Medicare Compliance & Reimbursement

Plus: New site may prevent communication gaps.

If you have questions about what constitutes violations against patient privacy or civil rights, you should check out the Office of Civil Rights' (OCR) brochure, "Protecting Your Civil Rights in Health Care and Social Services and Your Health Information Privacy Rights." 

The brochure provides three critical reminders that might help your health care organization avoid a costly violation:

1. Details on the OCR's enforcement of the anti-discrimination policy for organizations that receive money or other assistance from the Department of Health and Human Services (HHS).  Some organizations that might fall into this category include hospitals, health clinics, nursing homes, Medicaid and Medicare agencies, welfare programs, day care centers, doctors' offices, pharmacies, children's healthcare programs, alcohol and drug treatment centers, adoption agencies, and mental health centers.

2. Information on how the OCR will enforce patient privacy regulations.

3. Criteria for determining if a patient's privacy or civil rights have been violated.  According to the brochure, a patient may file a discrimination complaint with the OCR if a program has done any of the following based on race, color, nationality, disability status, and (in certain cases) sex or religion:

• Denied the patient services or benefits
• Prohibited the patient from participating in a program
• Delayed services

Caveat: Patients may file a complaint if a health care organization or entity does any of the following:

• Denies the patient the right to ask to see and receive a copy of health record;
• Fails to give the patient a notice describing how patient health information may be used; or
• Does not protect patient health information.

Resource: To view the brochure, go to www.hhs.gov/ocr/OCRbro20051202.pdf.

3 Key Resources Could Keep You Free Of Federal Scrutiny

Health care providers who encounter many patients with communication-related issues will need to check out a new OCR Web site.

Background: In December 2006, the OCR launched a new site designed to facilitate communication between healthcare providers and their patients (to view the site, go to www.hhs.gov/ocr/hospitalcommunication.html).

This site aims specifically to help providers learn how to deal with patients with special communications needs, including patients with limited English proficiency or who are deaf or hard-of-hearing. 

Compliance angle: Because it is illegal to discriminate on the basis of disability or national origin, a provider is expected to take what the OCR defines as "reasonable steps" to communicate effectively with patients with special needs and provide them with the same level of access to healthcare services. 

The three new resource areas on the site are:

1. The new website provides you with links to relevant anti-discrimination laws and regulations, including the Rehabilitation Act of 1973, which prohibits programs receiving financial assistance from HHS from discriminating on the basis of disability. 

2. The site also provides links to a variety of educational materials and information that describe how healthcare professionals can provide better service and access to those who present communication challenges. 

3. You can also find information that is useful for the patient in these links; for example, this section includes a link to the OCR's fact sheet detailing how to file a discrimination complaint and summaries and information on past communication complaints and investigations.