DISCLOSURE
OF MEDICARE ENTITLEMENT INFORMATIONby A. Maureen Hanna
DISCLOSURE
OF MEDICARE ENTITLEMENT INFORMATION
by A. Maureen Hanna
One of the biggest frustrations of Home Medical Equipment (HME) providers is obtaining current Medicare entitlement information regarding the beneficiaries they serve.
Members of the public can get information from Federal agencies based on the Freedom of Information Act (FOIA). The FOIA was established to make the Federal government accountable to the public for its actions and prevents agencies from having secret policies.
Under FOIA, an individual can inspect and
copy the following Social Security Administration (SSA) records:
1. Policy statements
and SSA manuals and instructions,
2. Final opinions from
adjudicating administrative cases, and
3. An index of SSA's administrative staff manuals and instructions.
If an individual requests his/her own record(s), the SSA will process your request under the Privacy Act instead of under the FOIA. The Privacy Act of 1974, 5 U.S.C. 5521 and section 1106 of the Social Security Act describe the policies and procedures concerning the disclosure of information about individuals, both with and without their consent. Regulations that apply to the disclosure of information about an individual contained in SSA's program records are set out in sections 401.00 through 402.103 and 401.115 through 401.195. That information includes health insurance records which SSA maintains for the Health Care Financing Administration (HCFA) programs under title XVIII of the Social Security Act as well as black lung benefit records which SSA maintains for the administration of the Federal Coal Mine Health and Safety Act.
If, for example, a home medical equipment (HME) provider request another person's records, you need the person's written consent to disclose them to you. In these cases, send your request, with the signed consent, to the manager of the Privacy Act System of Records (if you have this information) or your local Security Security office.
Consents presented to the SSA for the release
of personal information maintained in it files must:
1. Be in writing, signed
by the individual and dated;
2. Specify what information
is to be disclosed (e.g. Medicare coverage and/or history of rental
payments for standard wheelchair rental HCPCS code K0001);
3. Specify to whom to information shall be released to (e.g. name,
address, phone etc. of third party);
4. Specify time frame which
the information is to be disclosed;
5. Be presented to the SSA within a reasonable length of time
after the date it is signed by the individual.
Under Section 401.45 there is additional verification required to verify your identity when requesting notification of or access to sensitive records such as medical records. Such verification may include such particulars as the date of place of birth, names of parents, name of employer or the specific time the individual received medical treatment.
It is important to note that any false statements and/or representations made knowingly and willfully to the SSA to obtain information on an particular individuals records is punishable by fines and/or prison terms.
As an alternative, the SSA can mail a printout containing the entitlement information to the address on record (e.g. beneficiary address) then that individual can provide the document to the provider/supplier.
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