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Transcription, coding, and medical billing are all part of a covered entity's TPO and a certain portion of each are commonly being sent out of the US. I would like to ask:
1. Must a covered entity tell a patient that their PHI may be sent out of the US through business associates if it falls under the category of TPO?
2. If a patient does not want their PHI out of the US, is the facility obligated to comply? Or...
3. Is the obligation just to give the patient an opportunity for the right to refuse having their PHI sent out of the US, but the facility does not have to grant refusal because if falls under TPO?

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At the moment the answers she has been given, from people who deal with HIPAA issues all the time, are essentially in agreement that patients have no rights under HIPAA regarding the use of business associates regardless of where they are located.

I have invited one of the responders to this forum. Hopefully she will join us and allow us to explore this issue a bit further with her.

Nae

It's Monday, I prefer not to ponder that last question too long....

Jay

I don't know about that pondering...my heavy thougths get me abut as far as it is possible patients might boycot a specific physician...but they don't have that same sort of choice with their health insurance carrier or the hospital they need in an emergency.

Given the amount of my health bills (for a family of four with all the assorted and varied things teenagers need frequently to go the doc for and with crappy, crappy health insurance...) I know that if I was told my patient encounter was going to go up "X-amount more" because of special requests for handling of transcripts/coding/insurance claims I would probably decide it was not that big of an issue for me.

Nae

I used to have to get patients to sign a Privacy Act statement and it was included in their medical records. They were military medical records and they were treated much differently then than they are now or are in a civilian setting. Even now in the military arena they're done completely differently than when I was in a military hospital setting.

HIPAA only has to do with portability of medical information, not with the privacy of it. Unfortunately, since the advent of computers and other electronic equipment, your medical records may not be your own anyway since so much information is recorded in electronic means. That goes for everything from claims to prescriptions.

Meredith

Carole/gmts

Meredith

Nae

As far as I can tell, it only covers records that are kept by the government.

Meredith

Nae

And Nae, it would be a great idea for one of the law folks to shed some light on this. I'd love to refresh my memory on both Hipaa and the Privacy Act, if it still exists.

Thanks y'all for not making me out to look like a dummy. I thought I knew what I was talking about, but sometimes I just can't think straight. Must be the meds. (Can I use that as an excuse?) lol

Meredith

Diane

I'm Jill Dennis, and I facilitate AHIMA's HIPAA "community of practice" -- it's basically an electronic forum similar to MT chat. I was asked to sit in on this discussion to see if any of you have any remaining questions regarding the topic of whether HIPAA can be used by patients to prevent protected health information from being sent to offshore transcription companies.

It really cannot. Most patients won't even be aware that some healthcare providers use outside companies to do transcription. If a patient were aware of it, and wanted to try to restrict a provider from sending their information to that business associate, then the patient could request a restriction to that effect -- but the provider is not obligated under HIPAA to accept that restriction.

The incident in Pakistan just goes to show how important it is for a good contract to be in place. And under HIPAA, the business associate agreement with the outside transcription firm needs to conform to HIPAA's requirements for BA agreements. But it's really up to the individual provider to decide the level of privacy safeguards that should be in place.

I hope this adds something to your interesting discussion. Thanks for inviting me to sit in --

Jill Callahan Dennis

One of the things MTs hear, and that many believe, about the HIPAA regs is that "if the patient" knows where the dictation is going to be transcribed (assuming the hands on provider is even aware of where as well) up front then the patient has to the right to decide where it can or cannot be transcribed, hopefully your explanation...

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the patient could request a restriction to that effect -- but the provider is not obligated under HIPAA to accept that restriction.

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...will help to better understand what some of the limitations of HIPAA are.

Nae