the docs' database counterparts are linked in the relational database as well.