Use and Disclosure of PHI - Treatment, Payment, and Operations

Category: Privacy

Date: March 2003

Reviewed/Revised: April 2013

Purpose

To ensure that the use and disclosure of PHI for treatment, payment or health care operations is in accordance with Health Insurance Portability and Accountability Privacy regulations.

Procedure

1. For Treatment: PHI may be used and/or disclosed by physicians and other health care personnel to physicians and other health care personnel as necessary to facilitate the treatment of patients.
2. For Payment:  PHI may be used and/or disclosed by the health care provider (EVMS Medical Group) to obtain reimbursement for health care services. The Minimum Necessary standards apply. Only the minimum necessary information for the purpose may be used/disclosed.
3. For Health Care Operations: PHI may be used and/or disclosed in the operation of the Practice Plan. The Minimum Necessary standards apply. Only the minimum necessary information for the purpose may be used/disclosed. The following are activities which are considered health care operations.
   1. Conducting quality assessment and improvement activities.
   2. Reviewing the competence or qualifications of health care professionals, evaluating practitioner and provider performance, conducting training programs in which students, trainees or practitioners in areas of health care learn under supervision to practice or improve their skills as health care providers, training of non-health care professionals, accreditation, certification, licensing or credentialing activities.
   3. Conducting or arranging for medical review, legal services and auditing functions, including fraud and abuse detection and compliance programs.
   4. Business planning and development.
   5. Business management, risk management and general administrative activities of the entity.