Authorization Protocols

Written by Norene Anderson
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Authorization protocols have taken on a new meaning with the enforcement of HIPAA. This affects the maintaining, processing, and sharing of patient information in every form. It is not unusual to sign two or three documents that allow you to either restrict your personal information or allow your personal information to be shared.

In addition to the responsibility of the patient to determine the scope of sharing, the healthcare provider is under strict guidelines about the handling and processing of electronically dispensed data. This covers everything from obtaining procedural and diagnostic results online to filing insurance claims electronically. The data must be encrypted to preserve the integrity of the patient information.

Different Authorization Protocols

HIPAA requires authorization protocols that control access to the data and exactly what can be done with the data. There must be safeguards to prohibit the wrong person from deleting or modifying any patient information without the proper access. Protecting the patient's privacy must be up front at all times.

Authorization protocols must be followed when verifying payment for services. Most are familiar with the process of preauthorization for a surgical procedure or hospitalization. There are also many treatments and therapies that must be authorized before Medicare, Medicaid, and many managed care policies will cover the cost. If authorization is not obtained prior to dispensing, it is very possible payment will be denied. There are certain CPT drug codes and HCPCS codes that require the proper authorization protocols to be followed in order to secure reimbursement. Confidentiality is paramount in the transaction of all patient data including authorization for treatment.

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