Legal and Ethical Issues

1. Legal and Ethical Issues Carolyn Heyman-Layne Dorsey & Whitney LLP September 2008

2. Legal and Ethical Issues in Documentation • Legal • State Law • Federal Law • General Liability • Contracts • Audits • Ethical • Conflicts of Interest • Revision of Records • Disposal of Records

3. Alaska Document Retention Medicaid Reporting Requirements Specialized Records Federal HIPAA Medicare Medicaid JCAHO State & Federal Law

4. Alaska Medicaid • Documentation is key to successful audits • Public Guidance: • Statutes • Regulations • Provider Manuals • Department Guidance • Website • Check and double-check • Always record your source!!!!

5. Federal Law • HIPAA • Documentation of HIPAA compliance should be in the record • Notice of Privacy Practices • Record of Disclosures • Amendments to Records • Patient Requests • Always remember that HIPAA gives patients access to the record

6. Federal Law • Medicare/Medicaid • Medicare and Medicaid do not always have the same documentation requirements – be sure to check • Double-check all documentation: • Patient eligibility • Billing status • Contracts with patient • Contracts with government

7. General Liability • Lawsuits • Patients • Providers • Insurers • Failure to have compliance policies and procedures • Failure to obtain proper consent

8. Contracts • Hidden documentation requirements • Insurance companies • Government • Medicare/Medicaid Contracts • Certificate of Need • Settlement Agreements • Tribal • Funding Agreement • Compact

9. Audits • Sufficient documentation is the key to a successful audit • What you think is sufficient may not be enough • Guidance from national practice organization may not be enough • Over-the-phone guidance may not be enough • Information from public meetings may not be enough

10. Audits: When it happens • Address the auditor request • Number the documents provided • Keep a copy of all documents provided • Request clarification, if necessary • Do a self-audit before sending records out • Resolve issues, if possible and ethical…

11. Documentation: Ethical Issues • Conflicts of Interest • Revision of Records • Disposal of Records

12. Conflicts of Interest • Conflicts can affect documentation through: • Patient relationships • Small communities • Personal liability • Professional liability • Job implications UH-OH

13. Conflicts of Interest • How do you address a potential conflict? • Disclose • Be objective • Find a replacement • Work with a partner • Be sure documentation reflects all actions taken to address the conflict, but not necessarily in the medical record

14. Revision of Records • What do you do if a record is incomplete? • Add reliable info and substantiate • What do you do if a record is incorrect? • Amend and document • Substantiate amendment • What do you do if a record is missing? • Document efforts to locate • Recreate what can be substantiated

15. Disposal of Records • Make sure document retention period has passed • Make sure no litigation hold is in place • Double-check statute of limitations for potential controversies • Shred or otherwise destroy • Be careful with electronic records

16. Electronic Medical Records • Documentation should not be less than paper records • Documentation should be unique to patient and treatment – no “cut and paste” • Always store backups • Have emergency procedures in place • Confirm acceptance with payer

17. Questions? Carolyn Heyman-Layne Dorsey & Whitney LLP 1031 W. 4th Avenue, Suite 600 Anchorage, AK 99501 (907) 257-7870 Heyman.carolyn@dorsey.com