Disclosure of Information About Named Physicians and Other

140.3 - Disclosure of Information About Named Physicians and Other Suppliers of Service (RO's) (Rev. 1, 09-11-02) A. General Generally, the contractor will not honor requests for information about a specific physician or other supplier of services, or for information which would identify such a physician or other supplier of services, except in situations described in §140.1 above. Disclosure to third parties for program purposes of information about individual physicians and other suppliers who are natural persons is governed by the same restrictions and procedures as disclosure about named beneficiaries to third parties for program purposes. (See §50B of this chapter.) The contractor acknowledges such requests and refers them to the RO for response. If the information the contractor discloses is solely information that does not identify or make identifiable individuals (e.g., aggregate statistics or records on providers and other corporate entities), it uses the following language: Dear: We are prepared to make available to your organization certain social security records so that (state reason). However, before making these records available to you, we must point out that by law all information derived in the administration of the Social Security Act is subject to the provisions of the Freedom of Information Act, which exempts from disclosure certain categories of records. In order to assure that no records held confidential under the Freedom of Information Act are disclosed, you must agree to meet the following conditions before we make any social security records available to you: 1. Any information which is turned over to you will be used only for the specific purpose intended and for no other purpose. 2. All employees having access to this material will be instructed as to its confidential nature. 3. An official of your company will assume responsibility for ensuring that the information is not revealed to any other party. 4. The material must be returned to us as soon as you have finished the job. 5. We must have a letter from a responsible official in your office agreeing to these conditions and assuming responsibility for carrying them out. Upon receipt of this letter from your organization, the social security records will be made available to you. Sincerely yours, If the contractor receives a written request for a physician's or supplier's customary charges or for amounts of program payments made to physicians outside of its jurisdiction, it acknowledges the request and sends it to the appropriate contractor, when known. If not known, it sends the request to the RO. Disclosure of information about unidentifiable individuals, or about provider or corporate entities (e.g., clinics or independent laboratories) is not to be disclosed by third parties to which information is disclosed for program purposes. B. Physician Fee and Supplier Charge Information Customary charges may be disclosed to the public. However, requests from anyone (including a physician or supplier) for actual data used to determine the customary charge(s) should be referred to the RO. A/B MACs (B) or DME MACs may voluntarily specify a physician's or supplier's customary charges when explaining reimbursement or when furnishing denial or review notices. The A/B MAC (B) or DME MAC may furnish a physician or supplier with a copy of their own customary charges free of charge; requests for customary charges from other sources will be subject to FOIA fees. However, anyone may inspect the customary charges free at the office of the A/B MAC (B) or DME MAC serving the locality for which the screens are used. A/B MACs (B) or DME MACs produce a printout to be made available for inspection and/or photocopying in their office. If past experience with requests for customary charge screens from the public does not warrant the expense of producing a printout of all screens for inspection (i.e., there have been few request and no one has requested to inspect all the screens), printout copies of single screens or small numbers of screens may be furnished instead of photocopies; however, there will be no charge for the computer time for the printout nor shall the requesters be asked to pay more than they would if they were to request a photocopy of the screens. Requests specifically for printouts or tapes shall be furnished at cost to related Federal programs (for example, to TRICARE or Medicaid). A/B MACs (B) or DME MACs may release information to the public regarding the method used to determine Medicare allowances, e.g., that the median of the charges made by physician for a service is used as the customary charge, and that the 75th percentile of such customary charges in an area (weighted by frequency of service) is used to establish the prevailing charge. Written requests for lists A/B MACs (B) or DME MACs do not have should be referred to the RO immediately by telephone so that RO can indicate whether the A/B MAC (B) or DME MAC should create a list. Such request might be for all the customary charge screens of internists in a given county or for a list of all physicians who charge a given amount or less for a certain procedure. If requesters orally ask to see a list, which does not exist, the A/B MAC (B) or DME MAC will offer them the opportunity to inspect the screens and create their own list. C. Disclosure of Related Entrepreneurial Information Information such as the specialty and business address of a physician or supplier may be disclosed to the public. The A/B MAC (B) or DME MAC will refer to the RO written requests for special lists, such as a list of five orthopedists in a given city. However, if the A/B MAC (B) has processed a list of all orthopedists in that city, it may, upon request, disclose the entire list. It may fulfill oral requests by offering the requester the opportunity to look at whatever disclosable records (e.g., customary charge screens) there are that contain the data (or to purchase photocopies of the data) or by referring the requester to the medical society or licensing board in the requester's area, if appropriate.