Privacy Policy
Healthcare Management Services-Midwest,LLC
DBA HMS-Midwest, LLC
Healthcare Practice and Accounting Management Consultants
Privacy Notice for HMS-Midwest, LLC
As a healthcare professional partner, we care about our clients’ privacy
and strive to protect the confidentiality of your medical information
in our company. New federal legislation requires healthcare professionals
and its business partners to issue this official notice of privacy
practices. You have the right to the confidentiality of your medical
information, and this practice is required by law to maintain the privacy
of that information.
This company is required to abide by the terms of the Notice of Privacy
Practices currently in effect, and to provide notice of its legal duties
and privacy practices with respect to protected health information (PHI).
If you have any questions about this Notice, please contact our privacy
officer directly.
How We May Use and Disclose Medical Information About You
The following categories describe different ways that we may use and
disclose medical information without your specific consent or authorization.
Examples are provided for each category of uses or disclosures. Not all
possible uses or disclosures are listed.
For Treatment.
We may use medical information about you to provide you
with medical treatment or services. Example: In treating you with a specific
condition, we may need to know if you have allergies that could influence
which medications we prescribe for the treatment process.
For Payment.
We may use and disclose medical information about you so
that the treatment and services you receive from us may be billed and
payment may be collected from you, an insurance company or a third party
( e.g. EAP ). Example: We may need to send your Protected Health Information
(PHI), such as your name, address, office visit date, and codes identifying
your diagnosis and treatment to your insurance company for payment.
For Health Care Operations.
We may use and disclose medical information
about you for health care operations to assure that you receive quality
care. Example: We may use medical information to review our treatment
and services and evaluate the performance of our staff in caring for
you.
Other Uses or Disclosures That Can Be Made Without Your Consent or Authorization
- As required during an investigation by law enforcement agencies
- To avert a serious threat to public health or safety
- As required by military command authorities for their medical records
- To workers’ compensation or similar programs for processing
claims
- In response to a legal proceeding
- To a coroner or medical examiner for identification of a body
- If an inmate, to the correctional institution or law enforcement
official
- As required by the US Food and Drug Administration (FDA)
- Other healthcare providers’ treatment activities
- Other covered entities’ and providers’ payment activities
- Other covered entities’ healthcare operations activities (to
the extent permitted under HIPAA)
- Uses and disclosures required by law
- Uses and disclosures in domestic violence or neglect situations
- Health oversight activities
- Other public health activities
We may contact you to provide appointment reminders or information about
treatment alternatives or other health related benefits and services
that may be of interest to you
Uses and Disclosures of Protected Health Information Requiring Your
Written Authorization
Other uses and disclosures of medical information not covered by this
Notice or the laws that apply to us will be made only with your written
authorization. If you give us authorization to use or disclose medical
information about you, you may revoke that authorization about you for
the reasons covered by your written authorization. We are unable to take
back any disclosures we have already made with your authorization, and
we are required to retain our records of the care we have provided you.
Disclosures and Changes To Your Medical Information Right to Request
Restrictions.
You have the right to request a restriction or limitation on the medical
information we use or disclose about you for treatment, payment or health
care operations or to someone who is involved in your care or the payment
of your care. We are not required to agree to your request. If we do
agree, we will comply with your request unless the information is needed
to provide you with emergency treatment. To request restrictions, you
must submit your request in writing to the Privacy Officer at this practice.
In your request, you must tell us what information you want to limit.
Right to an Accounting of Non-Standard Disclosures
You have the right
to request a list of the disclosures we made of medical information about
you. To request this list, you must submit your request to the Privacy
Officer at this practice. Your request must state the time period for
which you want to receive a list of disclosures that is no longer than
six years, and may not include dates before April 14, 2003. Your request
should indicate in what form you want the list (example: on paper or
electronically). The first list you request within a 12 month period
will be free. For additional lists, we reserve the right to charge you
for the cost of providing the list.
Right to Amend
If you feel that medical information we have about you is incorrect or
incomplete, you may ask us to amend the information. You have the right
to request an amendment for as long as the information is kept. To
request an amendment, your request must be made in writing and submitted
to the Privacy Officer at this practice. In addition, you must provide
a reason that supports your request. We may deny your request for an
amendment if it is not in writing or does not include a reason to support
the request. In addition, we may deny your request, if the information
was not created by us, is not part of the medical information that
is kept at this practice, is not part of the information which you
would be permitted to inspect and copy, or which we deem to be accurate
and complete. If we deny your request for amendment, you have the right
to file a statement of disagreement with us. We may prepare a rebuttal
to your statement and will provide you with at copy of any such rebuttal.
Statements of disagreement and any corresponding rebuttals will be
kept on file and sent out with any future authorized requests for information
pertaining to the appropriate portion of your record.
Your Access To Medical Information Right to Inspect and Copy
You have the right to inspect and copy medical information that may be
used to make decisions about your care. Usually this includes medical
and billing records but does not include psychotherapy notes; information
complied for use in a civil, criminal, or administrative action or
proceeding, and protected health information to which access is prohibited
by law. To inspect and copy medical information that may be used to
make decisions about you, you must submit your request in writing to
the Privacy Officer at this practice. If you request a copy of this
information, we reserve the right to charge a fee for the costs of
copying, mailing or other supplies associated with your request. We
may deny your request to inspect and copy in certain very limited circumstances.
If you are denied access to medical information, you may request that
the denial be reviewed. Another licensed healthcare professional chosen
by this practice will review your request and the denial. The person
conducting the review will not be the person who denied your request.
We will comply with the outcome of the review.
Right to a Paper Copy of This Notice
You have the right to a paper copy of this Notice at any time. Even if
you have agreed to receive this Notice electronically, you are still
entitled to a paper copy. To obtain a paper copy of the current Notice,
please request one in writing from the Privacy Officer at this practice.
Right to Request Confidential Communications
You have the right to request how we should send communications to you
about medical matters, and where you would like those communications
sent. To request confidential communications, you must make your request
to the Privacy Officer at this practice. We will not ask you the reason
for your request. We will accommodate all reasonable requests. Your
request must specify how or where you wish to be contacted. We reserve
the right to deny a request if it imposes an unreasonable burden on
the practice.
Complaints
If you believe that your privacy rights have been violated, you may file
a complaint with the Privacy Officer at this practice or with the Secretary
of the Department of Health and Human Services. All complaints must
be submitted in writing. You will not be penalized or discriminated
against for filing a complaint.
Concerns or Complaints
To file a complaint with HMS-Midwest, LLC, please contact:
Tracy L. Freeze
P O Box 45
Portage, IN 46368
219-787-1510
email: tlfreeze@practicemanagers.com
State of Michigan
Allegations Division of the Department
of Consumer and Industry Services.
517-373-9196
State of Indiana
Health Professions Bureau
317-232-2960
State of Illinois and Wisconsin
Please use the address given below for the
US Department of Health and Human Services
US Department of Health and Human Services
Office of Civil Rights
233 N. Michigan Street Suite 240
Chicago, Illinois 60601
312-886-2359 TDD 312-353-5693
email: www.hhs.gov/ocr
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