Medicare Managed Care Manual (Pub. 100-16), Ch. 17f § 110
Confidentiality and Records
110 - Confidentiality and Records
(Rev. 77, Issued: 10-28-05, Effective Date: 10-28-05)
General Rule
For any medical records or other health and enrollment information it maintains with
respect to enrollees, a Medicare cost plan must establish procedures to do the following:
•
Abide by all Federal and state laws regarding confidentiality and disclosure of
medical records, or other health and enrollment information. The Medicare cost
plan must safeguard the privacy of any information that identifies a particular
enrollee and have procedures that specify:
o
For what purposes the information will be used within the organization
and
o
To whom and for what purposes it will disclose the information outside
the organization;
•
Ensure that medical information is released only in accordance with applicable
Federal or state law, or pursuant to court orders or subpoenas;
•
Maintain the records and information in an accurate and timely manner; and
•
Ensure timely access by enrollees to the records and information that pertains to
them.