What do you know about Protected Health information and disclosure rules

Protected Health Information (PHI) is health information that is acquired while treating patients. This can contain details such as name, social security ID, email Ids, contact details, medical record ID, health plan ID, names of close relatives, certificates, license number, fingerprint information, photos, etc.

There are stringent rules about disclosure of these details. Healthcare professionals are permitted to use PHI for purposes that may include treatment of a patient, to justify the payment for a patient’s treatment and for some financial, legal or other health-care business improvement initiatives. Also healthcare enterprises can make disclosures in case of enquiries into the patient’s location involving disaster relief or if the details are required by the patient’s relatives who have been identified and designated by the patient.

For any PHI disclosure, the healthcare professional requires either a written permission or authorization from the patient to utilize or disclose PHI for reasons that maybe separate from treatment, payment, healthcare requirements, etc. However the enterprise can disclose some general demographic information or treatment dates for fund-raising purposes, and this does not require any authorization. Healthcare enterprises can share PHI while coordinating or managing health care related services for treatment reasons or consultation between the patient and a third party.

This may be done to refer and consult another healthcare entity about the patient’s condition. When it concerns payment issues, then disclosures can be made to obtain reimbursements for services or to obtain health plan premiums and provide benefits under healthcare plans. Medical disclosures can also be done if the state or federal court requires the records for a particular case. In a pandemic scenario, healthcare professionals will have to divulge health details of persons infected with the disease for public health and safety. Also in extreme cases such as the case of an unstable patient who may either cause harm to himself or cause harm to others, health information can be given to the authorities like the police etc, to ensure that no harm is caused to either the patient or to the general public. Lastly there can be medical disclosures made in case of pending medical bills, or to settle on an elderly patient’s eligibility benefits.

Read more on: HIPAA compliance, Compliance management software, HITECH compliance