As a billing service working in the healthcare industry, 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 company is required by law to maintain the privacy of that information.
This company is also required to abide by the terms of the Notice of Privacy Practices
currently in effect, including the new requirements put in place by the HITECH Act [Health Information Technology for Economic and Clinical Health Act] effective 2/17/10. If you have any questions about this Notice, please contact our HIPAA Compliance officer directly at: email@example.com.
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.
We may use and disclose medical information about you so that the treatment and
services you receive from your midwife may be billed and payment may be collected
from you, an insurance company or a third party ( e.g. a collection agency). 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.
We may be summoned to forfeit PHI if there is an investigation by law enforcement
agencies investigating the practices of an insurance company or us as a billing service.
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 Compliance Officer of Larsen Billing Service, LLC. Your request must state the time period for which you want to receive a list of disclosures that is no longer than six years. 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 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 Compliance Officer at Larsen Billing
Service, LLS. 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.
Protocol: Breach of Protection
It is required to report and record cases in which PHI has been compromised. If Larsen Billing Service is the cause of said breach, we will send immediate notification to our client(s) involved.
If client is the cause of said breach, it is required of them to send immediate notification to
Larsen Billing Service, LLC detailing:
- Causes leading up to the breach
- Extent of the breach
- Outline of plan to recover from the breach
This notification can be sent to the Complaince Officer via email to firstname.lastname@example.org.