Ubusela beZazisi zezoNyango, iiRekhodi zeMpilo ezonakeleyo, kunye noBuqhophololo beeBhili¶

Ukufumana iNkcazelo yeeNzuzo (EOB) ingxelo ye-$ 42,000 yotyando lwezigulane ezigulayo, umyalelo we-opioid, okanye ukutyelela kwigumbi likaxakeka ongazange ulifumane lingaphezulu kwentloko yemali: yimeko engxamisekileyo yeklinikhi esongela ubomi. Ngokungafaniyo nobuqhetseba bekhadi letyala, apho ibhanki iguqula nje intlawulo, ubusela besazisi sonyango ludibanisa uhlobo lwegazi lomkhohlisi, ukuchasana neziyobisi, ukuxilongwa kwengqondo, kunye nembali yotyando ngqo kwinkosi yakho ** Ingxelo yezeMpilo ye-elektroniki (EHR)** kutshintshiselwano ngolwazi lwezempilo lwesizwe (CareEverywhere, CommonWell, Carequality, kwaye Surescripts). Ukuba uleqiswa kwiziko lezothuko ungekho zingqondweni kwaye itshati yakho yezempilo eyonakeleyo idwelisa udidi lwegazi olungalunganga, iyayishiya i-penicillin yakho ebulalayo ngenxa yokuba umkhohlisi uthi "Akukho Kwaziwa Kweziyobisi.NKDA)", okanye ikufake iflegi njengomntu ofuna iziyobisi, oogqirha bexesha likaxakeka banokwenza iimpazamo ezibulalayo. Xa umkhohlisi egqibe i-inshorensi yempilo yakho yonyaka okanye efake uxilongo olungeyonyani olungapheliyo kuvimba we-MIB Group (Medical Information Bureau), usenako ukwalelwa i-inshorensi yobomi, i-inshorensi yokukhubazeka, kunye neenkqubo zonyango ezibalulekileyo.

Ukuba wena okanye ilungu losapho likwimeko engxamisekileyo yonyango okanye anivunyelwa ukuba nifumane uncedo olungxamisekileyo esibhedlele ngenxa yetshati yonyango eyonakeleyo, tsalela umnxeba kwinombolo yakho kaxakeka yasekuhlaleni (911 eUnited States naseKhanada, 112 kwiManyano yaseYurophu, 999 eUnited Kingdom) okanye ujonge uluhlu lwethu lwamazwe ngamazwe amanani kaxakeka ngokukhawuleza, kwaye uxelele ugqirha we-triage kumntu ukuba angayihoyi itshathi ye-elektroniki ezenzekelayo kwaye aqhube uhlobo lwegazi elitsha kunye ne-crossmatch. Kuzo zonke ezinye iimeko zobusela bezazisi zonyango, iirekhodi zempilo ezingeyonyani, okanye ubuqhophololo bokuhlawula inkathalo yezempilo, landela inkqubo yolungiso engezantsi.

Yenza oku ngoku¶

1. Odola "iSeti yeRekhodi eMiselweyo" epheleleyo kunye "neNgxelo yeNkxaso" kuzo zonke izibhedlele ezichaphazelekayo, ikliniki, kunye ne-inshurensi: Phantsi kwe-US UMthetho we-Inshorensi yezeMpilo nokuPhendula (Accountability Act)HIPAA, 45 CFR § 164.524 kwaye § 164.528), unelungelo elisemthethweni lokufumana ikopi epheleleyo yeerekhodi zakho zonyango kunye neentlawulo zamatyala ngaphakathi ientsuku ezingama-30 zekhalenda, kunye ne- 6 yeminyaka eyi-6 ye-Accounting of Disclosures ebonisa wonke umbutho ongaphandle ofumene ulwazi lwakho lwezempilo olukhuselweyo. Ungathembeli kumbono womthengi osisiseko ngaphakathi kwi-portal yesigulana sakho kwi-intanethi (MyChart), efihla iikhowudi zangaphakathi zokuhlawula kunye namanqaku olawulo.
2. Fayila i-Federal Trade Commission i-Identity Identity Report (IdentityTheft.gov) kunye neNgxelo yamaPolisa asekuhlaleni: Ababoneleli bezonyango kunye nee-inshurensi zempilo bahlala besala ukucima amatyala obuqhophololo okanye ukuguqula iitshati zekliniki ngegama lesigulana kuphela. Ukuvelisa ngokusesikweni iNgxelo yokubiwa kwesazisi se-FTC kunye nokufumana ingingqi iNombolo yeNgxelo yeSiganeko samaPolisa kuxhokonxa ukhuseleko olusemthethweni lokuthintela amatyala phantsi koMthetho weNgxelo yeTyala ngoFair (FCRA § 605B, 15 U.S.C. § 1681c-2)** kwaye uyangqina ukuba ulixhoba lolwaphulo-mthetho.
3. Lumkisa ugqirha wakho wonyango oluphambili kunye nedesika yovavanyo lwesibhedlele sendawo ukuba ubeke "iFlegi yoKhuseleko lweKlinikhi" kwitshati yakho: Ngaphambi kokuba amaphepha asemthethweni athathe iintsuku ezingama-30 ukuya kwezingama-60 ukusetyenzwa, cela ugqirha wakho wokwenyani kunye noLawulo loLwazi lwezeMpilo lwesibhedlele sendawo (HIM) isebe ukubeka ngokukhawuleza ** i-High-Visibility Clinical Alert Banner** phezulu kwiikliniki zakho ezilumkisa itshathi ye-elektroniki: * "Ixhoba lokubiwa kwe-Medical Confirmed Medical Identity. Qinisekisa uhlobo lweGazi, i-Allergies, kunye noLuhlu lwamayeza ngokuthe ngqo kunye nesigulane ngaphambi kokulawulwa. Iirekhodi zobuqhetseba ukusuka [Imihla] ziphantsi kwe-HIPAA § 164.526 yokucoca."*526.
4. Ngenisa okusesikweni okubhaliweyo HIPAA § 164.526 Isicelo soLungiso kwiGosa laBucala lomnikezeli: Ungaze uphathe urhwaphilizo lwerekhodi yezonyango ngomnxeba unobhala wetyala oqhelekileyo. Thumela i-USPS Certified Mail imfuno ngokuthe ngqo kwiSibhedlele **iGosa laBucala le-HIPAA ** kunye **noLawulo loLwazi lwezeMpilo (HIM) UMlawuli ** ufuna ukuba yonke ikhowudi yoxilongo lobuxoki (ICD-10), ikhowudi yenkqubo (CPT), i-allergy override, kunye nenqaku lekliniki elenziwe ngumkhohlisi licocwe ngokusisigxina okanye lihlulwe kwitshathi yakho, kwaye izaziso ezilungisiweyo zigqithiselwe kulo lonke u-Epic CareEverywhere kunye ne-Surescripts.
5. Fowunela iCandelo loPhando oluKhethekileyo lwe-inshurensi yezempilo (SIU) okanye umnxeba woBuqhophololo weMedicare (1-800-MEDICARE): Abameli benkonzo yabathengi abasemgangathweni kwiinkampani zeinshorensi yezempilo abanako ukukhulula ubusela bezazisi zonyango. Buza ngokukodwa kwi-inshurensi Iyunithi yoPhando oluKhethekileyo (SIU) / Isebe lobuqhophololo ukuphawula amabango obuqhophololo, ukubuyisela ubomi bakho kunye nobuninzi benzuzo yonyaka, ukubala ngokutsha imali oyitsalwayo, kwaye ikunike inombolo yesazisi seLungu elitsha.
6. ** Tsala iingxelo zakho ezikhethekileyo zonyango kunye nomyalelo wabathengi (MIB Group, Milliman IntelliScript, kwaye LexisNexis)**: Kwanasemva kokuba isibhedlele silungise uvimba weenkcukacha zaso zasekuhlaleni, ukuxilonga okungeyonyani kunye nembali kagqirha iyaqhubeka ngaphakathi koovimba bolwazi bomntu wesithathu obusetyenziswa ngabo baphila, abakhubazekileyo, kunye neinshorensi zokhathalelo lwexesha elide. Cela kwaye uphikise iifayile zakho ezikhethekileyo kwi-MIB Group, Milliman IntelliScript, kunye ne LexisNexis Risk Solutions, kwaye umise iifayile zakho zetyala ezingundoqo e-Equifax, Experian, kunye neTransUnion ngokulandela zethu impendulo yokwaphulwa kwedatha kunye nesikhokelo sokuvuza kwegama lokugqitha.

Umthi wesigqibo: ukukhulula iirekhodi ezonakeleyo zeklinikhi ngokuchasene nokuhlawula i-inshurensi yobuqhophololo¶

Ubusela besazisi sezonyango buwela kwiindidi ezimbini ezahlukeneyo ezihlala zidibana: Ubusela beSigulana esikhohlisayo (apho umntu ongamaziyo ongakhuselwanga okanye umntu omaziyo ehlola ngokwasemzimbeni kwigumbi likaxakeka okanye ekhemesti esebenzisa igama lakho elibiweyo, umhla wokuzalwa, iNombolo yoKhuseleko lweNtlalo, okanye ikhadi le-inshorensi) kunye *IiKhowudi zangaphakathi / zoMboneleli kunye ne-Phantom Billing okanye inkampani yoRhwaphilizo yezonyango amatyala okugaya i-Medicare okanye inombolo ye-inshorensi yabucala yovavanyo lwemfuzo, i-back braces, okanye utyelelo olungazange lwenzeke). Sebenzisa leflowutshati ukwahlula zombini izoyikiso:

flowchart TD
    Start["Iflegi eBomvu ifunyenwe: Ingxelo ye-EOB engaqhelekanga, uTyelelo lweMyChart engaqhelekanga, iSilumkiso seKhemesti, okanye uMnxeba wokuQokelelwa"] --> Audit["1. Cela iSeti yeRekhodi eMisiweyo epheleleyo kunye ne-6-Yeminyaka ye-HIPAA ye-Akhawuntingi ye-Disclosures evela kuMboneleli kunye nomKhuseli"]
    Audit --> Type{"2. Ngaba uMkhohlisi Uye Wafumana Ukhathalelo Phantsi Kwegama Lakho, okanye Ngaba Yayibubuqhophololo bokuBhala iPhepha?"}
    Type -->|"Isigulana esinganyanisekanga sifumene Ukhathalelo loMzimba / iMimiselo"| Clinical["INGOZI EBALULEKILEYO YOKOLONI: Uhlobo lweGazi loMkhohlisi, izinto eziAlisa umzimba kunye neeLebhu zidityaniswa kwi-EHR yakho."]
    Type -->|"Phantom Provider Billing Kuphela (DME, iiLabs, Upcoding)"| Financial["Ingozi yezeMali kunye nokuBhala ngaphantsi: I-Benefit Caps Drained & False ICD-10 Uxilongo oluLogiweyo"]
    Clinical --> Alert["3A. Beka iSilumkiso soKhuseleko lweKlinikhi kwangoko kwiTshati yeSibhedlele seNdawo kwaye uphinde uQinisekise ukuLale okanye uHlobo lweGazi"]
    Alert --> Both["4. Ingxelo yeFayile ye-FTC yokubiwa kwesazisi (i-IdentityTheft.gov) + iNgxelo yamaPolisa asekuhlaleni + i-HHS OIG / i-SIU yesikhalazo"]
    Financial --> Both
    Both --> HIPAA["5. Thumela i-HIPAA esemthethweni § 164.526 isiHlomelo seTshati kunye neMfuno yoKwahlula ku-HIM / iGosa laBucala"]
    HIPAA --> HIE["6. Nyanzelisa ukuSasazwa koLuleko kuyo yonke i-Epic CareYonke indawo, iCommonWell, iCakequality & Surescripts"]
    HIE --> Specialty["7. Impikiswano kunye neQela le-MIB, iMilliman IntelliScript, iLexisNexis kunye neCredit Bureau Collection"]

Iidatabase ezi-6 ezifihliweyo apho ubusela besazisi zonyango konakalisa ubomi bakho¶

Xa uninzi lwezigulana lufumanisa ubusela besazisi zonyango, lufowunela inombolo yefowuni yokuhlawula kwi-invoyisi kwaye lucinge ukuba xa isibhedlele sikhupha i-bill, ingxaki iyasonjululwa. Kwiziseko ezingundoqo ze-IT zokhathalelo lwempilo lwanamhlanje, utyelelo lwegumbi elingxamisekileyo lobuqhophololo okanye ukhathalelo olungxamisekileyo luphindaphinda yonke into ** ezintandathu ezidityanisiweyo zedatha yelizwe ** phakathi kwemizuzwana. Ukuba awuzicoci zonke iileya ezintandathu, iprofayile yezonyango yomkhohlisi iya kosulela itshathi yakho ngalo lonke ixesha undwendwela ugqirha omtsha.

Inqanaba loku-1: Ukubona iimpawu zokuqala zokubiwa kwezazisi zonyango¶

Ngenxa yokuba izibhedlele kunye neelebhu azifane zifowunele isigulana ngaphambi kokuba zifake ibango le-elektroniki, ama-65 ekhulwini amaxhoba okubiwa kwezazisi zonyango awaqondi ukuba impilo yawo iye yathotywa de kwasemva kweenyanga. Ziphicothe iirekhodi zakho ukuba ubona nayiphi na kwezi flegi zibomvu zisibhozo:

1. Izinto ezingaqhelekanga kwiNgcaciso yeeNzuzo (EOB) okanye iSaziso sesiShwankathelo seMedicare (MSN): Ungaze ulahle i EOB imvulophu kuba nje iphepha elingaphambili libhalwe “LE AYILO IBILI: UMGULI UTYWALA I-R0.00.” Izixhobo zonyango ezonakeleyo ezomeleleyo (DME) i-bill bill Medicare okanye i-inshurensi yorhwebo ye-orthotic braces, iimonitha ze-glucose eziqhubekayo, iipaneli ze-PCR, okanye iimvavanyo zofuzo ngelixa ukhulula i-copay yesigulane ukuze ungaze ufumane i-invoyisi yomnikezeli. Funda yonke into yomgca kuyo yonke into EOB kwaye MSN ukuqinisekisa ukuba umbonile loo gqirha ngala mhla.
2. ** Ukungena okungaqhelekanga kweklinikhi, ukungezwani komzimba, okanye ubude / ubunzima bokutshintsha ngaphakathi MyChart**: Ngena kwizigulana zakho ezikwi-intanethi (Epic MyChart, Oracle Health, Healow, Athenahealth) kwaye uhlole isiShwankathelo seMpilo -> Izinto eziAlejiyo, Amayeza, Ugonyo, kunye noNdwelo oludlulileyo. Ukuba uhlobo lwegazi lakho lutshintshile, ubude bakho obudwelisiweyo butsibe ngeesentimitha ezili-10 (ii-intshi ezi-4), kuvela imbali yezinto ezingaqhelekanga, okanye utyelelo lwesebe olungxamisekileyo olungaziwayo ludweliswe, MPI (Isalathiso seSigulana esiPhambili) siye saqweqwediswa okanye sadityaniswa ("ukwaleka kwetshati").
3. Ukwala ngequbuliso ukhuseleko lwenkqubo yonyango esemthethweni okanye ummiselo: Ukuba ikhemesti yakho iyala ukuzalisa ummiselo wakho ngenxa yokuba amabango e-inshorensi azaliswe kwiintsuku ezidlulileyo kwidolophu yonke, okanye i-inshorensi yakho iyalukhanyela ugunyaziso lwangaphambili lwebrace yedolo, umatshini we-CPAP, okanye iseshoni yonyango lomzimba ngenxa yokuba umyinge wenzuzo yakho yonyaka uphelile, omnye umntu uchitha ipolisi yakho.
4. Izaziso ezingalindelekanga ezivela MyChart malunga nonxibelelwano lwekliniki lwangaphandle: Amaqonga ee-EHR anamhlanje athumela izilumkiso ezizenzekelayo xa ikliniki ekwenye inkqubo yezempilo iqhagamshela kwirekhodi yakho okanye icwangcisa idinga lezempilo. Phatha naluphi na unxibelelwano lwekliniki olungaqhelekanga njengokwaphulwa okusebenzayo.
5. Iminxeba yokuqokelela amatyala, iitekisi, okanye izimangalo zesibhedlele esingaqhelekanga, i-pathology, radiology, okanye i-ambulance bills: Ukutyelela kwigumbi likaxakeka kuvelisa amatyala amahlanu ahlukeneyo (intlawulo yoncedo lwesibhedlele, iqela likagqirha likaxakeka, i-radiologist, i-pathologist, kunye ne-ambulensi). Ukufumana isaziso sokuqokelela kwiqela elingaqhelekanga labasebenzi bakagqirha (* Umbono*, TeamHealth, okanye US Acute Care Solutions) kudla ngokuba luphawu lokuqala lokuba umkhohlisi usebenzise igama lakho kunye ne-SSN kwigumbi likaxakeka kwiinyanga ezidlulileyo.
6. ** Ukukrokra koogqirha malunga nemigqaliselo yeziyobisi ezilawulwayo **: Ukuba ugqirha okanye umongikazi ngokukhawuleza ekubuza malunga nokusetyenziswa kwe-opioid, wenqaba unyango oluqhelekileyo emva kokuhlinzwa, okanye ukhankanya ukutyelela ongazange ukwenze, bacele ukuba bahlole i-*State PDMP yakho (iNkqubo yokuHlola iDrug Monitoring) ** kunye ** kunye ne-*Epic CareEverywhere ** iilogi zemisebenzi yobuqhetseba.
7. Ukufumana i IRS Form 1095-A, 1095-B, okanye 1095-C kwipolisi ye-inshorensi yezempilo engaqhelekanga: Abathengisi beinshorensi abakhohlakeleyo ngamanye amaxesha basebenzisa iiNombolo zoKhuseleko lweNtlalo ezibiweyo kunye nemihla yokuzalwa ukubhalisa amaxhoba kwinkxaso-mali UMthetho woNonophelo oZifikelelekayo (Affordable Care Act)ACA) Izicwangciso zeNdawo yeMarike ngaphandle kwemvume kwiikomishoni zomthengisi. Xa ufaka imbuyekezo yakho yerhafu yomdibaniso, i-IRS iyayikhaba imbuyekezo yakho okanye ifuna imbuyekezo ye-** IiKhredithi zeRhafu eziPhambili (APTC)**.
8. Ukufumana ileta yesaziso sokwaphulwa kwedatha evela esibhedlele, kwindlu yokucoca (Change Healthcare), okanye ilebhu (Quest, LabCorp): Ukwaphulwa kokhathalelo lwempilo kuveza eyona nto ifunwa ngabaphuli-mthetho: Igama elipheleleyo, Umhla wokuzalwa, iNombolo yoKhuseleko lweNtlalo, i-ID yeLungu le-Inshurensi yezeMpilo, kunye neNombolo yeQela.

Inqanaba lesi-2: Ukukhusela ukhuseleko lwakho lwezonyango kunye nokuphicotha irekhodi yakho yonyango epheleleyo¶

Ngaphambi kokuba ulwe namasebe okuhlawula, eyona nto iphambili yakho kukuqinisekisa ukuba akukho gqirha, umongikazi, okanye i-paramedic exhomekeke kwidatha eyonakeleyo yezonyango ukuba ikunyange ngexesha likaxakeka.

Inyathelo loku-1: Beka iSilumkiso soKhuseleko lweKlinikhi "yokubiwa kwesazisi" kwangoko kwiitshathi zakho zokwenyani.¶

Qhagamshelana noLawulo loLwazi lwezeMpilo (HIM) / Isebe leeRekhodi zonyango** kwiofisi kagqirha wakho kunye neyona nkqubo yesibhedlele ikufutshane apho ungathathwa khona ngenqwelo yezigulana. - Yazisa i HIM UMlawuli ukuba ulixhoba eliqinisekisiweyo lobusela besazisi sonyango (okanye "IRekhodi yoNyango eDibeneyo / eNgqunyiweyo" apho ifayile yesinye isigulana yadityaniswa kweyakho). - Cela ukuba babeke I-Glass-Blass / High-Visibility Clinical Safety Banner kwi-Master Patient Index (MPI) rekhoda ukuze nawuphi na ugqirha ovula itshathi yakho abone isilumkiso esivelelayo kwangoko ukuze aqinisekise ubuwena ngesazisi sefoto, aqinisekise kwakhona aleji yakho yeziyobisi, kwaye aqhube uhlobo lwegazi elitsha kunye nesikrini. - Buza ugqirha wakho oyintloko ukuba aprinte i-**Isishwankathelo seKlinikhi esisayiniweyo, esiQinisekisiweyo sePhepha ** (uluhlu lwegazi lakho lokwenyani, i-allergies yeziyobisi, amayeza asebenzayo, kunye neemeko ezingapheliyo) kwaye uphathe ikopi kwi-wallet yakho ecaleni kwe-ID kunye nekhadi le-inshurensi.

Inyathelo lesi-2: Funa iQela lakho elipheleleyo "iSeti yeRekhodi echongiweyo" kunye "ne-Akhawuntingi yokuVeza" phantsi kwe-HIPAA¶

Sukusuka nje ucele umamkeli wasekliniki ikopi yamanqaku akho otyelelo. Phantsi komthetho womanyano (45 CFR § 164.524 kwaye 45 CFR § 164.528 eUnited States; UK GDPR Subject Access Request eUnited Kingdom; PIPEDA / PHIPA eKhanada; GDPR Article 15 kulo lonke iManyano yaseYurophu), ngenisa isicelo esibhaliweyo kumnikezeli ** iGosa laBucala le-HIPAA ** okanye ** Ukukhutshwa koLwazi (ROI) iSebe** lifuna iiseti zedatha ezintathu:

1. Iseti yeRekhodi eMisiweyo eGqibelelweyo (45 CFR § 164.524): Cela zonke iifomu zobhaliso, iikopi eziskeniweyo zelayisensi yokuqhuba kunye nekhadi le-inshorensi eniziswe xa kubhaliswa, iifomu ezityikityiweyo zemvume yokunyanga, amanqaku okunyanga, amanqaku kagqirha, iziphumo zelebhu kunye neradiology, izishwankathelo zokukhutshwa, kunye ne-*itemized UB-04 / CMS-1500 iifom zebango lokuhlawula ** ebonisa zonke ICD-10 ikhowudi yokuxilongwa kunye CPT ikhowudi yenkqubo iyahlawuliswa. Ngaphantsi federal HIPAA imithetho, umboneleli kufuneka anike ezi rekhodi ngaphakathi **30 iintsuku zekhalenda ** (okanye 15 iintsuku eCalifornia phantsi kweMpilo kunye neKhowudi yoKhuseleko § 123110).
2. I-6-Year HIPAA Accounting of Disclosures (45 CFR § 164.528): Funa ilog ebhaliweyo yalo lonke iqumrhu langaphandle, indawo yobhaliso, okanye iqabane leshishini elifumene iNkcukacha yeMpilo eKhuselweyo (PHI) kule minyaka mithandathu idlulileyo, kunye nelog ye ** yonke Health Information Exchange (HIE) umbuzo (Epic CareEverywhere, CommonWell, Carequality)** ezitsalele ukudibana kobuqhophololo kwiinkqubo ezingaphandle kwesibhedlele.
3. Umzila woPhicotho lwe-EHR / iiLogi zokuFikelela (45 CFR § 164.308(a)(1)(ii)(D) & 42 U.S.C. § 17935(e)): Ukuba ukrokrela ukuba umntu wangaphakathi (onjengomsebenzi wasesibhedlele okanye unobhala wetyala) webile okanye watshintsha irekhodi yakho, cela i-Electronic Health Record Audit Trail ebonisa izazisi zomsebenzisi, izitampu zexesha, kunye neendawo zokugcina zomsebenzi ngamnye oye wafikelela kwitshathi yakho ngexesha lobuqhetseba loluhlu lomhla.

Inqanaba lesi-3: Ukunyanzelisa izibhedlele ukuba zisuse iirekhodi zeklinikhi zobuxoki (HIPAA § 164.526)¶

Wakuba uphonononge iirekhodi kwaye uchonge lonke utyelelo, uvavanyo lwaselebhu, ukuxilongwa, okanye ummiselo ongengowakho, kufuneka unyanzelise ngokusemthethweni umboneleli wezempilo ukuba asuse okanye ahlule amangeniso awonakeleyo kwitshathi yakho.

Njani ngokomthetho HIPAA § 164.526 Imisebenzi yeNkqubo yoLungiso¶

Ngaphantsi 45 CFR § 164.526 (Ilungelo Lokulungisa Ulwazi Lwezempilo Olukhuselweyo): 1. IsiFundo sakho esiBhaliweyo esisiHlomelo: Ngenisa ileta esayiniweyo, ebhalwe umhla kwisibhedlele Igosa labucala le-HIPAA kunye noMlawuli woLawulo loLwazi lwezeMpilo (HIM) ukuchonga umhla ngamnye wenkonzo, ikhowudi yokuxilonga (ICD-10), iyeza, ukungena kokungalufuni, kunye nenqaku lekliniki eyeyesela lesazisi okanye impazamo yokwaleka kwetshati. 2. ISibhedlele seentsuku ezingama-60 esimisiweyo ngokusemthethweni: Ngaphantsi 45 CFR § 164.526(b)(2), umboneleli wezempilo kufuneka enze isilungiso kwisicelo sakho kwiintsuku ezingama-60 zekhalenda efunyenwe. 3. UkungaManyanisi kweTshati ("i-De-Overlay") vs. Isilungiso se-Line-Item: Ubungcali HIM imigangatho ekhutshwe ngu AHIMA (i-American Health Information Management Association) iyala isibhedlele ukuba ** sikhuphe kwaye sihlukanise yonke into yokuhlangana komkhohlisi kwindawo eyahlukileyo "ye-John / Jane Doe Akhawunti ye-Fraudulent" I-Master Patient Index (MPI) inombolo**, ukuyisusa kweyakho yokwenyani MPI itshathi kunye nokubuyisela idatha yakho yesiseko yekliniki. 4. Isaziso esisiSinyanzelo soMsinga (45 CFR § 164.526(c)(3)): Nje ukuba umboneleli esamkele isilungiso sakho kwaye angadibanisi ukudibana kobuqhophololo, umthetho wobumbano ufuna ukuba umboneleli adlulisele irekhodi elungisiweyo/engadityaniswanga ku wonke umntu okanye umbutho owuchongayo (oogqirha bakho bokwenyani, i-inshurensi yempilo yakho, kunye namaziko akhethekileyo afana MIB Group), kunye noTshintsho loLwazi lwezeMpilo (Epic CareEverywhere, CommonWell, Carequality) kunye nenethiwekhi yekhemesti (Surescripts) efumene idatha eyonakeleyo.

Kuthekani ukuba uMboneleli Uyakwala HIPAA § 164.526 Isicelo soLungiso?¶

Ukuba isibhedlele okanye ikliniki iyala ukulungisa okanye ukuqhawula unxulumano lwamangeno angeyonyani, umthetho wobumbano (45 CFR § 164.526(d)) ikunika amanyathelo amathathu asemthethweni achaseneyo: 1. Ilungelo lokuFayila "Inkcazo yokungavumelani" ngokusesikweni (45 CFR § 164.526(d)(2)): Ngenisa umbhalo othi Ingxelo yokungavumelani (uncamathisela iNgxelo yakho ye-FTC ye-Identity Theft kunye neNgxelo yamaPolisa) echaza ukuba zeziphi amangeno ezinobuqhophololo kunye nokuba yintoni uhlobo lwegazi lokwenyani, i-allergies, kunye nembali yonyango. 2. Ukuqhotyoshelwa okuSisiSiseko okuSisinyanzelo kuzo zonke iiNkcazo zexesha elizayo (45 CFR § 164.526(d)(4)): Emva kokuba ufake iSitetimenti Sokungavisisani, **isibhedlele siyafuneka ngokusemthethweni ukuba sihlomele ngokusisigxina iSitetimenti sakho Sokungavisisani kwirekhodi yezonyango ekuphikiswanayo *, kwaye kufuneka iquke iSitetimenti sakho sokungavisisani nako konke ukutyhilwa kwexesha elizayo okanye ukuhanjiswa kwe-HIE nge-elektroniki yaloo rekhodi. 3. Isikhalazo sokunyanzeliswa kweFederal nge HHS Office for Civil Rights (OCR):Fayila isikhalazo esisesikweni soMthetho waBucala we-HIPAA e-ocrportal.hhs.gov ngaphakathi kweentsuku ze-180, kwaye ukopishe iBhodi yakho yezoNyango kaRhulumente kunye neGqwetha Jikelele likaRhulumente.

Khuphela-kwaye-Uncamathisele iskripthi: Sisesikweni HIPAA § 164.526 Ukucoca iRekhodi yezoNyango kunye neMfuno yoLungiso¶

Thumela le leta nge-klzzwxh:0068 kumnikeze iGosa loBucala le-HIPAA**, **Ulawulo loLwazi lwezeMpo (HIM) UMlawuli, kunye **neeNkonzo zezeMali zabaguli/iSebe buQhinga**:

[Your Full Legal Name]
[Your Current Mailing Address]
[Your Date of Birth] | [Your Telephone Number]
[Date]

VIA USPS CERTIFIED MAIL: RETURN RECEIPT REQUESTED

TO: HIPAA Privacy Officer & Director of Health Information Management (HIM)
[Name of Hospital, Health System, or Medical Clinic]
[Hospital/Clinic Street Address]

RE: FORMAL DEMAND FOR MEDICAL RECORD AMENDMENT, CHART SEGREGATION, AND FCRA § 605B DEBT SUPPRESSION
Victim Name: [Your Full Legal Name] | DOB: [MM/DD/YYYY]
Affected Account / MRN Number(s): [List Numbers] | Disputed Date(s) of Service: [List Dates]
FTC Report #[Number] | Police Report #[Number]

Dear HIPAA Privacy Officer and HIM Director:

I am a confirmed victim of medical identity theft involving medical services and billing claims recorded under my identity at [Name of Facility] on [Disputed Date(s) of Service]. Enclosed are copies of my photo ID, my Federal Trade Commission (FTC) Identity Theft Report, and Police Incident Report #[Number]. I never visited [Name of Facility] on [Disputed Date(s) of Service] and never authorized anyone to use my identity or insurance. Because an impostor's clinical data has been merged into my Electronic Health Record (EHR), this corruption poses an immediate clinical safety hazard to my care. Pursuant to federal law, I make the following statutory demands:

1. DESIGNATED RECORD SET & ACCOUNTING OF DISCLOSURES (45 CFR § 164.524 & § 164.528): Within 30 calendar days, provide a complete copy of all intake forms, scanned IDs, signed consents, clinical notes, and itemized UB-04/CMS-1500 claims for the disputed encounters, plus a 6-year HIPAA Accounting of Disclosures and Health Information Exchange (HIE) transmission log (Epic CareEverywhere, CommonWell, Carequality, Surescripts).
2. CHART AMENDMENT & CLINICAL SEGREGATION (45 CFR § 164.526): Within 60 calendar days, permanently extract, unlink, and segregate all clinical notes, ICD-10 diagnosis codes, CPT codes, lab results, allergy changes, and prescriptions from [Disputed Date(s) of Service] out of my Master Patient Index (MPI) chart into a separate fraud investigation file.
3. DOWNSTREAM HIE NOTIFICATION (45 CFR § 164.526(c)(3)): Transmit an electronic Correction / Chart Unlink Notice to all Health Information Exchanges, Surescripts, my insurer ([Insurer Name, Member ID]), and every recipient on my Accounting of Disclosures.
4. BILLING SUPPRESSION (FCRA § 605B): Cancel all patient statements for Account(s) #[Numbers], withdraw claims submitted to my insurer so my benefit caps and deductibles are restored, and recall any accounts sent to collectors or credit bureaus under 15 U.S.C. § 1681c-2.

Sincerely,
[Your Signature & Printed Name]

Inqanaba lesi-4: Ukucoca amabango e-inshurensi yobuqhophololo, ii-ofisi ezikhethekileyo, kunye nobuqhophololo kwiMarike ye-ACA¶

Emva kokuba uvale iitshathi zakho zesibhedlele, coca imali, ukubhala phantsi, kunye nedatha yerhafu ezondla amabango ezempilo.

Inyathelo 1: I-Inshurensi yezeMpilo SIU, iMedicare (1-800-MEDICARE), kunye nekhadi leSazisi leLungu elitsha¶

1. I-Inshurensi yezeMpilo yaBucala / yabaqeshi: Fowunela inombolo engasemva kwekhadi lakho le-inshorensi uze ucele Iyunithi yoPhando oluKhethekileyo (SIU) / iSebe lobuqhophololo. Nikeza iinombolo zakho zeFTC kunye neeNgxelo zamaPolisa, kwaye ucele umphandi ukuba aliyeke lonke ibango lobuqhophololo EOB iziteyitimenti, buyisela imali yakho yonyaka etsalwayo kunye nobomi bakho bonke okanye ikepusi yenzuzo yonyaka, kwaye ukhuphe ikhadi elitsha kraca leSazisi seLungu.
2. I-Original Medicare (Part A, Part B, Part D) okanye iMedicaid: Fowuna 1-800-MEDICARE (1-800-633-4227) ukuxela izinto ezinobuqhophololo kwi-Medicare Summary Notice yakho (MSN), faka ingxelo ne-HHS iOfisi yoMhloli Jikelele (HHS-OIG)* e-oig.hhs.gov/fraud/report-fraud/ (1-800-447-8477), kwaye uqhagamshelane nelizwe lakho Senior Medicare Patrol (SMP) e-smpresource.org (1-877-808-2468) ukufumana i-Identifier ye-Medicare Beneficiary (MBI)** endaweni yayo.

INyathelo 2: Phicotha kwaye uphikise iiBureau ezi-3 zobuNgcaciso boNyango kunye nokuBhaliswa phantsi koMgangatho¶

Ubomi, ukukhubazeka, kunye ne-inshurensi yokunakekelwa kwexesha elide ikhupha iingxelo ezivela kuMthetho weNgxelo yoButyala obuNgcono (FCRA) ii-arhente ezikhethekileyo zokunika ingxelo yabathengi. Ukuba undwendwelo lwesibhedlele somkhohlisi okanye ikhemesti lizalisa uxilongo olungeyonyani okanye umyalelo we-opioid phantsi kwe-SSN yakho, phicotha kwaye uphikisane nazo zontathu:

Inyathelo lesi-3: Ukusonjululwa koBhaliso lweMarike ye-ACA yobuqhophololo (IRS Form 1095-A Ubuqhophololo kwiRhafu)¶

Ukuba i-arhente yeinshurensi ekhohlakeleyo okanye isela lesazisi libhalise inombolo yakho yoKhuseleko lweNtlalo kwi-Affordable Care Act (ACA) I-HealthCare.gov / isicwangciso seNdawo yeMarike yeSizwe ngaphandle kwemvume yakho, i-IRS iya kwala imbuyekezo yakho yerhafu yomdibaniso (Form 1040) kuba i-elektroniki Form 1095-A yakhutshwa phantsi kweSSN yakho ibonisa inyanga nenyanga Iikhredithi zeRhafu ze-Advance Premium (APTC). Musa ungaqhoboshi ubuqhophololo 1095-A ngokungathi ipolisi yeyakho. Landela i-CMS / IRS yeProtokholi yoBhaliso yeNdawo yeMarike engagunyaziswanga: 1. Fowunela iZiko leMinxeba le-HealthCare.gov (1-800-318-2596) kwaye uchaze ukuba unika ingxelo UBhaliso lweNdawo yeMarike engagunyaziswanga / ubuqhophololo kwi-Agent. Cela uphando kunye ne- I-Voided / Corrected Form 1095-A (ebonisa i-$ 0 kuzo zonke iinyanga) ithunyelwe kuwe kunye ne-IRS. 2. Xela uMmeli/uMrhwebi weRekhodi: Buza ummeli weMarike ngeIgama kunye neNombolo yoMvelisi weSizwe (NPN) ye-Agent/Broker ngesicelo sobuqhophololo, kwaye uzixele kuMkomishinala wakho we-Inshurensi yeSizwe** kunye IdentityTheft.gov. 3. Ukufaka iMbuyiselo yakho yeRhafu: Nge Imiyalelo ye-IRS yeFomu 8962 ("Umgaqo-nkqubo ofunyenwe Ngomnye uMhlawuli weRhafu"), emva kokuba uchaze umgaqo-nkqubo ongagunyaziswanga kwiMarike kwaye uqinisekisile ukuba ikhaya lakho alizange lisebenzise ipolisi, landela imiyalelo ye-IRS yokufayilisha ngolwabiwo olungenaziro okanye uncamathisele IRS Form 14039 de ivalwe 1095-A ifika.

Imibuzo edla ngokubuzwa¶

Ngaba isibhedlele okanye i-arhente yokuqokelela ingawonakalisa amanqaku am etyala ngetyala lobuqhophololo lonyango?¶

Hayi, ukuba usebenzisa amalungelo akho asemthethweni phantsi koMthetho weNgxelo yeTyala eliFanelekileyo (iCandelo leFCRA 605B, 15 U.S.C. 1681c-2) kunye noMthetho wokuQokelelwa kweTyala ngokuFanelekileyo (FDCPA). EUnited States, ii-credit bureaus ezintathu zelizwe lonke (i-Equifax, i-Experian, kunye ne-TransUnion) sele ingabandakanyi amatyala okuqokelela amayeza ahlawulweyo, amatyala ezonyango angaphantsi kwama-500 eedola, kunye namatyala ezonyango angaphantsi konyaka omnye ubudala kwiingxelo zekhredithi yabathengi. Kuba naliphi na ityala lobuqhophololo bonyango lwaso nasiphi na isixa seedola, ukuthumela ikopi yeNgxelo yobusela beSazisi ye-FTC esemthethweni kunye neNgxelo yamaPolisa kwiziko lamatyala kubanyanzele ngomthetho we-federal ukuba bavale ngokusisigxina umgca worhwebo phakathi kweentsuku ze-4 zokusebenza kwaye uvimbela isibhedlele okanye umqokeleli ukuba athengise okanye anike ingxelo yetyala kwakhona.

Kutheni isibhedlele singenako ukucinezela nje u-"Cima" ukucima utyelelo lobuqhophololo kwirekhodi yam yempilo yombane?¶

Ngaphantsi kwemithetho yokhuseleko ye-HIPAA ye-federal (45 CFR 164.312) kunye nemithetho yokugcinwa kwerekhodi yonyango, i-Electronic Health Record (EHR) isofthiwe efana ne-Epic kunye ne-Oracle Cerner yenziwe njenge-log engenakuguquleka yophicotho apho amanqaku eklinikhi angenako ukubhalwa ngaphandle komkhondo. Endaweni yoko, xa ungenisa ngokusemthethweni i-HIPAA yeCandelo le-164.526 Isicelo sokuLungiswa kunye nePolisa yakho kunye neeNgxelo zokuThenjwa kwe-Identity ye-FTC, iqela le-Health Information Management yesibhedlele (HIM) lenza "iTshathi engaxutywanga" okanye "i-De-Overlay": bakhupha yonke ingqungquthela yomkhohlisi kwi-Master Patient Index (MPI) yakho, uyifake kwifayile yakho yophando, uyifake kwifayile ye-Java. uhlobo lwegazi kunye neprofayili yokwaliwa, kunye nokuhambisa isaziso sokunganxibelelanisi nge-elektroniki kuyo yonke i-Epic CareEverywhere kunye nolunye uTshintsho loLwazi lwezeMpilo.

Ndifumanisa njani ukuba kukho umntu osebenzise isazisi sam ukuzalisa iopioid okanye imiyalelo yeziyobisi elawulwayo?¶

Kuya kufuneka uphicothe iinkqubo ezimbini ezahlukeneyo zokulandela ummiselo. Okokuqala, cela ugqirha wakho ophambili okanye usokhemesti oqhelekileyo ukuba akubuze imbali yakho yeminyaka emi-5 yeyeza zorhwebo ngokusebenzisa i-Surescripts (inethiwekhi ye-e-prescribing yelizwe lonke) kwaye ucele ukubhengezwa kwakho kwasimahla komthengi kwi-Milliman IntelliScript (rxhistories.com). Okwesibini, ngenxa yokuba i-cash-paid controlled substance prescriptions (iShedyuli II-V opioids, i-stimulants, kunye ne-benzodiazepines) ilandelwa ngokwahlukileyo ngoorhulumente baseburhulumenteni, qhagamshelana neBhodi yakho ye-State of Pharmacy okanye iSebe lezeMpilo leSizwe ukuba ucele iProgram yoMgulane yokuHlola iDrug Monitoring Programme (PDMP) ingxelo, kwaye ungenise ingxelo yakho yePolisa kunye ne-FTC Identity Theft Report ukuze ugcwalise nayiphi na i-Identity Theft Report.

Imithombo ijongiwe¶

• ISebe lezeMpilo lase-US kunye neeNkonzo zoLuntu, iOfisi yamaLungelo oLuntu (HHS OCR): * IKhowudi ye-Federal Regulations Title 45, iSigaba 164, i-HIPAA yoBucala boMthetho weLungelo lokuFikelela (45 CFR § 164.524), iLungelo lokuLungisa uLwazi lwezeMpilo oluKhuselweyo (45 CFR § 164.526), kunye neLungelo loCwangciso-mali lokuDiza (45 CFR § 164.528)*.
• Umbutho woLawulo loLwazi lwezeMpilo waseMelika (AHIMA): Ziqhelanise noMafutshane: Ukunciphisa ubusela besazisi sezoNyango kunye nokuLawula iSalathiso seSigulana esiPhambili (MPI) IiNgqungquthela kunye neziHlomelo kwiiRekhodi zezeMpilo zoMbane.
• IKomishoni yoRhwebo yoMdibaniso (FTC, eUnited States): Izikhokelo zokuLungisa ubusela besazisi sonyango, IdentityTheft.gov Isicwangciso soBuyiselo, kunye noMthetho weNgxelo yeTyala ngokufanelekileyo iCandelo 605B (15 U.S.C. § 1681c-2) IiMyalelo zeBhloko yeentsuku ezi-4.
• Amaziko eMedicare kunye neeNkonzo zeMedicaid (CMS) kunye neOfisi yeHHS yoMhloli Jikelele (HHS-OIG): Isazisi soMxhamli weMedicare (MBI) IiProtokholi zokuthobela, uPatrol oMkhulu weMedicare (SMP) Ukulungiswa koBuqhophololo, kunye ne-HealthCare.gov uBhaliso olungagunyaziswanga kwindawo yeMarike (Form 1095-A) Iinkqubo zeSisombululo.
• IZiko loKhuseleko lweMali yoMthengi (CFPB, eUnited States): UMthetho wokuNika iNgxelo yeTyala ngoLuhlu oluKhethekileyo lwe-Arhente yeNgxelo yabaThengi (MIB Group, Milliman IntelliScript, LexisNexis, ExamOne) kunye neMithetho yokuQokelelwa kweTyala loNyango phantsi koMmiselo F (FDCPA).

Izikhokelo ezinxulumeneyo¶

• Impendulo yokophulwa kwedatha, amagama ayimfihlo avuzayo, kunye nokumiswa kwetyala
• Ubusela besazisi somntwana kunye nefayile yetyala eyenziweyo iyamiswa
• Ubuqhophololo bokubonelela ngomsebenzi ongeyonyani, izixhobo zokujonga ubuqhetseba, kunye nobusela besazisi se-I-9
• I-akhawunti ye-imeyile igqekeziwe, imithetho yokuthunyelwa efihliweyo, kunye nokubuyisela
• Amanani kaxakeka ngokwelizwe