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HIPAA Consult: Answers to your questions about. . .


Bill payments; accounting rules; accidental disclosures; disclosure to a spouse; treatment for STDs; document shredding


HIPAA Consult

Answers to your questions about . . .

Jump to:
Choose article section...Bill payments Accounting rules Accidental disclosures Disclosure to a spouse Treatment for STDs Document shredding

By Katherine M. Layman, JD

Bill payments

Q: Can we talk to a patient's spouse or guardian about payment of a bill?

A: Yes. A doctor—or a staff member acting on a doctor's behalf—may disclose protected health information to someone other than the patient in order to obtain payment. But you should disclose only the minimum information necessary and should honor any reasonable request about confidentiality that the patient made beforehand.

Accounting rules

Q:Does the "disclosure accounting" requirement under HIPAA mean we have to track every release of health information?

A: No. The requirement applies only to disclosures for purposes other than treatment, payment, or practice management. And even within this broad area, there are many other disclosures—like patient-designated disclosures to family members—that would not be included in an accounting and thus needn't be tracked.

Accidental disclosures

Q:What am I required to do if health information is accidentally disclosed?

A: The specific action you take will depend on the disclosure—and its potential harm. To determine this, you should investigate each incident and, when practical, take reasonable steps to mitigate any harm to the patient. Take the example of a woman who's been referred to an abuse shelter and that information is accidentally disclosed to her abuser. Under these circumstances, it would be practical and reasonable to warn the victim so she can seek further protection, if necessary. The warning fulfills your obligation to mitigate the potentially harmful effects of the disclosure.

Disclosure to a spouse

Q:Because she was too upset to do it herself, a patient asked her husband to call my office to schedule a repeat test. In the process, the husband asked why a second test was necessary. What should we have told him?

A: As a rule of thumb, you shouldn't give any protected health information to a family member unless the patient has given her permission beforehand. But, in the absence of specific guidance from the patient, you can use your professional judgment to determine whether the patient would agree to or object to the disclosure.

Treatment for STDs

Q:If I'm treating a teenager who's not a minor for a sexually transmitted disease and she's covered under her parent's medical plan, am I permitted to discuss the treatment with the parent?

A: Under normal situations, No. Even though the parent is paying for the patient's care, the patient still controls access to, and disclosure of, her health information, as long as she's legally able to consent to being treated on her own. You must honor her wishes, unless there's an emergency and she's incapacitated.

Document shredding

Q:Do we have to shred documents that contain protected health information?

A: No. Health information needn't be disposed of in any particular manner. But whatever disposal method you choose, the key is to protect health information from accidental disclosure.


Katherine M. Layman is a member of the Health Law Department at Cozen O'Connor in Philadelphia. She can be reached at klayman@cozen.com. This column answers common HIPAA-related questions. It isn't intended to provide specific legal advice. If you have a question, please submit it via e-mail to mehipaa@medec.com, or by regular mail to Medical Economics, 5 Paragon Drive, Montvale, NJ 07645. ATTN: HIPAA CONSULT. If we select your query, we'll address it in an upcoming issue. Your name will not be used.


Katherine Layman. HIPAA Consult: Answers to your questions about. . ..

Medical Economics

Jul. 25, 2003;80:23.

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