SIU Today Summer 2021 - 8

HIPAA & canvassing.
For canvassing, a medical canvassing company is not looking for a
covered entity to release any medical information about the claimant.
Because there is no PHI being requested, HIPAA is not applicable.
The covered entity is free to disclose to the medical canvassing
provider the answer of " yes " or " no " when asked about whether
or not the claimant was provided treatment at the facility. Even if
HIPAA did apply, covered entities are permitted to disclose PHI in
connection with Treatment, Payment and Health Care Operations.
The covered entity could also release patient information to
an insurance carrier, third party administrator, etc. in order to
facilitate payment.
A note about HIPAA.
When it comes to medical canvassing, the
covered entity is not releasing any medical
information about the claimant, and no
PHI is being requested, therefore, HIPAA
does not apply.
HIPAA & record retrieval.
For record retrieval, record retrieval companies are looking for PHI -
medical and billing records from a covered entity. For record retrieval
to comply with HIPAA, a medical canvassing provider therefore
needs either a Patient Authorization or for the request to fall under
one of the national priority purposes for which PHI is permitted to
be released without an authorization. For example, under the Judicial
and Administrative Proceedings purpose, a subpoena qualifies as a
permitted reason for a covered entity to disclose PHI so long as there
are assurances the patient was properly notified. Medical canvassing
providers are well-versed in what is required for a covered entity to
release PHI - including its proprietary database of facility-specific
authorizations required for record requests.
CONCLUSION
In conclusion, when it comes to medical canvassing, the covered
entity is not releasing any medical information about the claimant
and no PHI is being requested, therefore, HIPAA does not apply.
When patient records are being obtained from a covered entity
(record retrieval), it must comply with HIPAA.
Melanie Pita, Esq., is the Chief Legal Officer and Chief Product Officer at INTERTEL,
an Ontellus Company, the national leader in providing medical canvassing and social
media intelligence. Melanie is a licensed attorney and industry executive with more
than 20 years of experience in the claims and litigation field.
Steven DeRossett is the President at INTERTEL, an Ontellus Company, the national
leader in providing medical canvassing and social media intelligence. Steve has more
than 20 years of experience in the claims data and claims investigation field.
All INTERTEL employees undergo HIPAA privacy training on an annual basis. In
the event a custodian attempts to provide PHI to INTERTEL as part of the canvassing
effort, the custodian is reminded that PHI is not being sought and will not be accepted.
Thank You Annual Sponsors!
8 SIU TODAY | SUMMER 2021
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