Patients Seeing More Than One Doctor in a Group • Requests for a Deceased Patient’s Medical Record • Blue Cross 2010 Authorizati

Dear SDCMS Office Managers,

This will be my last time writing for you in San Diego Physician. I have decided to leave my position as your office manager advocate to begin a nursing program here in San Diego. It has been my pleasure meeting many of you here at our SDCMS office manager forums as well as in your own offices.

Thank you for all of the help that you have provided me over the past two years. I was very encouraged by the enthusiasm that many of you have for serving your physicians and patients. I hope to see many of you in a different environment in the future.

Lauren

QUESTION: Some of our patients see more than one doctor in the medical group. Can our physicians have access to other physicians’ records without authorization from the patient?

ANSWER: Yes. The law generally authorizes physicians to share medical information for treatment and billing purposes even in the absence of the patient’s written consent. Moreover, although the law is not entirely clear, the patient may well be viewed as the patient of both the treating physician and the group practice. For further information, consult CMA ON-CALL document #1100: “Medical Records: Most Commonly Asked Questions,” available free to SDCMS-CMA members at CMAnet.org.

QUESTION: We received a request for a copy of a deceased patient’s medical records from a relative. Are we obligated to comply with the relative’s request?

ANSWER: The beneficiary or personal representative of a deceased patient has a full right of access to the deceased person’s medical records under the same requirements that would apply to requests from the patient himself or herself. The HIPAA Privacy Rules do not change this result; however, it does require covered physicians to verify the identity and authority of any person requesting personal health information (PHI) that the physicians do not know, following written policies and procedures established for this purpose.

The rules though provide that the physician may rely, if such reliance is reasonable under the circumstances, on documentation, statements, or representations that, on their face, meet the applicable requirements. Physicians who have a reason to question whether the individual requesting access to the deceased person’s records is a beneficiary or personal representative are best advised to request that the individual attach some documentation of their status as executor or beneficiary of the deceased patient’s estate to the request for record access.

In the absence of such doubt, the individual’s attestation on the request form that he or she is the beneficiary or personal representative of the deceased patient should be sufficient, particularly to the extent that the individual is a family member or other person who was involved in the deceased patient’s care or payment for that care. For further information, consult CMA ON-CALL document #1150: “Patient Access to Medical Records,” — available free to SDCMS-CMA members at CMAnet.org.

QUESTION: We received notice that Blue Cross will be implementing a new echocardiography pre-notification and pre-authorization program at the beginning of 2010. Is this program still going into effect?

ANSWER: The California Medical Association was advised that right now it is just a voluntary notification process even though the original documentation did not indicate such. Blue Cross is targeting April 2010 for the authorization requirement. Physicians will receive 90 days’ notice from Blue Cross before the authorization requirement is implemented.