Medicare Compliance & Reimbursement

Untangle the intricacies of OHCAs and NPPs.

Knowing how to address the Health Insurance Portability and Accountability Act's (HIPAA's) notice of privacy practices (NPP) isn't always a piece of cake for physicians who work in OHCAs, but assessing the situation carefully can help you avoid conflicts and lawsuits.

The American Medical Association defines an Organized Health Care Arrangements (OHCA) as one that allows two or more covered entities (CEs) that participate in joint activities to share protected health information in order to manage and benefit their joint operations.

Easy enough, right? Well, OHCA participants--who often play different roles in different venues--may not know which NPP to follow.     Direct Versus Indirect Treatment There are two key factors covered entities need to consider to determine which NPP holds sway: the first is whether you're providing direct or indirect treatment for the patient; the second is where that treatment is being administered.

The most straightforward instance is when you administer direct treatment to patients in your practice, says Kristen Rosati with Coppersmith Gordon Schermer Owens & Nelson in Phoenix.

In this case, there is one NPP involved: yours. You're obligated to provide the patient with the privacy statement at delivery of the first service, document the patient's receipt of the NPP, and then stow the documentation away for the next six years, Rosati says.  If your NPP meets the reg's implementation specifications, then you're in good shape.

The hitch: It's when you provide service at a hospital that things can become more complicated. Many hospitals have established OHCAs that cover themselves, their outlying delivery facilities, their employees and members of their medical staff under a joint NPP. Oftentimes, the hospital will add a requirement to its medical staff policies to follow the joint NPP. The hospital then outlines the facili- ties, providers, and other OHCA participants in the NPP they distribute to patients, asserts Rosati.

In addition to helping hospitals, the OHCA helps patients and providers as well. Patients expect the care they receive in the hospital to be integrated, and the OHCA helps provide that, explains Brian Gradle, an attorney in the DC office of Epstein Becker & Green. In other words, it means that a patient receives and acknowledges only one notice rather than several. 

Providers benefit, too, from the coverage they receive under the OHCA's joint notice. This makes treating patients in hospitals more convenient. All providers who are CEs still need to have NPPs for their own practices, but the OHCA keeps them from having to "carry around a stack of notices with them when they come to the hospital," Rosati adds.

You should check with your hospital's privacy official to verify how they're handling NPPs and to review the wording of their [...]