by Kim Stanger

Physicians, dentists, and other healthcare providers who run into problems with their state medical board or other licensing agency are often offered a stipulated resolution to avoid formal proceedings, additional costs, and potentially more severe sanctions. Although such stipulations may be an appropriate and efficient way to resolve concerns, providers should beware of the unanticipated consequences of such stipulations, including the following:

1. NPDB Reports. Licensing boards are generally required to report such stipulations involving physicians or dentists to the National Practitioners Data Bank (“NPDB”). (See 45 CFR § 60.8). Hospitals and other entities are required or permitted to check the NPDB during the physician credentialing process. An NPDB report will become a black mark on the physician’s record for the rest of his or her career unless removed, and may lead to the further actions described below.

By Kim Stanger

Ed. note: This article also appears in an issue of the Idaho MGMA monthly newsletter.

Question:  What is the difference between a “designated record set” and “legal health record,” and what must we provide when we receive a request for “records”?

Answer:  HIPAA defines “designated record set” as:

A group of records maintained by or for a covered entity that is:

(i)        The medical records and billing records about individuals maintained by or for a covered health care provider; [or]

(iii)      Used, in whole or in part, by or for the covered entity to make decisions about individuals.

(45 CFR 164.501).  With very limited exceptions, patients and their personal representatives generally have a right to access protected health information in their designated record set.  (45 CFR 164.524).  As the OCR recently summarized: Continue reading →