Page 21 - Home Health Marketing

SECTION 4. 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. USE MEDFORMS’ GENERIC
HIPAA NOTICE (EXAMPLE HERE)
Our agency is required by law to maintain the privacy of protected health information, to provide you adequate
USE YOUR AGENCY’S
notice of your rights and our legal duties and privacy practices with respect to protected health information and to
HIPAA NOTICE (PLEASE ATTACH)
notify affected individuals following a breach of unsecured protected health information. We will use or disclose
protected health information in a manner that is consistent with this notice.
The agency maintains a record (paper/electronic file) of the information we receive and collect about you and of
the care we provide to you. This record includes physicians’ orders, assessments, medication lists, clinical
progress notes and billing information.

As required by law, the agency maintains policies and procedures about our work practices, including how we
coordinate care and services provided to our patients. These policies and procedures include how we create,
receive, access, transmit, maintain and protect the confidentiality of all health information in our workforce and
with contracted business associates and/or subcontractors; security of the agency building and electronic files;
and how we educate staff on privacy of patient information.
As our patient, information about you must be used and disclosed to other parties for purposes of treatment,
payment and health care operations. Examples of information that must be disclosed:
 Treatment: Providing, coordinating or managing health care and related services, consultation between health
care providers relating to a patient or referral of a patient for health care from one provider to another. For
example, we meet on a regular basis to discuss how to coordinate care for patients and to schedule visits.
 Payment: Billing and collecting for services provided, determining plan eligibility and coverage, utilization
review (UR), precertification, medical necessity review. For example, occasionally the insurance company
requests a copy of the medical record be sent to them for a coverage review prior to paying the bill.
 Health Care Operations: General agency administrative and business functions, quality assurance/improvement
activities; medical review; auditing functions; developing clinical guidelines; determining the competence or
qualifications of health care professionals; evaluating agency performance; conducting training programs with
students or new employees; licensing, survey, certification, accreditation and credentialing activities; internal
auditing; and certain fundraising activities and with your authorization, marketing activities. For example, our
agency periodically holds clinical record review meetings where the consulting professional of our record review
committee will audit clinical records for meeting professional standards and utilization review.

The following uses and disclosures do not require your consent, and include, but are not limited to, a release
of information contained in financial records and/or medical records, including information concerning
communicable diseases such as Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency
Syndrome (AIDS), drug/alcohol abuse, psychiatric diagnosis and treatment records and/or laboratory test results,
medical history, treatment progress and/or any other related information as permitted by state law to:
 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;
 Any person or entity affiliated with or representing us for purposes of administration, billing and quality and
risk management;
 Any hospital, nursing home or other health care facility to which you may be admitted;
 Any assisted living or personal care facility of which you are a resident;
 Any physician providing you care;
 Law enforcement, paramedics, other first responders and public health authorities;
 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;
 Contact you to raise funds for the Agency; you will be given the right to opt out of receiving such communications;

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