Ole Idanimọ iṣoogun, Awọn igbasilẹ Ilera ti bajẹ, ati Sisanwo Ẹtan¶

Ṣiṣawari Alaye ti Awọn anfani (EOB) alaye fun iṣẹ abẹ inpatient $42,000, iwe ilana oogun opioid, tabi ibẹwo yara pajawiri ti iwọ ko gba rara ju orififo owo lọ: o jẹ pajawiri ile-iwosan ti o lewu. Ko dabi jegudujera kaadi kirẹditi, nibiti banki kan n yi idiyele kan pada, ** ole idanimo iṣoogun *** dapọ iru ẹjẹ ẹlẹtan, awọn nkan ti ara korira, awọn iwadii ọpọlọ, ati itan-akọọlẹ iṣẹ abẹ taara sinu oluwa rẹ ** Igbasilẹ Ilera ItannaEHR*** kọja awọn paṣipaarọ alaye ilera jakejado orilẹ-ede (CareEverywhere, CommonWell, Carequality, ati Surescripts). Ti o ba yara daku sinu ile-iṣẹ ibalokanjẹ ati pe iwe eto ilera rẹ ti o bajẹ ṣe atokọ iru ẹjẹ ti ko tọ, yọkuro aleji penicillin ti o ku nitori apanirun naa sọ pe “Ko si Awọn Ẹhun Oògùn Ti a mọNKDA)", tabi ṣe asia fun ọ bi oluwadi oogun narcotic, awọn oniwosan pajawiri le ṣe awọn aṣiṣe itọju apaniyan. Ni kete ti apanirun ba mu fila anfani iṣeduro ilera lododun rẹ kuro tabi fi awọn iwadii aisan onibaje eke sinu aaye data MIB Group (Ajọ Alaye Iṣoogun), o tun le kọ iṣeduro igbesi aye, agbegbe ailera, ati awọn ilana iṣoogun to ṣe pataki.

Ti iwọ tabi ọmọ ẹgbẹ ẹbi kan ba ni iriri pajawiri iṣoogun nla kan tabi ti wọn ko ni itọju ile-iwosan ni iyara nitori apẹrẹ iṣoogun ti ibajẹ, pe nọmba pajawiri agbegbe rẹ (911 ni Ilu Amẹrika ati Kanada, 112 jakejado European Union, 999 ni United Kingdom) tabi kan si itọsọna wa ti kariaye pajawiri awọn nọmba lesekese, ki o si sọ fun dọkita triage ni eniyan lati foju adase itanna chart ati ṣiṣe awọn alabapade ẹjẹ iru ati crossmatch. Fun gbogbo awọn ọran miiran ti ole idanimo iṣoogun, awọn igbasilẹ ilera eke, tabi ìdíyelé ilera arekereke, tẹle iṣan-iṣẹ atunṣe ni isalẹ.

Ṣe eyi ni bayi¶

1. **Paṣẹ pipe “Eto Igbasilẹ Apẹrẹ” ATI “Iṣiro Awọn Iṣipaya” lati gbogbo ile-iwosan ti o kan, ile-iwosan, ati alabojuto : Labẹ AMẸRIKA ** Gbigbe Iṣeduro Iṣeduro Ilera ati Ofin Ikasi (HIPAA, 45 CFR § 164.524 ati § 164.528, o ni ẹtọ labẹ ofin lati gba ẹda pipe ti iṣoogun rẹ ati awọn igbasilẹ ìdíyelé laarin awọn ọjọ kalẹnda 30 **, pẹlu Iṣiro Iṣiro Ọdun 6 ti Awọn ifihan *** nfihan gbogbo agbari ti ita ti o gba alaye ilera to ni aabo rẹ. Maṣe gbẹkẹle wiwo olumulo ipilẹ inu ọna abawọle alaisan ori ayelujara rẹ (MyChart), eyiti o tọju awọn koodu ìdíyelé inu ati awọn akọsilẹ iṣakoso.
2. ** Faili Ijabọ ole Idanimọ Federal Trade Commission osise kan (IdentityTheft.gov) ati Iroyin ọlọpa agbegbe kan ***: Awọn olupese iṣoogun ati awọn alabojuto ilera nigbagbogbo kọ lati paarẹ gbese arekereke tabi paarọ awọn shatti ile-iwosan lori ọrọ alaisan nikan. Ṣiṣẹda lodo FTC Ijabọ ole Idanimọ *** ati gbigba Nọmba Ijabọ Iṣẹlẹ ọlọpa ti agbegbe kan nfa awọn aabo idilọwọ gbese-aṣẹ labẹ ofin ** Ofin Ijabọ Kirẹditi Fair (FCRA § 605B, 15 U.S.C. § 1681c-2) ati pe o jẹ olufaragba ilufin.
3. **Kilọ fun dokita alabojuto akọkọ rẹ ati tabili ipinya ile-iwosan agbegbe lati gbe “Asia Aabo Ile-iwosan” sori chart rẹ ***: Ṣaaju ki iwe aṣẹ ti ofin gba 30 si 60 ọjọ lati ṣe ilana, beere lọwọ dokita gidi rẹ ati iṣakoso Alaye Ile-iwosan agbegbe (HIM) Ẹka lati gbe lẹsẹkẹsẹ ** Asia Itaniji Ile-iwosan giga-High-High-High-High-Visibility Clinical Alert ** ni oke ti awọn oniwosan ikilọ chart itanna rẹ: * "Timo Olufaragba Identity Identity Fọwọsi. Ṣe idaniloju Iru Ẹjẹ, Ẹhun, ati Akojọ Oogun taara pẹlu alaisan ṣaaju iṣakoso. Awọn igbasilẹ arekereke lati [Awọn ọjọ] wa labẹ HIPAA § 164.526 nu.”
4. ** Fi iwe kikọ silẹ ni deede HIPAA § 164.526 Ibere fun Atunse si Oṣiṣẹ Aṣiri ti olupese ***: Maṣe mu ibajẹ igbasilẹ iṣoogun mu lori foonu pẹlu akọwe ìdíyelé kan. Firanṣẹ ifiweranṣẹ ** USPS Ifọwọsi *** ibeere taara si ile-iwosan ** HIPAA Oṣiṣẹ Aṣiri ** ati ** Isakoso Alaye Ilera (HIM) Oludari *** nbeere pe gbogbo koodu ayẹwo eke (ICD-10), koodu ilana (CPT), ifasilẹ aleji, ati akọsilẹ ile-iwosan ti a ṣẹda nipasẹ apanirun jẹ mimọ patapata tabi ya sọtọ lati inu chart rẹ, ati pe awọn akiyesi atunṣe jẹ gbigbe kaakiri ** Apọju ItọjuNi gbogbo aye *** ati ** Awọn iwe afọwọkọ **.
5. Pe Ẹka Awọn iwadii Pataki ti oludaniloju ilera rẹ (SIU(1-800-MEDICARE*: Awọn aṣoju iṣẹ alabara boṣewa ni awọn ile-iṣẹ iṣeduro ilera ko le yọkuro ole idanimo iṣoogun. Beere ni pataki fun ile-iṣẹ iṣeduro **Ẹka Awọn iwadii Pataki (SIU) / Ẹka Ẹtan *** lati ṣe asia awọn ẹtọ arekereke, mu igbesi aye rẹ pada ati awọn anfani anfani ọdọọdun, ṣe atunto iyokuro rẹ, ati fun ọ ni ** nọmba ID ọmọ ẹgbẹ tuntun kan **.
6. ** Fa iṣoogun pataki rẹ ati awọn ijabọ olumulo iwe ilana oogun (MIB Group, Milliman IntelliScript, ati LexisNexis*** Paapaa lẹhin ti ile-iwosan kan ṣe atunṣe ibi ipamọ data agbegbe rẹ, awọn iwadii eke ati awọn itan-akọọlẹ iwe ilana oogun tẹsiwaju ninu awọn apoti isura infomesonu ti ẹnikẹta ti a lo nipasẹ igbesi aye, ailera, ati awọn alamọdaju itọju igba pipẹ. Beere ati jiyan awọn faili pataki rẹ ni MIB Group, Milliman IntelliScript, ati LexisNexis Ewu Solutions, ati di awọn faili kirẹditi akọkọ rẹ ni Equifax, Experian, ati TransUnion ni atẹle wa. esi data csin ati ọrọigbaniwọle jo guide.

Ipinnu igi: unntangling ibaje isẹgun igbasilẹ vs. arekereke insurance ìdíyelé¶

Jija idanimo iṣoogun ṣubu si awọn ẹka ọtọtọ meji ti o nigbagbogbo ni lqkan: ** ole Alaisan Apanilẹrin ** (nibiti alejò ti ko ni iṣeduro tabi ojulumọ ṣe ayẹwo ti ara sinu yara pajawiri tabi ile elegbogi nipa lilo orukọ ji rẹ, ọjọ ibi, Nọmba Aabo Awujọ, tabi kaadi iṣeduro) ati ** Insider / Olupese Upcoding & Phantom Billing Fraud, ile-iwosan tabi ile-iṣẹ iṣoogun ti ilera, ti o le jẹ ti ile-iwosan. Nọmba iṣeduro aladani fun awọn idanwo jiini, awọn àmúró ẹhin, tabi awọn abẹwo ti ko ṣẹlẹ rara). Lo apẹrẹ ṣiṣan yii lati ya awọn irokeke mejeeji ya sọtọ:

flowchart TD
    Start["Ti ṣe awari Flag Pupa: Gbólóhùn EOB ajeji, Ibẹwo MyChart ti a ko mọ, Itaniji Ile elegbogi, tabi Ipe Gbigba"] --> Audit["1. Beere Eto Igbasilẹ ti a yan ni kikun & Iṣiro HIPAA Ọdun 6 ti Awọn ifihan lati ọdọ Olupese & Insurer"]
    Audit --> Type{"2. Ǹjẹ́ Afàwọ̀rajà kan Gba Ìtọ́jú Lọ́nà Ti ara Lábẹ́ Orukọ Rẹ, Àbí Ó Ha Jẹ́ Jibiti-Idiyelé Iwe Bi?"}
    Type -->|"Alaisan Impostor Gba Itọju Ti ara / Awọn iwe ilana oogun"| Clinical["EWU Isẹgun to ṣe pataki: Iru Ẹjẹ Impostor, Ẹhun & Labs Ti Darapọ mọ EHR Rẹ"]
    Type -->|"Ìdíyelé Olupese Phantom Nikan (DME, Labs, Upcoding)"| Financial["Olowo & Ewu Akọsilẹ: Awọn Ifi-anfani Ti Danu & Irọ ICD-10 Awọn iwadii Ti Wọle"]
    Clinical --> Alert["3A. Fi Itaniji Aabo Ile-iwosan Lẹsẹkẹsẹ sori Atọka Ile-iwosan Agbegbe & Tun-Ṣeyẹwo Awọn Ẹhun/Iru Ẹjẹ"]
    Alert --> Both["4. Faili FTC Identity Ijabọ Ijabọ (IdentityTheft.gov) + Iroyin ọlọpa Agbegbe + HHS OIG / Ẹdun SIU"]
    Financial --> Both
    Both --> HIPAA["5. Mail Formal HIPAA § 164.526 Atunse Chart & Ibeere Iyapa si HIM / Oṣiṣẹ Aṣiri"]
    HIPAA --> HIE["6. Fi agbara mu Itankalẹ Atunse Kọja Apọju Itọju Ni gbogbo ibi, WellWell, Itọju abojuto & Awọn iwe afọwọkọ"]
    HIE --> Specialty["7. Àríyànjiyàn & Purge MIB Group, Milliman IntelliScript, LexisNexis & Awọn iṣowo Gbigba Ajọ Kirẹditi"]

Awọn apoti isura infomesonu 6 ti o farapamọ nibiti ole idanimo iṣoogun ti ba igbesi aye rẹ jẹ¶

Nigbati ọpọlọpọ awọn alaisan ṣe iwari jija idanimọ iṣoogun, wọn pe nọmba foonu ìdíyelé lori risiti kan wọn ro pe ni kete ti ile-iwosan ba yọ owo naa kuro, iṣoro naa ti yanju. Ninu awọn amayederun IT ti ilera ode oni, ibẹwo yara pajawiri ẹlẹtan kan tabi ṣayẹwo-itọju ni iyara awọn atunwi kọja ** awọn eto ilolupo data orilẹ-ede mẹfa ti o ni asopọ *** laarin iṣẹju-aaya. Ti o ko ba wẹ gbogbo awọn ipele mẹfa kuro, profaili iṣoogun ti ẹlẹtan yoo tun ṣe akoran chart rẹ ni gbogbo igba ti o ba ṣabẹwo si dokita tuntun kan.

Ipele 1: Ṣiṣafihan awọn ami ikilọ kutukutu ti ole idanimo iṣoogun¶

Nitoripe awọn ile-iwosan ati awọn ile-iṣere ṣọwọn pe alaisan ṣaaju fifisilẹ ibeere itanna kan, ida 65 ti awọn olufaragba idanimo iṣoogun ko mọ idanimọ ilera wọn ti ni ipalara titi di oṣu diẹ lẹhinna. Ṣe ayẹwo awọn igbasilẹ rẹ ti o ba ṣe akiyesi eyikeyi ninu awọn asia pupa mẹjọ wọnyi:

1. ** Awọn nkan ti a ko mọ lori Alaye Awọn anfani (EOB) tabi Akiyesi Lakotan Eto ilera (MSN***: Maṣe danu rara EOB apoowe nitori pe oju-iwe iwaju sọ *“EYI KO ṢE IYE: Alaisan NI gbese $0.00.” * Awọn ohun elo iṣoogun ti o tọ ti ibajẹ (DME) Mills Bill Medicare tabi iṣeduro iṣowo fun awọn àmúró orthotic, awọn diigi glukosi ti nlọsiwaju, awọn panẹli PCR, tabi awọn idanwo jiini lakoko ti o n yọkuro idakọ-owo alaisan ki o ko gba iwe-owo olupese kan rara. Ka gbogbo ohun ila lori gbogbo EOB ati MSN lati rii daju pe o rii dokita yẹn ni ọjọ yẹn.
2. ** Awọn titẹ sii ile-iwosan ajeji, awọn nkan ti ara korira, tabi awọn iyipada iga/ iwuwo inu MyChart**: Wọle si awọn ọna abawọle alaisan ori ayelujara (Epic MyChart, Oracle Health, Healow, Athenahealth) ati ṣayẹwo ** Akopọ Ilera -> Awọn Ẹhun, Awọn oogun, Ajẹsara, ati Awọn abẹwo ti o ti kọja **. Ti iru ẹjẹ rẹ ba yipada, giga ti a ṣe akojọ rẹ fo nipasẹ awọn sẹntimita 10 (inṣi 4), itan-akọọlẹ nkan ti ko mọ, tabi ibẹwo ẹka pajawiri ti a ko mọ ti wa ni atokọ, rẹ MPI (Atọka Alaisan Ọga) ti jija tabi dapọ ("apọju chart").
3. ** Kiko agbegbe lojiji fun ilana iṣoogun ti o tọ tabi iwe ilana oogun ***: Ti ile elegbogi rẹ ba kọ lati kun iwe oogun rẹ nitori pe iṣeduro sọ pe o kun awọn ọjọ sẹhin kọja ilu, tabi alabojuto rẹ kọ aṣẹ ṣaaju fun àmúró orokun, ẹrọ CPAP, tabi igba itọju ti ara nitori opin anfani anfani ọdọọdun rẹ ti rẹ, ẹlomiiran n pa eto imulo rẹ run.
4. ** Awọn iwifunni airotẹlẹ lati MyChart nipa awọn ọna asopọ ile-iwosan ita ***: Awọn iru ẹrọ EHR ode oni firanṣẹ awọn itaniji adaṣe nigbati ile-iwosan kan ninu eto ilera miiran sopọ si igbasilẹ rẹ tabi ṣeto ipinnu lati pade ilera tẹlifoonu. Ṣe itọju eyikeyi asopọ ile-iwosan ti ko mọ bi irufin ti nṣiṣe lọwọ.
5. ** Awọn ipe gbigba gbese, awọn ọrọ, tabi awọn ẹjọ fun ile-iwosan ti ko mọ, Ẹkọ aisan ara, radiology, tabi awọn owo ọkọ alaisan ***: Awọn abẹwo yara pajawiri n gbejade awọn owo-owo ọtọtọ marun marun (ọya ile-iwosan, ẹgbẹ dokita pajawiri, onimọ-jinlẹ, onimọ-jinlẹ, ati ọkọ alaisan). Gbigba akiyesi gbigba kan lati ọdọ ẹgbẹ oṣiṣẹ dokita ti ko mọ (*Envision *, TeamHealth, tabi *US Awọn solusan Itọju Itọju Aje) nigbagbogbo jẹ ami akọkọ ti apanirun lo orukọ rẹ ati SSN ni yara pajawiri ni awọn oṣu diẹ sẹhin.
6. ** Ifura lati ọdọ awọn dokita nipa awọn ilana ilana nkan ti iṣakoso ***: Ti dokita tabi nọọsi ba beere lọwọ rẹ lojiji nipa lilo opioid, kọ oogun oogun ti o ṣe deede lẹhin iṣẹ abẹ, tabi mẹnuba awọn abẹwo ti iwọ ko ṣe, beere lọwọ wọn lati ṣayẹwo rẹ State PDMP (Eto Abojuto Oogun oogun) ati ** Apọju CareEverywhere *** ṣe igbasilẹ fun iṣẹ apanirun.
7. ** Gbigba ohun IRS Form 1095-A, 1095-B, tabi 1095-C fun eto imulo iṣeduro ilera ti ko mọ *: Awọn alagbata iṣeduro Rogue nigbakan lo Awọn nọmba Aabo Awujọ ti ji ati awọn ọjọ ibi lati forukọsilẹ awọn olufaragba ni ifunni ** Ofin Itọju Ifarada (ACA) Awọn ero ibi ọja *** laisi aṣẹ si awọn igbimọ alagbata apo. Nigbati o ba ṣajọ ipadabọ owo-ori ijọba rẹ, IRS kọ ipadabọ rẹ tabi beere isanpada ti ** Awọn Kirẹditi Owo-ori Ere Ilọsiwaju (APTC).
8. ** Gbigba lẹta ifitonileti irufin data lati ile-iwosan kan, ile imukuro (Change Healthcare), tabi lab (Quest, LabCorp***: Awọn irufin ilera ṣe afihan package gangan ti awọn ọdaràn nilo: Orukọ Kikun, Ọjọ ibi, Nọmba Aabo Awujọ, ID Ọmọ ẹgbẹ Iṣeduro Ilera, ati Nọmba Ẹgbẹ.

Ipele 2: Ṣiṣe aabo aabo ile-iwosan rẹ ati ṣiṣayẹwo igbasilẹ iṣoogun pipe rẹ¶

Ṣaaju ki o to ja pẹlu awọn apa ìdíyelé, pataki pataki rẹ ni ṣiṣe idaniloju pe ko si dokita, nọọsi, tabi paramedic ti o gbẹkẹle data iṣoogun ti ibajẹ lati tọju rẹ ni pajawiri.

Igbesẹ 1: Fi “Idaniloju Jile Idanimọ Oogun” Itaniji Aabo Ile-iwosan Lẹsẹkẹsẹ sori Awọn shatti Gidi Rẹ¶

Kan si ** Isakoso Alaye Alaye Ilera (HIM) / Ẹka Igbasilẹ Iṣoogun *** ni ọfiisi dokita alabojuto akọkọ rẹ ati eto ile-iwosan ti o sunmọ julọ nibiti a yoo mu ọ ni ọkọ alaisan. - Sọ fun awọn HIM Oludari pe o jẹ olufaragba ti a fọwọsi ti ole idanimo iṣoogun (tabi “Adapọ / Igbasilẹ Iṣoogun Apoju” nibiti faili alaisan miiran ti dapọ si tirẹ). - Beere pe ki wọn gbe **Break-The-Glass / Asia Aabo Ile-iwosan Hihan Giga *** sori Atọka Alaisan Titunto rẹ (MPI) ṣe igbasilẹ ki eyikeyi oniwosan ti n ṣii chart rẹ rii ikilọ agbejade lẹsẹkẹsẹ lati rii daju idanimọ rẹ pẹlu ID fọto, tun-ṣayẹwo awọn nkan ti ara korira rẹ, ati ṣiṣe iru ẹjẹ tuntun ati iboju. - Beere lọwọ dokita alabojuto akọkọ lati tẹ sita **Afọwọsi, Akopọ Iwosan Iwe Imudaniloju ** (kikojọ iru ẹjẹ otitọ rẹ, awọn nkan ti ara korira, awọn oogun ti nṣiṣe lọwọ, ati awọn ipo onibaje) ati gbe ẹda kan sinu apamọwọ rẹ lẹgbẹẹ ID ati kaadi iṣeduro rẹ.

Igbesẹ 2: Beere Ipari rẹ “Ṣeto Igbasilẹ Apẹrẹ” ati “Iṣiro ti Awọn ifihan” Labẹ HIPAA¶

Maṣe beere lọwọ olugba ile-iwosan kan fun ẹda awọn akọsilẹ ibẹwo rẹ. Labẹ ofin apapo (45 CFR § 164.524 ati 45 CFR § 164.528 ni Orilẹ Amẹrika; UK GDPR Subject Access Request ni United Kingdom; PIPEDA / PHIPA ni Canada; GDPR Article 15 kọja European Union), fi ibeere kikọ silẹ si olupese ti olupese ** HIPAA Oṣiṣẹ Aṣiri ** tabi ** Tu Alaye silẹ (ROI) Ẹka *** nbeere awọn ipilẹ data mẹta:

1. ** Eto Igbasilẹ Apejuwe pipe (45 CFR § 164.524***: Beere gbogbo awọn fọọmu iforukọsilẹ gbigbe, awọn ẹda ti a ṣayẹwo ti iwe-aṣẹ awakọ ati kaadi iṣeduro ti a gbekalẹ ni iforukọsilẹ, awọn fọọmu ifọwọsi-si-itọju, awọn akọsilẹ nọọsi, awọn akọsilẹ dokita, yàrá ati awọn abajade redio, awọn akopọ idasilẹ, ati awọn fọọmu ibeere idiyele idiyele UB-04 / CMS-1500 ** nfihan gbogbo ICD-10 okunfa koodu ati CPT owo ilana koodu. Labẹ apapo HIPAA Awọn ofin, olupese gbọdọ pese awọn igbasilẹ wọnyi laarin awọn ọjọ kalẹnda 30 *** (tabi ** ọjọ 15 ni California *** labẹ Ilera & Koodu Aabo § 123110).
2. ** Iṣiro HIPAA Ọdun 6 kan ti Awọn ifihan (45 CFR § 164.528*: Beere iwe kikọ ti gbogbo nkan ita, iforukọsilẹ, tabi alabaṣiṣẹpọ ti o gba Alaye Ilera ti o ni aabo (PHI) ni ọdun mẹfa sẹhin, pẹlu akọọlẹ kan ti ** Gbogbo Iyipada Alaye Ilera (HIE) ibeere (Epic CareEverywhere, CommonWell, Carequality) ti o fa ipade arekereke sinu awọn eto ile-iwosan ita.
3. ** Itọpa Ayẹwo EHR / Awọn Akọsilẹ Wiwọle (45 CFR § 164.308(a)(1)(ii)(D) & 42 U.S.C. § 17935(e)***: Ti o ba fura pe onimọran kan (gẹgẹbi oṣiṣẹ ile-iwosan tabi akọwe ìdíyelé) ji tabi paarọ igbasilẹ rẹ, beere **Itọpa Igbasilẹ Igbasilẹ Ilera Itanna ** ti n ṣafihan awọn ID olumulo, awọn ami akoko, ati awọn ipo ebute ti gbogbo ọmọ ẹgbẹ oṣiṣẹ ti o wọle si chart rẹ lakoko iwọn ọjọ arekereke.

Ipele 3: Fi ipa mu awọn ile-iwosan lati nu awọn igbasilẹ ile-iwosan eke kuro (HIPAA § 164.526)¶

Ni kete ti o ba ti ṣe atunwo awọn igbasilẹ ati ṣe idanimọ gbogbo ibẹwo, idanwo ile-iwosan, iwadii aisan, tabi iwe ilana oogun ti kii ṣe tirẹ, o gbọdọ fi ipa mu olupese ilera ni ofin lati yọkuro tabi sọtọ awọn titẹ sii ibaje lati inu chart rẹ.

Bawo ni Ofin HIPAA § 164.526 Ilana Atunse Awọn iṣẹ¶

Labẹ 45 CFR § 164.526 (Ẹtọ lati Ṣatunṣe Alaye Ilera Aabo): 1. ** Ibeere Atunse Ikọwe rẹ : Fi iwe ti a fowo si, ti ọjọ-ọjọ ranṣẹ si ile-iwosan ** HIPAA Oṣiṣẹ Aṣiri ** ati ** Oludari Iṣakoso Alaye Ilera (HIM idamo ọjọ iṣẹ kọọkan, koodu ayẹwo (ICD-10), oogun, titẹsi aleji, ati akọsilẹ ile-iwosan ti o jẹ ti ole idanimo tabi aṣiṣe agbekọja chart. 2. **Ipari Ofin Ọjọ 60 ti Ile-iwosan ***: Labẹ 45 CFR § 164.526(b)(2), olupese ilera ** gbọdọ ṣiṣẹ lori ibeere atunṣe rẹ laarin awọn ọjọ kalẹnda 60 ** ti gbigba. 3. ** Unmerging Chart ("De-overlay") la Atunse Laini-Nkan ***: Ọjọgbọn HIM Awọn iṣedede ti a gbejade nipasẹ **AHIMA (Ẹgbẹ Aṣoju Alaye Alaye Ilera ti Amẹrika) *** kọ ile-iwosan lati ** jade ati pin gbogbo ipade alatan naa si lọtọ “Akọọlẹ arekereke John/Jane Doe” Atọka Alaisan Titunto (MPI) nọmba , unlinking o lati rẹ gidi MPI chart ati mimu-pada sipo rẹ ipetele data isẹgun. 4. ** Ifitonileti ibosile ti o jẹ dandan (45 CFR § 164.526(c)(3) Ni kete ti olupese ba gba atunṣe rẹ ti o si ṣe apejọ ipade arekereke, ofin apapo nilo olupese lati ** gbe igbasilẹ atunṣe / ti ko ni asopọ si *** gbogbo eniyan tabi agbari ti o ṣe idanimọ (awọn dokita gidi rẹ, alabojuto ilera rẹ, ati awọn ile-iṣẹ pataki bi). MIB Group), ati gbogbo Paṣipaarọ Alaye Ilera (Epic CareEverywhere, CommonWell, Carequality) ati nẹtiwọki ile elegbogi (Surescripts) ti o gba data ti o bajẹ.

Kini ti Olupese ba Kọ Rẹ HIPAA § 164.526 Ibere ​​Atunse?¶

Ti ile-iwosan tabi ile-iwosan ba kọ lati tunse tabi yọkuro awọn titẹ sii eke, ofin apapo (45 CFR § 164.526(d)) yoo fun ọ ni ** awọn ọna atako ofin mẹta : 1. ** Ẹtọ lati Faili “Gbólóhùn ti Iyapa” Kan Lodo kan (45 CFR § 164.526(d)(2) Gbólóhùn Àìfohùnṣọ̀kan** (fisọ̀rọ̀ Ìjábọ̀ Ìdánimọ̀ Ìdámọ̀ FTC rẹ àti Ìròyìn Ọlọ́pàá) tí ó ń ṣàlàyé àwọn ohun tí wọ́n kọ sínú ẹ̀tàn àti ohun tí irú ẹ̀jẹ̀ rẹ̀ jẹ́ òtítọ́, ẹ̀dùn, àti ìtàn ìṣègùn. 2. ** Asomọ Yẹ Dandandan si Gbogbo Awọn Ifihan Ọjọ iwaju (45 CFR § 164.526(d)(4)***: Ni kete ti o ba gbejade Gbólóhùn Iyatọ kan, ** ile-iwosan ni o nilo labẹ ofin lati fi Gbólóhùn Iyatọ rẹ si ayeraye si igbasilẹ iṣoogun ti ariyanjiyan ***, ati ** gbọdọ ni Gbólóhùn Iyapa rẹ pẹlu gbogbo ifihan ọjọ iwaju tabi gbigbe HIE itanna ti igbasilẹ yẹn *. 3. ** Ẹdun Agbofinro Federal pẹlu HHS Office for Civil Rights (OCR): Ṣe ẹjọ ẹdun Ofin Aṣiri HIPAA kan ni ocrportal.hhs.gov laarin awọn ọjọ 180, ati daakọ Igbimọ Iṣoogun ti Ipinle rẹ ati Attorney General ti Ipinle.

Daakọ-ati-lẹẹ mọ iwe afọwọkọ: Lodo HIPAA § 164.526 Igbasilẹ Iṣoogun Purge & Ibeere Atunse¶

Fi lẹta yii ranṣẹ nipasẹ ** Imeeli Ifọwọsi USPS pẹlu Gbigba Ipadabọ ti a beere *** si olupese ti olupese ** HIPAA Oṣiṣẹ Aṣiri **, ** Isakoso Alaye Ilera (HIM) Oludari ***, ati ** Awọn iṣẹ Iṣowo Alaisan / Ẹka Ẹtan ***:

[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]

Ipele 4: Mimu awọn iṣeduro iṣeduro arekereke, awọn bureaus pataki, ati jibiti Ibi Ọja ACA¶

Lẹhin titiipa awọn shatti ile-iwosan rẹ, nu owo, iwe afọwọkọ, ati awọn data data owo-ori ti o jẹ ifunni awọn ẹtọ ilera.

Igbesẹ 1: Iṣeduro Ilera SIU, Eto ilera (1-800-MEDICARE), ati Kaadi ID Ẹgbẹ Tuntun¶

1. ** Iṣeduro Ilera ti Ikọkọ / Agbanisiṣẹ ***: Pe nọmba ti o wa ni ẹhin kaadi iṣeduro rẹ ki o beere fun Ẹka Awọn iwadii Pataki SIU) / Ẹka Ẹtan. Pese FTC rẹ ati awọn nọmba Ijabọ ọlọpa, ki o si beere lọwọ oniwadii lati ** sofo gbogbo ibeere arekereke ** lori rẹ EOB awọn alaye, ** mu pada rẹ lododun deductible ati s'aiye tabi lododun anfani bọtini ***, ati ** oro kan brand-titun Ẹgbẹ ID kaadi ***.
2. ** Eto ilera atilẹba (Part A, Part B, Part D) tabi Medikedi**: Pe 1-800-MEDICARE (1-800-633-4227* lati jabo awọn nkan arekereke lori ** Akiyesi Lakotan Medical Care (MSN, ṣe ijabọ kan pẹlu ** HHS Office of Inspector General (HHS-OIG ni oig.hhs.gov/fraud/report-fraud/ (1-800-447-8477), ki o si kan si ipinle rẹ Sẹnior Medicare Patrol (SMP* ni smpresource.org (1-877-808-2468) lati gba ikọlu ** Oludamo Alanfani Iṣoogun (Medicare).MBI)** rọpo.

Igbesẹ 2: Ṣiṣayẹwo ati Jiyàn Awọn Ile-iṣẹ Iṣoogun Pataki 3 & Awọn ile-iṣẹ Abẹkọ iwe-aṣẹ¶

Igbesi aye, ailera, ati iṣeduro iṣeduro igba pipẹ fa awọn iroyin lati Ofin Iroyin Kirẹditi Itọkasi mẹta (FCRA) awọn ile-iṣẹ ijabọ alabara pataki. Ti ibẹwo ile-iwosan alatan kan tabi ile elegbogi fọwọsi ayẹwo eke tabi iwe ilana oogun opioid labẹ SSN rẹ, ṣayẹwo ati jiyan gbogbo awọn mẹta:

Igbesẹ 3: Ṣiṣatunṣe Iforukọsilẹ Ibi Ọja ACA arekereke (IRS Form 1095-A Jibiti owo-ori)¶

Ti o ba jẹ pe aṣoju iṣeduro rogue kan tabi ole idanimo forukọsilẹ Nọmba Aabo Awujọ rẹ ni Ofin Itọju Ti ifarada ((ACAHealthCare.gov / Eto Ibi ọja Ipinle *** laisi aṣẹ rẹ, IRS yoo kọ ipadabọ owo-ori ijọba rẹ (Form 1040) nitori ẹrọ itanna Form 1095-A Ti ṣejade labẹ SSN rẹ ti n ṣafihan oṣooṣu ** Awọn Kirẹditi Owo-ori Ere Ilọsiwaju (APTC)**. Maa ṣe ** ko ** so awọn arekereke 1095-A bi ẹnipe eto imulo jẹ tirẹ. Tẹle Ilana Ilana Iforukọsilẹ Ibi ọja Laigba CMS / IRS : 1. ** Pe Ile-iṣẹ Ipe Ibi ọja HealthCare.gov (1-800-318-2596) ki o si sọ pe o n ṣe ijabọ Iforukọsilẹ Ibi ọja Laigba aṣẹ / Jegudujera Aṣoju ** Beere fun iwadii ati ** Sofo / Fọọmu Atunse 1095-A (fifihan $0 ni gbogbo awọn oṣu) ti a firanṣẹ si ọ ati IRS. 2. ** Jabọ Aṣoju/Alagbata Igbasilẹ ***: Beere aṣoju Ibi ọja fun ** Orukọ ati Nọmba Olupilẹṣẹrilẹ-ede (klzxh:0065) ti Aṣoju/Alagbata ** lori ohun elo arekereke, ki o jabo wọn i **omisona IṣedurIpinle **ati **IdentityTheft.gov**. 3. ** Iforukọsil ipadabọ owo-ori rẹ *: Fun ** Awọnlana IRS fun Fọọmu 8962 (*“ Ilana ti o gba nipasẹ Olusanwoi miiran”*)**,i kete ti o ba ti royin eto imulo laigba aṣẹ si Ibi ọja ati jẹrisi pe idile rẹ ko lo eto imulo naa, tẹle awọn ilana IRS fun iforukọsilẹ pẹlu ipin odo tabi somọ IRS Form 14039 titi di ofo 1095-A de.

Awọn ibeere ti a beere nigbagbogbo¶

Njẹ ile-iwosan tabi ile-ibẹwẹ ikojọpọ le ba Dimegilio kirẹditi mi jẹ lori iwe-owo iṣoogun arekereke bi?¶

Rara, pese ti o ba lo awọn ẹtọ ti ofin rẹ labẹ Ofin Ijabọ Kirẹditi Irẹwẹsi (Abala FCRA 605B, 15 U.S.C. 1681c-2) ati Ofin Awọn adaṣe Gbigba Gbese Ti ododo (FDCPA). Ni Orilẹ Amẹrika, awọn bureaus kirẹditi mẹta ti orilẹ-ede (Equifax, Experian, ati TransUnion) ti yọkuro awọn gbese gbigba iṣoogun ti isanwo, awọn gbese iṣoogun labẹ awọn dọla 500, ati awọn gbese iṣoogun ti o kere ju ọdun kan lọ lati awọn ijabọ kirẹditi olumulo. Fun eyikeyi iwe-owo iṣoogun arekereke ti eyikeyi owo dola, fifiranṣẹ ẹda kan ti Ijabọ Ijabọ Idanimọ idanimọ FTC osise rẹ ati Ijabọ ọlọpa si awọn ile-iṣẹ kirẹditi fi agbara mu wọn nipasẹ ofin apapo lati di laini iṣowo duro patapata laarin awọn ọjọ iṣowo 4 ati ṣe idiwọ ile-iwosan tabi olugba lati lailai ta tabi jijabọ gbese naa lẹẹkansi.

Kilode ti ile-iwosan ko le kan tẹ “Paarẹ” lati pa ibẹwo arekereke rẹ kuro ni igbasilẹ ilera eletiriki mi?¶

Labẹ awọn ilana aabo HIPAA ti ijọba ijọba (45 CFR 164.312) ati awọn ofin igbasilẹ igbasilẹ iṣoogun ti ipinlẹ, sọfitiwia Igbasilẹ Ilera Itanna (EHR) bii Epic ati Oracle Cerner jẹ ayaworan bi iwe iṣayẹwo ti ko yipada nibiti awọn akọsilẹ ile-iwosan ko le rọrun ni atunkọ laisi itọpa. Dipo, nigba ti o ba fi Abala HIPAA kan silẹ 164.526 Ibeere fun Atunse pẹlu ọlọpa rẹ ati Awọn ijabọ Identity Identity FTC, ẹgbẹ iṣakoso Alaye Ilera (HIM) ti ile-iwosan ṣe “Chart Unmerging” tabi “De-overlay”: wọn yọ gbogbo ipade alatan jade kuro ninu Atọka Alaisan Titunto rẹ (MPI) lati ṣe atunṣe nọmba kan ti a fi silẹ fun iwadi John. Iru ẹjẹ ipilẹ ati profaili aleji, ati atagba akiyesi aisopọ itanna kan kọja Apọju CareNi gbogbo ati Awọn paṣipaarọ Alaye Alaye Ilera miiran.

Bawo ni MO ṣe rii boya ẹnikan lo idanimọ mi lati kun opioid tabi awọn ilana ilana nkan ti iṣakoso?¶

O yẹ ki o ṣayẹwo awọn eto ipasẹ oogun lọtọ meji. Ni akọkọ, beere lọwọ dokita alabojuto akọkọ tabi oniwosan elegbogi deede lati beere itan-akọọlẹ oogun iṣowo ọdun 5 rẹ nipasẹ Surescripts (nẹtiwọọki e-deede jakejado orilẹ-ede) ati beere fun ifihan alabara ọfẹ rẹ lati Milliman IntelliScript (rxhistories.com). Ẹlẹẹkeji, nitori awọn iwe ilana ilana iṣakoso ti owo-sanwo (Schedule II-V opioids, stimulants, and benzodiazepines) ni a tọpinpin lọtọ nipasẹ awọn ijọba ipinlẹ, kan si Igbimọ Ile-iwosan ti Ipinle rẹ tabi Ẹka Ilera ti Ipinle lati beere ijabọ Eto Abojuto Oògùn Alaisan ti ara ẹni (PDMP), ki o si fi Ijabọ ọlọpa rẹ ati Ijabọ Identity Identity FTC silẹ eyikeyi.

Awọn orisun ṣayẹwo¶

• Ẹka Ilera ti AMẸRIKA ati Awọn Iṣẹ Eda Eniyan, Ọfiisi fun Awọn ẹtọ Ilu (HHS OCR): * Koodu ti Awọn Ilana Federal Akọle 45, Apá 164, Ofin Aṣiri HIPAA Ẹtọ Wiwọle (45 CFR § 164.524), Ẹtọ lati Ṣatunṣe Alaye Ilera Ti Aabo (45 CFR § 164.526), ati ẹtọ si Iṣiro ti Awọn ifihan (45 CFR § 164.528)*.
• Ẹgbẹ Iṣakoso Alaye Ilera ti Amẹrika (AHIMA): * Finifini adaṣe: Dinku ole Identity Medical ati Ṣiṣakoso Atọka Alaisan Titunto (MPI) Awọn agbekọja ati Awọn atunṣe ni Awọn igbasilẹ Ilera Itanna *.
• Igbimọ Iṣowo Federal (FTC, Orílẹ̀-Èdè Amẹ́ríkà): *Àwọn Ìtọ́nisọ́nà Ìṣàtúnṣe Ìṣàtúnṣe Ìdánimọ̀ Ìdámọ̀ ole, IdentityTheft.gov Ètò Ìmúpadàbọ̀sípò, àti Ìṣirò Ìròyìn Kírẹ́dì Títọ́ Abala 605B (15 U.S.C. § 1681c-2) Awọn Aṣẹ Idina Ọjọ 4 *.
• Awọn ile-iṣẹ fun Eto ilera ati Awọn iṣẹ Medikedi (CMS) & Ọfiisi HHS ti Oluyewo Gbogbogbo (HHS-OIG): * Oludamo Alanfani Ilera (MBI) Awọn Ilana Ibanujẹ, Alabojuto Eto ilera Agba (SMP) Atunse jegudujera, ati HealthCare.gov Iforukọsilẹ Ibi ọja Laigba aṣẹ (Form 1095-A) Awọn ilana Ipinnu *.
• Ajọ Idaabobo Owo Onibara (CFPB, Orilẹ Amẹrika): Ofin Ijabọ Kirẹditi Itọkasi Atokọ Ile-ibẹwẹ Ijabọ Onibara pataki (MIB Group, Milliman IntelliScript, LexisNexis, ExamOne) ati Awọn ofin Gbigba Gbese Iṣoogun labẹ Ilana F (FDCPA).

Jẹmọ awọn itọsọna¶

• Idahun irufin data, awọn ọrọ igbaniwọle ti jo, ati awọn didi kirẹditi
• Ji ọmọ idanimo ati sintetiki kirẹditi faili di
• Iro iṣẹ isakoṣo latọna jijin nfunni awọn itanjẹ, ṣayẹwo ẹtan ohun elo, ati ole idanimo I-9
• Ti gepa iroyin imeeli, awọn ofin fifiranšẹ ti o farapamọ, ati imularada
• Awọn nọmba pajawiri nipasẹ orilẹ-ede