Notice of Privacy Practices for Protected Health Information

This Notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully!

Management Services Network’s (“MSN”) goal is to take appropriate steps to attempt to protect any medical or other personal information that is provided to us.  We are required to: a) protect the privacy of medical information provided to us; b) provide notice of our legal duties and privacy practices; and c) abide by and enforce the terms and obligations of MSN’s Notice of Privacy Practices currently in effect.

Protected health information is the information we create and obtain in providing our services to you.  Such information may include your name, address, and telephone number; information relating to your medical history; your insurance information and coverage; and documenting your symptoms, procedures, test results, and diagnoses as required in the provision of billing services.  In creating your billing record, information is gathered about you from providers, including hospitals and physicians, who provide medical care and treatment to you.

MSN maintains a website that provides information about the organization and this Notice can be accessed at www.msnllc.com.

Who is Required to Follow this Notice?
This Notice describes the practices of all MSN employees and staff, as well as all individuals who are affiliated with MSN through independent contractor agreements.  All of these individuals are required to follow the terms of this Notice and may share information about you among themselves for treatment, payment, and health care operations purposes.

How May MSN Use and Disclose Information About You?

A. Routine Uses and Disclosures of Protected Health Information

MSN may use protected health information about you in different ways.  MSN is permitted under federal law to use and disclose your protected health information, without your written authorization, for certain routine purposes, such as for treatment, payment and the operation of our business.  The ways we may use and disclose information without your authorization will fall into one of the following categories, but not every possible use or disclosure in each category is listed:

For Treatment Purposes:  MSN provides billing services to providers who will use your information for treatment purposes.  Therefore, MSN will not be using your protected health information for treatment purposes.

For Payment Purposes:  MSN will submit requests for payment to your health insurance company.  The health insurance company (or other business associate helping us obtain payment) may request information from us about the medical care provided to you.  We will provide information to them about you and the medical services provided to help us collect payment from your insurance company.  For example, we may need to give a payer information about your current medical condition so they will pay for an ultrasound examination.  We may also need to inform your payer of tests that you are going to receive in order to obtain prior approval or to determine if the service is covered under your health benefit plan.

For Health Care Operations:  MSN may periodically obtain services from other business associates such as quality assessment and improvement audits, outcomes evaluation, training programs, legal services, and insurance.  We may share protected health information about you with these business associates as necessary to evaluate our operations and to learn how we may improve our service to you.

B. Uses and Disclosures that May be Made without Your Authorization or Opportunity to Object

MSN may use or disclose your protected health information in the following situations without your authorization or providing you the opportunity to object.

Required by the Secretary of the Department of Health and Human Services. We may be required to disclose your protected health information to the Secretary of the Department of Health and Human Services (“Secretary”) to investigate or determine our compliance with the requirements of the final rule on Standards for Privacy of Individually Identifiable Health Information.

Required by Law. We may disclose protected health information about you when we are required to do so by federal, state, or local law.

Public Health. We may disclose protected health information about you in connection with certain public health reporting activities.  For instance, we may disclose such information to a public health authority authorized to collect or receive protected health information for the purpose of preventing or controlling disease, injury or disability, or at the direction of a public health authority, to an official of a foreign government agency that is acting in collaboration with a public health authority.   Public health authorities include state health departments, the Center for Disease Control, the Food and Drug Administration, the Occupational Safety and Health Administration and the Environmental Protection Agency, to name a few.

Health Oversight. We may disclose protected health information in connection with certain health oversight activities of licensing and other agencies. Health oversight activities include audit, investigation, inspection, licensure or disciplinary actions, and civil, criminal, or administrative proceedings or actions or any other activity necessary for the oversight of 1) the health care system, 2) governmental benefit programs for which health information is relevant to determining beneficiary eligibility, 3) entities subject to governmental regulatory programs for which health information is necessary for determining compliance with program standards, or 4) entities subject to civil rights laws for which health information is necessary for determining compliance.

Abuse or Neglect. If you have been a victim of abuse, neglect, or domestic violence, we may disclose your protected health information to a government agency authorized to receive such information. In addition, we may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect.

Judicial and Administrative Proceedings. We may disclose information in response to a warrant, subpoena, or other order of a court or administrative hearing body, and in connection with certain government investigations and law enforcement activities.  We may also disclose your protected health information for legal or administrative proceedings that involve you.  We may release such information upon order of a court or administrative tribunal.  We may also release protected health information in the absence of such an order and in response to a discovery or other lawful request, if efforts have been made to notify you or secure a protective order.

Coroners, Funeral Directors and Organ Donation. We may release personal health information to a coroner or medical examiner to identify a deceased person or determine the cause of death, or to a funeral director if necessary to perform their legally authorized duties.  We also may release personal health information to organ procurement organizations, transplant centers, and eye or tissue banks if you are an organ donor as necessary to facilitate organ donation or transplantation.

Workers’ Compensation. We may release your personal health information to workers’ compensation or similar programs.

Serious Threat to Health or Safety. We may disclose information about you when we believe it is necessary to prevent a serious threat to your health and safety or the health and safety of others.

Specialized Government Functions.  If you are a member of the Armed Forces, we may release personal health information about you as required by military command authorities or for purposes of a determination by the Department of Veterans Affairs of your eligibility for benefits.  We may release personal health information about foreign military personnel to the appropriate foreign military authority.  We may also disclose protected health information for national security and intelligence activities and for the provision of protective services to the President of the United States and other officials or foreign heads of state, for national security purposes, or to public assistance program personnel.

Correctional Institutions. If you are an inmate, we may release protected health information about you to a correctional institution where you are incarcerated or to law enforcement officials.

Our Business Associates.  MSN, in the course of conducting its business, works with outside individuals and businesses who help to operate the business efficiently and successfully.  We may disclose your health information to these business associates so that they can perform the tasks they are hired to do.  All of our Business Associates must commit to us, through a written agreement, that they will respect the confidentiality and privacy of your personal and identifiable health information.

Law Enforcement. We may disclose your protected health information, so long as applicable legal requirements are met, for law enforcement purposes, such as when required by a court order, or in cases involving felony prosecutions, or to the extent an individual is in the custody of law enforcement.

C. Uses and Disclosures that May be Made Either with Your Agreement or the Opportunity to Object

Unless you object, we may disclose information to individuals involved in your care or in the payment for your care to the extent such information directly relates to the individual’s involvement in your health care.  This includes people and organizations that are part of your “circle of care” – such as your spouse, your other doctors, or an aide who may be providing services to you.  Although we must be able to speak with your other physicians or health care providers, you may let us know if we should not speak with other individuals, such as your spouse or family.  If you are unable to agree or object to such disclosure, we may disclose such information as necessary if we determine it is in your best interest based on our professional judgment.  Unless you object, we may also use or disclose your protected health information to notify, or assist in notifying a family member, personal representative, or other person responsible for your care, about your location, and about your general condition, or your death.

D. Uses and Disclosures of Protected Health Information Based Upon Your Written Authorization

Psychotherapy Notes: We must obtain your written authorization to use and disclose your protected health information for most uses and disclosures of psychotherapy notes.

Marketing. We must obtain your written authorization to use and disclose your protected health information for most marketing purposes.

Sale of Protected Health Information. We must obtain your written authorization for any disclosure of your protected health information which constitutes a sale of protected health information.

Other Uses. Other uses and disclosures besides those identified in this Notice will be made only as otherwise authorized by law or with written authorization and you may revoke the authorization as previously provided.

Your Individual Health Rights

The billing records maintained by MSN are the physical property of the physician who provides you with services and/or of the hospital where you were treated.  The information itself, however, belongs to you.  You have the right to ask for restrictions on the ways in which we use and disclose your medical information beyond those imposed by law and we will consider your request.  Please recognize that, while we are required to consider your request, we are not required to accept the request. 

A. Request a Restriction of Your Protected Health Information

You have the right to request a restriction on certain uses and disclosures of your health information by delivering the request in writing to our office.  Your request must state the specific restriction requested and to whom you want the restriction to apply. We are not required to agree to a restriction that you may request, except that we must agree not to disclose your protected health information to your health plan if the disclosure (1) is for payment or health care operations and is not otherwise required by law, and (2) relates to a health care item or service which you, or someone on your behalf (other than a health plan), paid for in full. If we agree to the requested restriction, we may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment.

B. Obtain a Copy of this Notice

You have the right to obtain a paper copy of the Notice of Privacy Practices for Protected Health Information (“Notice”) by making a request at our office.

C. Inspect and Copy Your Protected Health Information

You have the right to request that you be allowed to inspect and copy your billing records.  You may exercise this right by delivering the request in writing to our office using the form we provide to you upon request.  We are required to provide you access to your protected health information for inspection and copying within 30 days after receipt of your request (with up to a 30-day extension if needed) and we may charge you a reasonable fee to cover duplication, mailing and other costs we incur in complying with your request.  In addition, there are situations in which we may deny your request, and you have the right to appeal a denial of access to your protected health information, except in certain circumstances.

D. Amend Your Protected Health Information

You have the right to request that your billing record be amended to correct incomplete or incorrect information by delivering a written request to our office using the form we provide to you upon request. Your physician or other health care provider is not required to make such amendments.  We will respond to your request within 60 days (with up to a 30-day extension if needed).  We may deny your request if, for example, we determine your protected health information is accurate and complete.  If we deny your request, we will send you a written explanation.  You have the right to file a statement of disagreement if your amendment is denied, and require that the request for amendment and any denial be attached in all future disclosures of your protected health information.

E. Receive an Accounting of Certain Disclosures We Have Made of Your Protected Health Information

You have the right to obtain an accounting of disclosures of your health information as required to be maintained by law by delivering a written request to our office using the form we provide to you upon request.  An accounting will not include internal uses of information for treatment, payment, or health care operations, as described in this Notice, disclosures made to you or made at your request, or disclosures made to family members or friends in the course of providing care.  The right to receive this information is subject to certain exceptions, restrictions and limitations.  You must specify a time period for the accounting , which may not be greater than 6 years and cannot include any date before April 14, 2003.  You may request a shorter timeframe.  You have the right to one free request within any 12-month period, but we may charge you for any additional requests within the same 12-month period.  We will notify you of any such charges and you are free to withdraw or modify your request prior to charges being incurred.  We will respond to your request within 60 days (with up to a 30-day extension if needed).

F. Request to Receive Confidential Communications From Us by Alternative Means or at an Alternative Location

You have the right to request that communications of your health information be made by alternative means or at an alternative location by delivering the request in writing to our office using the form we give you upon request.  We will accommodate reasonable requests.

G. Revoke Prior Authorizations

You have the right to revoke authorizations made previously by you to use or disclose information except to the extent information or action has already been taken by delivering a written revocation to our office.

H. Receive Notification Regarding Breach

You have the right to be notified if you are affected by a breach of unsecured protected health information.

I. Opt Out Of Receiving Fundraising Communications

We may contact you for fundraising purposes, and you have the right to opt out of receiving fundraising communications from us. 

If you would like to exercise any of the above rights, please contact (insert name of designated staff member, phone number, or address), in person or in writing, during normal hours.  They will provide you with assistance on the steps to take to exercise your right.

MSN’s Responsibilities

All MSN personnel are required to:

  • Maintain the privacy of your protected health information as required by law;
  • Provide you with a Notice regarding our duties and privacy practices related to the information we collect and maintain about you;
  • Abide by the terms of this Notice;
  • Notify you if we cannot accommodate a requested restriction or request; and
  • Accommodate your reasonable requests regarding methods of communicating health information with you.

Changes to this Notice

MSN reserves the right to amend, change, or eliminate provisions in our privacy and access practices and to implement new provisions regarding the protected health information we maintain.  If our information practices change, we will amend our Notice and distribute the revised Notice as required by law.  You are entitled to receive a revised copy of the Notice by calling and requesting a copy, visiting our office and picking up a copy, or viewing the Notice at www.msnllc.com

To Request Information or File a Complaint

If you have questions, would like additional information, or want to report a problem regarding the handling of your information, you may contact [insert name, title, and telephone number of internal contact person].

If you believe your privacy rights may have been violated, you may file a written complaint at our office by delivering the written complaint to [list internal staff member].  You may also file a complaint by mailing or e-mailing it to the Office for Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue, SW, Room 509F HHH Building, Washington, D.C. 20201 (e-mail: ocrmail@hhs.gov).

We cannot, and will not, require you to waive the right to file a complaint with the Secretary of the U.S. Department of Health and Human Services (“HHS”) as a condition of receiving services from MSN.

We cannot, and will not, retaliate against you for filing a complaint with Secretary of HHS.

Effective Date: February 1, 2003 (revised July 2013)