If you need to copy some medical records that include PHI, you're probably on point when taking steps to ensure privacy. You make sure no one's around. You grab the documents right from the copier when you're done, you don't forget the originals, and you take the records where they need to go. No one sees them. No HIPAA violations here.
Ah. Breathe a sigh of relief, Mr. and Mrs. HIPAA privacy and security officer. Another year is winding down, and your facility hasn't suffered a major breach of patient information.
The utilization review (UR) process is a required process to determine if the care a physician provides the patient is medically necessary and reimbursable by the payer source. While the exact definition of medical necessity varies amongst insurers and government agencies, section 1862 (a)(1)(a) of the Social Security Act provides the basic groundwork, stating, "Notwithstanding any other provisions of this tile, no payment may be made … for any expenses incurred for items or services, which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member."
With the transition to ICD-10, some documentation issues have required the capture of new information while others involve updated, modified, and otherwise expanded documentation needs. As we gain experience with ICD-10 and more questions are answered, physicians, coding professionals, and other clinical staff must continue training in clinical documentation improvement (CDI) and ICD-10. Now comes the hard work: ensuring consistency and reliability of ICD-10 coded accounts and the analytics that will be the outcome of ICD-10 data.
