The HIPAA Countdown continues, and there are now only ten days left before we must all be in perfect HIPAA compliance.  This week we feature some last-minute questions, and Ray Posa's very helpful list of the required forms to have prepared by April 14th.  Let's see.... 18 forms to customize, 10 days to finish, patients to see, too.... who needs to sleep?

As a reminder, FootZine's "Links" page can connect you to APMA (for their free-to-members compliance manual); to CMS, the official HIPAA entity; and to NJHIPAA, home of even more HIPAA resources from Ray Posa and associates.  Here's the link to "Links":
http://www.footzine.com/FZ_3.htm

  ~ Gayle

The WSPMA/WSPMAA (Washington State) Annual meeting is going to be April 25-27 at the Quinault Beach Resort and Casino in Ocean Shores, WA.  One attendee from Alaska would like to share expenses for the room she has reserved there.  Assistants interested in sharing should contact Janna Krauss at (907) 451-9202, or by email at jannakrauss@alaska.net

We understand that the rooms at the resort are already fully booked, so if others would like to share, let me know and I'll post the information for you.

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From:  Prakash Mavani
re:      Employment in Boston

Dear Gayle

I have been trying to get a position as a PMAC since 2001 and without any luck.  Are there any PMACS in the Boston area that I can get in touch with?  Could you help me in any way you can?

Many thanks,

Prakash
prakash mavani
shenley26@hotmail.com


Notices of positions wanted or positions available, as well as other "classified" information, are welcome. They are posted at the FootZine web site's Networking page. Have a look at http://www.footzine.com/FZ_6.htm

The Question:  See the question in Volume 24 (3/29/2003)

The Answer:

This question covers several important areas.  The key point to remember in all of this is that our primary goal is to protect a patient's privacy.  I know a lot of practices clip the super bill to the outside of the folder.  The problem with this is once the super bill is filled out, you have the patient's procedure codes and diagnostic codes marked, so any unauthorized person viewing the file is now seeing protected health information (PHI).  This is a serious violation.

The key is to put as little on the outside as possible.  If they want to use a color-coded sticker system known only to the employees to alert themselves to look inside the chart, that would be fine.  Just don't disclose information on the outside of the folder.  Having a patient's name visible on the chart is not disclosing any PHI and thus is permissible.

The other problem with putting a lot of information on the outside of the folder is not only that it would be visible while hanging in a chart-holder outside of a door, but also when this chart now moves to the front desk for processing and maybe things are a little busy and charts pile up.  What would a patient at the front desk see?  Charts with diagnoses and treatment codes and patient names; so we want to keep this information inside the chart.  One possible solution to keeping the information private, yet still giving the staff easy access to the information, would be to use a colored piece of paper inside the chart and keep the insurance, co-pay and any important notes on this page.  Then you can easily flip through the chart and look for, say, the goldenrod-color page and there is all of your information.

Complying with HIPAA may be inconvenient at times, but the cost of not complying will be infinitely more inconvenient.

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The Second Question:

We are a small office and I would like to know which forms I need to have to be in compliance with HIPAA. The information is very confusing and the money to invest in books is too much for a small practice.  Please help.

The Second Answer:

Here is a list of the Forms and Policies that we use for our clients. They cover the whole privacy regulation.

Privacy Policies
The Practice’s Policy on Patient Privacy and Employee Acknowledgement
Patient Request to Inspect and Copy Their Medical Record
Patient Request to Amend Their PHI
Patient Request for Special Privacy Protections
Privacy Protection, Record Protection and Retention
Privacy Officer’s Duties and Responsibilities
Employee Privacy Rule Training Certification
Privacy Forms
Notice of Privacy Practices
Patient Authorization to Use and Disclose PHI
Patient’s Request for Amendment of PHI
Response to Patient Granting Request to Amend PHI
Notice of Amendment of PHI (to third parties)
Denial of Request for Amendment of PHI
Patient Complaint Regarding Privacy Practices
Patient Request To Inspect and Copy Medical Record or other recorded
Patient Request for Accounting of Disclosures of PHI
Business Associate Agreement
Business Associate Agreement for Attorney

Unfortunately, HIPAA does not distinguish between large and small practices.  All covered entities are required to have their policies in place and to abide by them.  You also have a mandatory education requirement for all staff members which must be documented and signed off. 

While the information may be confusing, the regulation requires that you have a thorough knowledge of it.  What we recommend is that you have your Privacy Officer (yes, you should have already declared a Privacy Officer by now) take a good HIPAA training class.  We normally hold a class called "Train the Trainer."  We give the Privacy Officer an intensive training class, then they go back to the office and train the staff.  We find that this serves to really reinforce the material for the Privacy Officer. 

Finally, I understand that the cost of some of the books is a bit much and trying to decide which are really helpful can be an ordeal.  I would suggest spending the money on a training class; the interaction and the ability to ask questions and get clarification is invaluable.  Lastly, while the training cost may be high, if you don't do it, the cost of the fines will be much more costly.  Remember that not only can you be fined by the government for infractions, but infractions can also be a violation of a patient's civil rights and have large civil judgments.

By: Raymond F. Posa, MBA
Technology Advisor to the American Academy of Podiatric Practice Management
President, R. Francis Associates

Any questions or comments can be addressed to Mr. Posa by E-mail: Rposa@Rfrancis.com

These questions and their answers will be archived on the FootZine web site on the "HIPAA FAQ" page, at http://www.footzine.com/FZ_50.htm
Email your HIPAA questions to: gaylepmac@attbi.com

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One more note from Ray, regarding where to find samples of the forms listed above:

"Yes, the APMA HIPAA Privacy Manual has samples.  I must stress in no uncertain terms that those are just samples, and must be customized for each practice.

"Also, if you are uncertain about the regulations and what they mean, then you really should get outside help.  You have a requirement to be knowledgeable about the regs and to be trained on them.  These documents become legally binding; even after we write them for a practice,we have a disclaimer stating that they must still be reviewed by an attorney.  The problem with HIPAA is that when trouble hits, it is going to be a legal nightmare for all those involved."

What is the difference between a 28289 and a 28290?

The 28289 is defined as “Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint”.

The 28290 is defined as “Correction, Hallux valgus (bunion), with or without sesamoidectomy; simple exostectomy (eg, Silver type procedure)”.

If the intent of the surgical procedure is to remove the medial emminence and correct a HAV via soft tissue release then the 28290 would be appropriate.  If the intent of the procedure is to correct a limitation of motion at the 1^st MTPJ by removing bone on the dorsal aspect of the joint then the 28289 would be the appropriate code.  Remember to attach the correct diagnosis for the procedures. For the 28289 a diagnosis of hallux limitus/rigidus (735.2) is appropriate.  For the 28290 a diagnosis of HAV (735.0) is appropriate.

Crystal-Clear Coding tips are posted on the FootZine web site on this page:
http://www.footzine.com/FZ_C.htm

It has taken just over six months to arrive at Volume 25 of FootZine, and we have been fortunate to have some great information and ideas to share with you in that time.   Thanks to our regular contributors, Drs. Ornstein, Guiliana, and Ward; Ray Posa; Lynn Homisak; and to the FootZine Advisory Board for all of their behind-the-scenes help.
Thanks also to everyone who writes with their questions, answers and comments.
 FootZine is here because I heard from many people expressing interest in this kind of forum, and we're happy to continue as long as there are letters and questions to share, answers and information to pass along.

Again, Thanks, and don't forget to write!

 ~ Gayle

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