Disclosure of Claims Payment Information in Alcohol and Drug

170.5 - Disclosure of Claims Payment Information in Alcohol and Drug Abuse Cases (Rev. 1, 09-11-02) The law requires providers to observe more stringent rules when disclosing medical information for claims processing purposes from the records of alcohol and drug abuse patients. Since the standard consent statement on the provider billing form is not sufficient authority, under the law, to permit the provider to release information from the records of alcohol or drug abuse patients, more explicit consent statements are required. Providers that participate in Medicare and alcohol and drug abuse prevention and treatment programs must obtain written consent in each alcohol or drug abuse case from beneficiaries to release medical information. This written consent, which allows the provider to disclose the records of the patient, must include all of the following: • The name of the organization (e.g., hospital name) that is to make the disclosure; • The name or title of the person or organization to which disclosure is to be made (e.g., CMS, including the appropriate MAC, specified by name); • The name of the patient; • The purpose or need for the information to be disclosed (e.g., for processing a claim for Medicare payment and for such evaluation of the treatment program as is legally and administratively required in the overall conduct of the Medicare program); • The specific extent or nature of information to be disclosed (e.g., all medical records regarding the beneficiary's treatment, hospitalization, and/or outpatient care including treatment for drug abuse or alcoholism); • A statement that the beneficiary may revoke their consent at any time to prohibit disclosures on or after date or revocation; • A statement specifying a date (not to exceed 2 years), event, or condition upon which consent expires without revocation; • The date on which the consent is signed; and • The signature of the patient or the signature of their authorized or legal representative. If the beneficiary wishes, the consent statement may be expanded to permit disclosure by the provider to any other person, organization, or program (e.g., PRO), as appropriate. Providers may also give authorization to CMS and its contractors to re-disclose specific information to third party payers for complementary insurance purposes. The provider keeps the consent statement with the patient's medical and other records. The duration of the consent statement is not to exceed 2 years after which it must be renewed by the beneficiary if further disclosures are necessary.