Protected Health Information

All covered entities (which include medical payments companies as well as physicians) need to understand exactly what Protected Health Information (PHI) is

PHI is considered:

Individually identifiable health information held or transmitted by a covered business or its business associate.

This includes any health information (which extends to demographic data) that is related to:

Past, present or future physical or mental health condition

The health care provision

Past, present or future payments of health care by the person

The Privacy Rule

The privacy rule contains national standards for the protection of individually identifiable health information. The rule, established in 2000, tries to make sure the individual information is appropriately protected. At the same time it has to allow the proper flow of health information necessary to ensure high quality health care and protect the health and well being of the general public.

The rule requires privacy protection safeguards, sets limits on the uses of the information (if done without patient authorization) and uses patient proper rights concerning their health information.

The Privacy Rule and How it Affects PHI

There are three main situations when PHI can be disclosed according to the privacy rule:

As the Privacy Rule allows

If it is authorized in writing by the individual

As part of HHS concurrence investigation, review or enforcement action

Permitted Use and Disclosure

Following are some ways PHI can be used without an peoples certification:

For treatment payment and health care operations

In an incident to an otherwise permitted use. This could happen if a hospital visitor overhears two doctors discussing someone’s healthcare while they are deciding on treatment.

Public interest as required by court order, FDA, law enforcement or because of a legal issue

A smallish data set is allowed for the purpose of research with a data use agreement

Covered Entities Notice of Policy Practice

Covered entities must provide news of their privacy practice to include: PHI use and disclosure permitted and used; duties to protect privacy; a privacy practice notice; a proper rights and grievance process if those proper rights have been violated; and a point of contact for more information and to receive complaints.

The Notice of Privacy Practice must be distributed to each individual no later than the first service encounter. It needs to be through with a prompt delivering and posted one specific of the covered business.