Treatment: We may use and disclose PHI about you
to provide, coordinate or manage your health care and related
services. We may consult with other health care providers
regarding your treatment and coordinate and manage your
health care with others. For example, we may use and disclose
PHI when you need a prescription, lab work, an X-ray, or
other health care services. In addition, we may use and
disclose PHI about you when referring you to another health
care provider. For example, if you are referred to another
physician, we may disclose PHI to your new physician regarding
whether you are allergic to any medications. In emergencies,
we may use and disclose PHI to provide the treatment you
need.
We may also disclose PHI about you for the treatment activities
of another health care provider. For example, we may send
a report about you to a physician that we refer you to so
that the other physician may treat you.
Payment: We may use and disclose
PHI so that we can bill and collect payment for the treatment
and services provided to you. Before providing treatment
or services, we may share details with your health plan
concerning the services you are scheduled to receive. For
example, we may ask for payment approval from your health
plan before we provide care or services. We may use and
disclose PHI to find out if your health plan will cover
the cost of care and services we provide. We may use and
disclose PHI to confirm you are receiving the appropriate
amount of care to obtain payment for services. We may use
and disclose PHI for billing, claims management, and collection
activities. We may disclose PHI to insurance companies providing
you with additional coverage. We may disclose limited PHI
to consumer reporting agencies relating to collection of
payments owed to us.
We may also disclose PHI to another health care provider
or to a company or health plan required to comply with the
HIPAA Privacy Rule for the payment activities of that health
care provider, company, or health plan. For example, we
may allow a health insurance company to review PHI for the
insurance company’s activities to determine the insurance
benefits to be paid for your care.
Health Care Operations: We
may use and disclose PHI in performing business activities
that are called health care operations. Health care operations
include doing things that allow us to improve the quality
of care we provide. Health care operations also include
things that we do to reduce costs. For example, we may use
and disclose PHI about you in health care operations to
do the following things:
• Review and improve the quality, efficiency and cost
of care that we provide to our patients.
For example, we may use PHI about you to develop
ways to assist our physicians and staff
in deciding how we can improve the medical
treatment we provide to others.
• Improve health care and lower costs for groups of
people who have similar health problems;
• Identify groups of people with similar health problems
to give them information, for example,
about treatment alternatives and educational
classes. We may also use this information to
help manage and coordinate the care for these
groups of people;
• Review and evaluate the skills, qualifications,
and performance of health care providers
taking care of you and our other patients.
• Provide training programs for students, trainees,
health care providers, or non-health care
professionals (for example, billing personnel)
to help them learn or improve their skills.
•
Cooperate with outside organizations that assess the quality
of the care that we provide.
• Cooperate with outside organizations that evaluate,
certify, or license health care providers
or staff in a particular field or specialty.
For example, we may use or disclose PHI so that
one of our nurses may become certified as having
expertise in a specific field of nursing.
• Cooperate with various people who review our activities.
For example, PHI may be seen by
doctors reviewing the services provided to
you, and by accountants, lawyers, and others
who assist us in complying with the law and
managing our business.
• Assist us in making plans for our practice’s
future operations.
• Resolve grievances within
our practice.
• Review our activities and use or disclose PHI in
the event that we sell our health care
system to someone else or combine with another
health care system.
• Do business planning and development,
such as cost-management analyses.
• Do business management and general administrative
activities of our health care system,
including managing our activities related to
complying with the HIPAA Privacy Rule and other
legal requirements.
• Create "de-identified" information that
is not identifiable to any individual, and disclose PHI
to a business associate for the purpose of
creating de-identified information, regardless of
whether we will use the de-identified information.
• Create a "limited data set" of information
that does not contain information directly
identifying a patient. Our ability to disclose
this information to others under limited
conditions is discussed later in this Notice.
If another health care provider, company, or
health plan that is required to comply with the
HIPAA Privacy Rule also has or once had a relationship
with you, we may disclose PHI about
you for certain health care operations of that
health care provider or company. For example,
we may use and disclose PHI to do the following
things: review and improve the quality,
efficiency, and cost of care provided to you;
review and evaluate the skills, qualifications,
and performance of health care providers; provide
training programs for students, trainees,
health care providers, or non-health care professionals;
cooperate with outside
organizations that evaluate, certify, or license
health care providers or staff in a particular
field or specialty; and assist with legal compliance
activities of that health care provider or
company.
We may also disclose PHI for the health care operations
of any organized health care arrangement in which we participate.
An example of an organized health care arrangement is the
joint care provided by a hospital and the physicians who
see patients at the hospital.
If another health care provider, company, or health plan
that is required to comply with the HIPAA Privacy Rule also
has or once had a relationship with you, we may disclose
PHI about you for certain health care operations of that
health care provider or company. For example, we may use
and disclose PHI to do the following things: review and
improve the quality, efficiency, and cost of care provided
to you; review and evaluate the skills, qualifications,
and performance of health care providers; provide training
programs for students, trainees, health care providers,
or non-health care professionals; cooperate with outside
organizations that evaluate, certify, or license health
care providers or staff in a particular field or specialty;
and assist with legal compliance activities of that health
care provider or company.
We may also disclose PHI for the health care operations
of any organized health care arrangement in which we participate.
An example of an organized health care arrangement is the
joint care provided by a hospital and the physicians who
see patients at the hospital.
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