One of the most frustrating elements a caregiver deals with is all the health privacy requirements.
We frequently are unable to talk to providers and purchase services for our loved ones without a clear legal permission document of some sort. In some cases, a POA (power-of-attorney for healthcare) will be adequate. Medicare also has a “MEDICARE Authorization to Disclose Personal Health Information” Form. This form can be found on Medicare.gov. (at this link).
In 1996, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law 104-191 states protected health information (PHI) is any information in the medical record or designated record set that can be used to identify an individual and that was created, used, or disclosed in the course of providing a health care service such as diagnosis or treatment.
By law, Medicare must have your (loved one) written permission (an “authorization”) to use or give out personal medical information for any purpose that isn’t set out in the privacy notice contained in the Medicare & You handbook. You may take back (“revoke”) your written permission at any time, except if Medicare has already acted based on your permission.
Regardless, if our loved one has a physical, mental, or emotional need, we would be wise to obtain this permission. In the course of care, whether temporary or permanent, we will need to make decisions on behalf of our loved one. You will need to provide copies of this document to providers or other caregivers. I carry one with me just to save time when someone can’t find the form in their records.
Health providers may talk to you if they know your relationship but they will not provide you with copies of records or other documents unless you are authorized. This authorization criteria are written into their Medicare contracts when providers are applying to be in-network with Medicare, as most are. They may have a similar arrangement with other insurance companies. Providers must follow this rule for all Medicare patients.
This prior authorization will allow the caregiver to make decisions about medical, hospital, outpatient services, durable medical equipment, appointments, admissions to care facilities, etc. Most of the time our loved one’s cognitive functions are impaired. They are sick; not sleeping well; taking different medications; overwhelmed; or otherwise not able to clearly understand the decisions to be made. We can make these decisions on the loved one’s behalf with an authorization.
Suffice to say, this authorization needs to be in place while our loved one is still able to make their own decisions.
I recommend the authorized person be a spouse, child, sibling, or close friend who understands the loved ones wishes. Also, these decisions will affect care giving. So, the authorized person should be the caregiver or someone in close contact with the caregiver. The authorization allows caregivers to obtain copies of medical records; access digital records; talk to billing folks about claims, denials, and billing corrections. This step saves caregivers a lot of angst if our loved one is unable to participate in their care.
Good caregiving is dependent on being one step ahead of the problem.
Caregiving is hard but very rewarding. You are to be admired.
Written by Wanda Cantrell, RHIA, CCS, CCS-P, LPN
The column is based on Medicare guidance and reflects the views of the writer.
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