2. Ms. Marie, a health information department staffmember at New Directions Medical Center, re-ceived a call from the emergency room at St. John’sHospital requesting that all previous records for apatient named Sally Smith be faxed them immedi-ately. (Sally Smith was a health information de-partment staff member at New Directions, and sheresigned last year to return to college full-time.) Be-cause of the urgency of her medical condition,Sally Smith is being taken to the surgery suite im-mediately. Ms. Marie knows Sally’s family and isconsidering calling Sally’s sister. What actionshould Ms. Marie take?3. Pam Page, an office manager for Dr. Brown, re-ceives an email from a patient requesting that shereply with his lab test results. Pam knows that theoffice’s email system does not encrypt messages.What action should Pam take?INTERNET LINKSGo to http://hipaa.yale.edu for information on HIPAA.To determine whether a business, individual, or govern-ment agency is a covered entity, use the decision tools athttp://www.cms.hhs.gov/hipaa/hipaa2/support/tools/decisionsupport/default.asp and answer the questionsuntil an answer is determined.The privacy rule is enforced by the DHHS Office for CivilRights (OCR), and more information can be found athttp://www.hhs.gov/ocr/hipaa.The Electronic Code of Federal Regulations (e-CFR) isavailable at http://www.access.gpo.gov/ecfr. Title 42—Public Health contains CMS regulations.Go to http://www.ahima.org and click on the POLICY&GOVERNMENTRELATIONSlink under HIM Resources to view“Regulation Analysis” documents.Click on the CITATIONSlink at http://cms.hhs.gov/cop toview CMS Conditions of Participation(CoP) and Conditionsfor Coverage(CfC) that health care organizations must meetto participate in the Medicare and Medicaid programs.The Standards of Privacy for Individually Identifiable HealthInformation; Final Rule: Regulation Text(dated August 14,2002) can be found at http://cms.hhs.gov/hipaa/hipaa2/regulations/privacy/finalrule/privrulepd.pdf.Go to the Electronic Privacy Information Center (EPIC)athttp://www.epic.org, click on PRIVACYA TOZ, and scrolldown to the end and click on the STATEPRIVACYLAWSlinkto determine whether your state has enacted its own pri-vacy legislation.
Why is it important to prepare a clean claim ? What suggestions might you make to ensure that submission of a clean claim takes place? Provide examples. Due day 4 in the Main Forum. Week # 8 Discussion Question 2 It is very important to prepare a clean claim so that a payer does not have to find a reason to review the claim for additional information, or to avoid investigation for fraud and abuse, and to avoid review for medical necessity. Also it is important to submit a clean claim so that the provider can be reimbursed in a timely manner. To ensure that submission of a clean claim takes place a good suggestion would be to always check the claim carefully before submitting it, review the claim to make sure nothing is missing such as facility name, address, the providers name, patient’s birth date, other payer information if a secondary payer is involved, and check for correct coding of diagnosis and procedures. For each claim that is prepared a checklist of data elements should be checked by the insurance specialist or employee completing the billing