The rules for making proper level-of-care decisions are lengthy and confusing, which makes the role of the physician advisor within the utilization review (UR) committee extremely critical.
Q. An insurance company is requesting copies of medical records to review our CPT coding. These cases are at least a year old and have been paid already. The insurance company said its review will not affect our payment. Do we need patient authorization to release these records, since this does not involve treatment, payment, or office operations?
Almost every digital copier built since 2002 contains a hard drive, like the ones on computers, storing an image of every document copied, scanned, or e-mailed by the machine. This advanced technology has opened a dangerous hole in data security. Used copy machines, which are often resold, can contain lots of sensitive information, including PHI.
One of the more talked-about initiatives in the Patient Protection and Affordable Care Act is the creation of accountable care organizations (ACO) and the global payment pilot projects.
