Practice management faq
Ideally, records should be maintained and kept accessible indefinitely, since they are the history of the patient’s treatment, but retention laws do exist. HIPAA mandates for record retention are superseded by individual state regulations if state mandates are more stringent. Due to storage issues, sometimes offices seek alternative means for record keeping. Choices include using a records storage service, transferring records to microfilm or microfiche, or scanning records and storing them digitally. It is recommended that you contact your state’s Dental and Medical Boards for specific state regulations. In addition, refer to your liability carrier or healthcare attorney for further guidance, especially for regulations on treating patients with a medical power of attorney, or patients involved in a civil or criminal proceeding. In these cases, records may need to be kept indefinitely.
For information on medical record retention, please visit the American Health Information Management Association (AHIMA) and the November/December 2003 Practice Management Notes The OMS’s Guide to Record Retention.
Record disposal is mandated by federal and state regulations; your office should have a written record retention schedule and destruction policy in accordance with those laws. These policies should also be reviewed and approved by your malpractice insurer and legal counsel.
Prior to disposing of or donating your outdated computers, it is essential that you “scrub” them first, so your patients’ protected health information (PHI) is completely removed from the computers’ hard drives. Deleting files or documents, or repartitioning the hard drive does not completely erase the material from your computer. There are several options to consider for complete erasure. You can purchase software known as “secure erase tools” or you can have a reputable computer service perform the proper erasure procedures. Please note that you would need to have a business associate agreement with the company assisting you with the erasure of your hard drives, since they will have access to your patients’ PHI. Not only does complete erasure ensure the proper removal of the patients’ PHI, it also protects the doctors and office personnel from potential identity theft, and eliminates access to any financial data that was stored on the computer.
The American with Disabilities Act mandates that health care providers provide “auxiliary aids and services” to enable a patient with a disability to benefit from practice services. Under the ADA laws, if a patient requests an interpreter, one must be provided by the office. If the office refuses to do so, the practice may be subject to a claim for discrimination. In addition, the cost of the interpreter must be covered by the office, and may not be passed on to the patient. For more information, please visit American with Disabilities Act or HHS Office for Civil Rights.
In addition, if the office earns any income from Medicare or Medicaid or any federal health care program, the requirement to provide interpreters also applies for Limited-English Proficiency (LEP) patients. We recommend you contact your office attorney for further guidance on any additional state regulations that may apply. For more information, please see the Language Services Action Kit from NHeLP (National Health Law Program), which provides instruction and information on the federal laws and policies regarding interpreter services for people with LEP. LEP information is also available from the US Department of Justice and the HHS Office for Civil Rights web sites. In addition, state dental boards and dental associations may have additional information or guidance.
Safety precautions should be followed by all employees who access the x-ray machine, including making sure equipment works properly. Employees should stand outside the room at least 6 feet away from the active beam, and be shielded by a barrier/wall and a leaded apron. State laws may require monitoring of all personnel, but, specifically, the National Council on Radiation Protection and Measurements (NCRP) recommends that personal dosimeters (x-ray badges) be provided for known pregnant personnel. Other work restrictions for pregnant employees should be based on the recommendation of the employee’s physician, plus institutional policies and state law, where applicable. For further information on Radiation Safety and the guidelines from the National Council on Radiation Protection and Measurements (NCRP) please visit osap.org and ncrponline.org.
OSAP’s (Organization for Safety and Asepsis Procedures) February 2005 issue of Infection Control In Practice explains the guidelines from the NCRP, and outlines recommendations from the CDC, FDA and ADA).
Additional websites for information on exposure incldes
- OSHA Post-Exposure Evaluation
- Recording and Reporting Occupational Injuries and Illness
- OSHA 300 Forms
- CDC Infection Control Guidelines
- AAOMS Model Exposure Control Plan
The FAQs sampling above is just the tip of the iceberg as to the very strict laws and regulations governing a medical or dental practice. Especially for new practitioners, navigating the medical waters can be a nightmare, and the consequences of mistakes can be severe. Lloyds Solutions, Inc. has done it all before, and we can guide you to a successful, or more successful, worry-free practice.