HIPAA Policy

Notice of Privacy Practices of the following Covered Entities
East Texas Spine Institute, PA
Ritesh R. Prasad, MD
DRM Business Health, PLLC
C Perry Marshall, MD
R2 Partners, LP
R2 Medical Management, Inc.
B. Coby Marrow, MPT
Racheal Cox, SLP-CCC
Lauren Meeker, SLP

Disclosures That Can Be Made Without Your Authorization
There are situations in which we are permitted by law to disclose or use your medical information without your written authorization or an opportunity to object. In other situations we will ask for your written authorization before using or disclosing any identifiable health information about you. If you choose to sign an authorization to disclose information, you can later revoke that authorization, in writing, to stop future uses and disclosures. However, any revocation will not apply to disclosures or uses already made or taken in reliance on that authorization. 

Public Health, Abuse or Neglect, and Health Oversight
We may disclose your medical information for public health activities. Public health activities are mandated by federal, state, or local government for the collection of information about disease, vital statistics (like births and death), or injury by a public health authority. We may disclose medical information, if authorized by law, to a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition. We may disclose your medical information to report reactions to medications, problems with products, or to notify people of recalls of products they may be using. We may also disclose medical information to a public agency authorized to receive reports of child abuse or neglect. Texas law requires physicians to report child abuse or neglect. Regulations also permit the disclosure of information to report abuse or neglect of elders or the disabled. We may disclose your medical information to a health oversight agency for those activities authorized by law. Examples of these activities are audits, investigations, licensure applications and inspections which are all government activities undertaken to monitor the health care delivery system and compliance with other laws, such as civil rights laws. 

Legal Proceedings and Law Enforcement
We may disclose your medical information in the course of judicial or administrative proceedings in response to an order of the court (or the administrative decision-maker) or other appropriate legal process. Certain requirements must be met before the information is disclosed. If asked by a law enforcement official, we may disclose your medical information under limited circumstances provided that the information:

Is release pursuant to legal process, such as a warrant or subpoena;

Pertains to a victim of crime and you are incapacitated;

Pertains to a person who has died under circumstances that may be related to criminal conduct;

Is about a victim or crime and we are unable to obtain the person’s agreement;

Is released because of a crime that has occurred on these premises; or

Is released to locate a fugitive, missing person, or suspect.

We may also release information if we believe the disclosure is necessary to prevent of lessen an imminent threat to the health or safety of a person. 

Workers’ Compensation
We may disclose your medical information as required by the Texas workers’ compensation law. 

Inmates
If you are an inmate or under the custody of law enforcement, we may release your medical information to the correctional institution or law enforcement official. This release is permitted to allow the institution to provide you with medical care to protect your health or the health and safety of others, or for the safety and security of the institution.

Military, National Security, and Intelligence Activities, Protection of the President
We may disclose your medical information for specialized governmental functions such as separation or discharge from military service, requests as necessary by appropriate military command officers (if you are in the military), authorized national security and intelligence activities, as well as authorized activities for the provision of protective services for the President of the United States, other authorized government officials, or foreign heads of state. 

Research, Organ Donation, Coroners, Medical Examiners, and Funeral Directors
When a research project and its privacy protections have been approved by an Institutional Review Board or privacy board, we may release medical information to researchers for research purposes. We may release medical information to organ procurement organizations for the purpose of facilitating organ, eye, or tissue donation if you are a donor. Also, we may release your medical information to a coroner or medical examiner to identify a deceased or a cause of death. Further, we may release your medical information to a funeral director where such a disclosure is necessary for the director to carry out his duties. 

Required by Law
We may release your medical information where the disclosure is required by law. 

Your Rights Under Federal Privacy Regulations 
The United States Department of Health and Human Services created regulations intended to protect patient privacy as required by the Health Insurance Portability and Accountability Act (HIPAA). Those regulations create several privileges that patients may exercise. We will not retaliate against a patient that exercises their HIPAA rights. 

Requested Restrictions
You may request that we restrict or limit how your protected health information is used or disclosed for treatment, payment, or healthcare operations. We do NOT have to agree to this restriction, but if we do agree, we will comply with your request except under emergency circumstances. To request a restriction, submit the following in writing: (a) The information to be restricted, (b) what kind of restriction you are requesting (i.e. on the use of information, disclosure of information of both), and (c) to whom the limits apply. Please send the request to the address and person listed below. You may also request that we limit disclosure to family members, other relatives, or close personal friends that may or may not be involved in your care. 

Receiving Confidential Communications by Alternative Means
You may request that we send communications of protected health information by alternative means or to an alternative location. This request must be made in writing to the person listed below. We are required to accommodate only reasonable requests. Please specify in your correspondence exactly how you want us to communicate with you and, if you are directing us to send it to a particular place, the contact/address information.  

Inspection and Copies of Protected Health Information
You may inspect and/or copy health information that is within the designated record set, which is information that is used to make decisions about your care. Texas law requires that requests for copies be made in writing and we ask that requests for inspection of your health information also be made in writing. Please send your request to the person listed below.We can refuse to provide some of the information you ask to inspect or ask to be copied if the information 

Includes psychotherapy notes.

Includes the identity of a person who provided information if it was obtained under a promise of  confidentiality.

Is subject to the Clinical Laboratory Improvements Amendments of 1988.

Has been compiled in anticipation of litigation.

 We can refuse to provide assess to or copies of some information for other reasons, provided that we provide a review of our decision on your request. Another licensed health care provider who was not involved in the prior decision to deny access will make any such review. Texas law requires that we are ready to provide copies or a narrative within 15 days of your request. We will inform you of when the records are ready or if we believe access should be limited. If we deny access, we will inform you in writing. HIPAA permits us to charge a reasonable cost based fee. The Texas State Board of Medical Examiners (TSBME) has set limits on fees for copies of medical records that under some circumstances may be lower than the charges permitted by HIPAA. In any event, the lower of the fee permitted by HIPAA or the fee permitted by the TSBME will be charged. 

Amendment of Medical Information
You may request an amendment of your medical information in the designated record set. Any such request must be made in writing to the person listed below. We will respond within 60 days of your request. We may refuse to allow an amendment if the information: 

Wasn’t created by this practice or the physicians here in this practice.

Is not part of the Designated Records Set.

Is not available for inspection because of an appropriate denial.

If the information is accurate and complete.

 Even if we refuse to allow an amendment you are permitted to include a patient statement about the information at issue in your medical record. If we refuse to allow an amendment we will inform you in writing. If we approve the amendment, we will inform you in writing, allow the amendment to by made and tell others that we know have the incorrect information. 

Accounting of Certain Disclosures
The HIPAA privacy regulations permit you to request, and us to provide, an accounting of disclosures that are other than for treatment, payment, health care operations, or made via an authorization signed by you or your representative. Please submit any request for an accounting to the person listed below. Your first accounting of disclosures (within a 12 month period) will be free. For additional requests within that period we are permitted to charge for the cost of providing the list. If there is a charge we will notify you and you may choose to withdraw or modify your request before any costs are incurred. 

Appointment Reminders, Treatment Alternatives, and Other Health-related Benefits 
We may contact you by telephone, mail, or both to provide appointment reminders, information about treatment alternatives, or other health-related benefits and services that may be of interest to you. 

Complaints 
If you are concerned that your privacy rights have been violated, you may contact the person listed below. You may also send a written complaint to the United States Department of Health and Human Services. We will not retaliate against you for filling a complaint with the government or us. The contact information for the United States Department of Health and Human Services is: U.S. Department of Health and Human ServicesHIPAA Complaint7500 Security Blvd., C5-24-04Baltimore, MD 21244 

Our Promise to You 
We are required by law and regulation to protect the privacy of your medical information, to provide you with this notice of our privacy practices with respect to protected health information, and to abide by the terms of the notice of privacy practices in effect. 

Questions and Contact Person for Requests 
If you have any questions or want to make a request pursuant to the rights described above, please contact: Direct RehabMedAttn: Johnny Lollar 3110 Park Center Dr., Tyler, TX 75701(903) 593-9999, Fax (903) 526-2679 This notice is effective on the following date: 4/14/03 

We may change our policies and this notice at any time and have those revised policies apply to all the protected health information we maintain. If or when we change our notice, we will post the new notice in the office where it can be seen.

Refund Policy

Payment of professional fees is due at the time of service. Internet communication may not be covered by insurances. If it is covered, then it is the patient responsibility to file claims for internet based services with their carrier. If Direct RehabMed, East Texas Spine Institute, PA receives payment from a third party in compensation for office charges previously paid by the patient, a refund to the patient may be generated within 30 days of receipt.

Financial Policy

APPOINTMENTS
The scheduling of an appointment constitutes an agreement to pay for the professional time reserved exclusively for you. Missed Appointments – Our policy is to charge for missed appointments or appointments cancelled with less than 24 hours notice. If you fail to keep a scheduled appointment with a provider, and do not give the office at least 24 hours notice of cancellation, you will be charged a missed appointment fee of $50.00. Insurance plans do not cover these fees; you will be billed directly for this. Failure to pay a no-show fee will be treated according to our policy on unpaid balances, with the exception of collection accounts. The number to call and cancel an appointment 24 hours a day is (903) 593-9999. 

ALL PATIENTS MUST COMPLETE OUR “PATIENT DATA FORM” BEFORE BEING SEEN BY A HEALTH CARE PROVIDER. 

All patients are expected to complete a patient information and financial responsibility form annually. An updated patient information form must be completed anytime there is a change. For Group Insurance patients, A valid insurance card is required to be presented for copying at each visit. Failure to provide correct information at the time of your visit may result in a delay in care and responsibility for the cost of the entire visit. 

INSURANCE
Our practice accepts insurance from most major insurance companies. It is YOUR responsibility to know your coverage and benefits. As a courtesy, we will file your claim to the respective insurance company. To avoid any misunderstandings regarding payment for professional services, Direct RehabMed requests that you authorize all insurance company payments directly to our practice. If you choose not to do so, all charges will be due and payable by you at the time of service. You will be responsible for any portion of your bill which is denied, applied to deductible, considered a co-payment or co-insurance portion or is considered non-covered by your insurance plan. Working together we can resolve most insurance issues in a mutually acceptable and convenient manner.

WORKERS’ COMPENSATION
If you are seeking treatment for a work related injury, we expect you to notify us that this injury was related to your job. We ask that you notify our office in advance of your appointment so that we can verify coverage of your care. 

MEDICARE
Deductibles and 20% of the allowable charges are due at the time of service. As we are Medicare providers, we will file your insurance claims. If you have a secondary insurance, please check with the front desk to see if we file with that company. Please bring your Medicare Explanation of Benefits (EOB) showing you have met your deductible.

PAYMENT OF FEES
ALL CHARGES ARE YOUR RESPONSIBILITY FROM THE DATE THE SERVICES ARE RENDERED.
Any balance on your account over 60 days old, including those balances that insurance has not paid, will be due in full. All accounts over 120 days old will be turned over for collections. We realize that emergencies do arise and may affect timely payments of your account. If such extreme cases do occur, please contact us promptly for assistance in the management of your account. Please understand that payment of your bill is considered a part of your treatment. You have the right to refuse any services rendered to you if you think they are non-covered services or not payable by your insurance company. 

INSURANCE
We cannot waive co-payments, deductibles, co-insurance or non-covered service amounts defined as patient responsibility under the terms of our contract with the various health plans. Payment of co-payments and co-insurances are due at the time of the office visit. Please be ready to make payment on the day you visit the office. Any remaining balance on your account after the insurance company has processed your claim is due upon receipt of a statement from our office. If a patient is a member of an insurance plan with which we do not participate, our office will also file a claim on the patient’s behalf; however, the patient is expected to make payment in full at the time of service. Please contact your insurance company with any questions about your insurance coverage.

WORKERS’ COMPENSATION
We will file your claim with your company’s Workers’ Compensation Insurance carrier. In the event you fail to prosecute the claim for Workers’ Compensation (for this illness of condition) or it is determined by the Workers’ Compensation Board that this illness of condition is not a compensable injury, you will be responsible for the payment of your balance due. 

Methods of Payment
Cash, personal check, Visa, MasterCard or American Express are accepted methods of payment to Direct RehabMed East Texas Spine Institute, PA and DRM Business Health, PLLC. Returned check fee is $25.00.

Past Due Accounts
All patient-responsible balances that remain delinquent after 120 days, with no response to our requests for payment, may be referred to a collection agency. Once the account is turned over to the collection agency, the patient or responsible party will have to settle the debt with the agency. Please be aware that if a balance remains unpaid, you and/or your immediate family members may be discharged from Direct RehabMed. If this is to occur, you will be notified by certified mail that you have 30 days to find alternative medical care. During that 30 day period, our providers will only be able to treat you on an emergency basis.Please let us know if you are having difficulty paying your account. We may be able to help by setting up a payment plan based on your financial condition, call (903) 593-3101 for assistance.

MEDICAL RECORDS

If in the future, should you need copies of your medical records, we do charge a $25.00 fee for this service. We require a written release of records to be signed and dated due to the HIPAA Law. It takes our office eight to ten days in order to process a request so please plan ahead.

Medication Agreement

As part of your treatment, our medical staff may prescribe medications for you. As you know, medications can have serious side effects if they are not managed properly. Your health and safety are very important to us, and we need your help to make sure your treatment follows the prescribed guidelines. No prescriptions will be written for you unless you accept the following agreement.

You will agree to follow the dosing schedule prescribed to me by my doctor.

You will agree to never share, sell or exchange my medications with anyone for any reason.

You will agree that you are solely responsible for the safekeeping of my medications. You will treat my medications as you would any valuable   possession. You know that Your physician will not replace LOST OR STOLEN prescriptions or controlled medications.

You will agree that you will not drive or operate heavy machinery while taking medications that may cause drowsiness or impair cognitive function.

You will agree to notify your physician’s staff if you experience any adverse effects or dosage problems with your prescribed medications. You may be asked to bring any unused medication to your physician for disposal.

You will agree that if you receive a controlled substance prescription from your physician, you are not allowed to accept controlled substance prescriptions from any other physician without your doctor’s consent.

You will agree to use only one pharmacy for your pain-related medications. In the event, that circumstances require the use of another pharmacy, You will notify your physician, or their staff, of this immediately and provide them with all pertinent contact information.

You understand that medication refill prescriptions involving narcotic pain medicine require a scheduled appointment with your primary physician in the office. Narcotic pain medication refills will not be called into a pharmacy. Narcotic dosages will not be increased by phone.

You will agree to keep all scheduled appointments. You understand that no medications will be given for canceled or no-show appointments. You understand that if you are more than 15 minutes late to my scheduled appointment time, you will have to reschedule for another time. 

You understand that you can not be seen at the office without a scheduled appointment for ANY reason.

The physician’s staff phone triage hours are 8:00am to 3:00pm, Monday through Friday for Non-Emergency medication questions and refill requests. You know that you can not call this line more than two times in any day.

You know that you can be asked to bring any or all of my prescribed medications to your office appointment or at a random time for a prescription compliance check (Pill Count).

You understand that your physician will write and dispense narcotic medication prescriptions on a 30 day basis. In order to receive another narcotic medication prescription you must schedule another office visit within 30 days of the date on your current prescription so your physician can properly evaluate your progress.

You understand that abusive behavior or harassment toward any staff can not be tolerated. The physicians will determine what actions can be considered harassment on a case-by-case basis and, if warranted, You can be dismissed from the practice.

You understand that dealing with a forged, falsified or altered prescription will result in my immediate dismissal by your provider.

You understand that your physician reserves the right to PERFORM A URINE DRUG SCREEN AT ANY TIME WHILE I AM BEING TREATED WITH PRESCRIBED CONTROLLED SUBSTANCES. If the results of the urine drug screen do not reflect medicine prescribed by your doctor, or test positive for illegal drugs, You understand that you can be dismissed immediately from the practice.

Disclaimer

Direct RehabMed, East Texas Spine Institute, PA and/or DRM Business Health, PLLC  have provided the information on this Web site for education purposes only. It is in no way intended to replace a visit with your doctor or to provide medical advice in the absence of your health care providers. It is important that you establish a relationship with your physician and be sure that all questions regarding treatment, treatment outcomes, medications, surgery, and risks have been thoroughly discussed. We do not attempt to make diagnosis or suggest treatment without records, history, and a visit with a physician.