BOT 2673 - Understanding Health Insurance: Chapter 5

James is excited to obtain employment at a large practice in the suburbs. The position is titled assistant release of information technician. James is responsible for obtaining appropriate patient release of information to process requests for information from third parties (e.g., payers, attorneys, providers, and so on). James is also responsible for applying all state and federal laws to the release of protected health information (PHI). The training about the practice's policies and procedures for appropriately releasing patient information included the following requirements:

• Validate a patient's signature by comparing it to a patient-signed document in the patient record (e.g., consent to treatment, assignment of benefits).
• Explain to requestors that the practice requires ten days to process such requests for information.
• Contact the patient, if necessary, to verify that someone other than the patient has permission to obtain copies of patient records.

James arrived at work eager to learn as much as possible about the new position and to actually be working in the profession. The team leader, Teresa, went on lunch break at a time that is normally busy for the release of information section. At first it was quiet, and James reviewed notes about official policies and procedures related to the release of information. Then, James felt ready to answer any questions in the absence of the team leader.

James heard a person walk to the front counter. The person was older, quite well dressed and very tall. The person said they were there to pick up the spouse's patient records. James was able to find the records and made copies of them. Upon review of the release of information signed by the patient, it appeared that the patient had authorized the spouse to pick up the records. Prior to handing over the copies of the record, James asked the person for identification for verification purposes. The person said the wallet was in the car. The person was impatient and muttered that it was ridiculous since everything was signed and in order. The person grabbed the manila envelope containing the copies of the patient records out of James' hand and quickly left. James was quite distraught over this incident.

When Teresa returned from lunch and saw that James was upset, James told her what happened. Teresa's face dropped. "You are never supposed to give out patient records without a valid patient authorization and photo identification."

1.) What steps to the practice's release of information policy and procedure did James forget to follow?

2.) How should Teresa handle the situation, based on James having inappropriately released patient information?