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If your health care organization is self-insured, the government is holding up a new hoop and waiting for you to jump through it.
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To comply with the reporting requirements of MMSEA Section 111, an affected health care provider must first register with the Centers for Medicare & Medicaid Services (CMS) Coordination of Benefits Contractor (COBC).
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A pregnant woman presented to a hospital emergency department (ED) for delivery of her third child. Because of her high-risk pregnancy, the woman was scheduled for a cesarean. The cesarean was performed, followed by a hysterectomy. However, complications arose during the hysterectomy, and the woman slipped into a coma and died three days later.
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A young girl was brought to a hospital for an infection following the removal of her appendix and was admitted to the pediatric intensive care unit. An antifungal drug suitable for children was prescribed, but due to an alleged pharmacy error, the adult version of the drug was dispensed and administered. The girl had an adverse reaction to the drug and suffers from post-traumatic stress disorder (PTSD).
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Risk managers across the country cheered when they heard of dramatic decrease in the number of malpractice lawsuits filed in Tennessee after reform efforts there, wondering if the same experience might be replicated in their own states.
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The Joint Commission has been working closely with several other organizations, including the National Association of Psychiatric Health Systems and the National Association of State Mental Health Program Directors, to collect data and further define the standard of care in psychiatry, notes Alan Lambert, MD, JD, chair of health care practice with the law firm of Butzel Long in New York City.
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It's a common scenario in any health care facility, especially hospital emergency rooms: The local police ask the nurse or doctor for information about a patient who is either a suspect, a victim, or a witness to a crime. Or perhaps the risk manager receives a more formal request for records. How much can you tell them without violating the Health Insurance Portability and Accountability Act (HIPAA)?
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HIPAA states that covered entities may disclose protected health information to law enforcement officials for law enforcement purposes under the following six circumstances, and subject to specified conditions:
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"Customer service is something that is sometimes really hard to monitor," says Linda Smith, manager of patient registration and centralized scheduling at Barnes-Jewish St. Peters (MO) Hospital. "Unless you have direct interaction with staff, you don't always know.
