Patient rights under HIPAA

Patient rights under HIPAA

Patient rights under HIPAA

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Patient Rights - The Core Six

  • Access: Right to inspect & receive a copy of their Protected Health Information (PHI).
  • Amendment: Right to request corrections to inaccurate or incomplete PHI.
  • Accounting of Disclosures: Right to a list of who their PHI was shared with (for non-routine purposes) over the past 6 years.
  • Restriction: Right to request limits on PHI use/disclosure.
    • Mandatory for providers if patient pays out-of-pocket for a service.
  • Confidential Communications: Right to choose how and where they receive PHI.
  • Notice of Privacy Practices: Right to a written notice of how their PHI is used and shared.

⭐ A key testable timeline: Providers have 30 days to provide patients with their medical records upon request.

Access & Amendment - See and Fix

  • Right of Access: Patients can inspect & obtain a copy of their Protected Health Information (PHI).
    • Providers must respond within 30 days.
    • A reasonable, cost-based fee for copies is allowed.
    • Access can be denied for specific records like psychotherapy notes or information gathered for legal action.
  • Right to Amend: Patients can request corrections to inaccurate or incomplete PHI.
    • Providers must act on the request within 60 days.
    • If denied, a written explanation is required, and the patient may file a statement of disagreement to be included in the record.

⭐ Psychotherapy notes are specially protected and are not subject to a patient's general right of access to their medical records.

Disclosure & Restriction - Who Sees What

  • Minimum Necessary Rule: Default is to disclose only the minimum Protected Health Information (PHI) needed for a given purpose.
  • No Authorization for TPO: PHI can be used and disclosed without patient authorization for:
    • Treatment (e.g., consulting with another provider)
    • Payment (e.g., submitting claims)
    • Operations (e.g., quality assessment, training)
  • Patient Authorization: Required for most non-TPO disclosures (e.g., marketing). Must be specific and time-limited.
  • Right to Restrict: Patients can request restrictions on disclosures. A covered entity must agree if the patient pays 100% out-of-pocket for a service and requests the information not be sent to their health plan.

⭐ The right to restrict disclosure to a health plan for services paid fully out-of-pocket is a key patient empowerment rule.

Breach Notification - Sound the Alarm

  • Definition: An impermissible use or disclosure of Protected Health Information (PHI) is presumed to be a breach unless a low probability of compromise is demonstrated through a risk assessment.

  • Individual Notice: Must be provided without unreasonable delay, and in no case later than 60 calendar days following the discovery of a breach.

  • HHS Notification:

    • Breaches affecting ≥500 individuals: Notify the HHS Secretary without unreasonable delay (and no later than 60 days).
    • Breaches affecting <500 individuals: Log and notify HHS annually.
  • Media Notice: If a breach affects more than 500 residents of a single state or jurisdiction, a prominent media outlet must be notified.

⭐ The burden of proof is on the covered entity to demonstrate that a breach did not occur or that all required notifications were made.

High-Yield Points - ⚡ Biggest Takeaways

  • Patients have a right to access, inspect, and obtain a copy of their Protected Health Information (PHI).
  • They can request amendments to correct errors in their medical records.
  • Patients are entitled to an accounting of disclosures, listing who has received their PHI.
  • They can request restrictions on PHI use, especially for services paid out-of-pocket.
  • The right to request confidential communications allows them to specify contact methods.

Practice Questions: Patient rights under HIPAA

Test your understanding with these related questions

A 79-year-old male presents to your office for his annual flu shot. On physical exam you note several linear bruises on his back. Upon further questioning he denies abuse from his daughter and son-in-law, who live in the same house. The patient states he does not want this information shared with anyone. What is the most appropriate next step, paired with its justification?

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Flashcards: Patient rights under HIPAA

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A _____ is a medical outcome that should never occur

TAP TO REVEAL ANSWER

A _____ is a medical outcome that should never occur

"never event"

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