Notice of Privacy Practices for the Original Medicare Plan

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY
BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS
INFORMATION. PLEASE REVIEW IT CAREFULLY.

By law, Medicare is required to protect the privacy of your personal medical
information. Medicare is also required to give you this notice to tell you how
Medicare may use and give out (“disclose”) your personal medical
information held by Medicare.

Medicare must use and give out your personal medical information to
provide information:

To you or someone who has the legal right to act for you (your personal
representative),
To the Secretary of the Department of Health and Human Services, if
necessary, to make sure your privacy is protected, and
Where required by law.

Medicare has the right to use and give out your personal medical information
to pay for your health care and to operate the Medicare program. For
example:

Medicare Carriers use your personal medical information to pay or deny your
claims, to collect your premiums, to share your benefit payment with your
other insurer(s), or to prepare your Medicare Summary Notice.
Medicare may use your personal medical information to make sure you and
other Medicare beneficiaries get quality health care, to provide customer
services to you, to resolve any complaints you have, or to contact you about
research studies.

Medicare may use or give out your personal medical information for the
following purposes under limited circumstances:

To State and other Federal agencies that have the legal right to receive
Medicare data (such as to make sure Medicare is making proper payments
and to assist Federal/State Medicaid programs),
For public health activities (such as reporting disease outbreaks),
For government health care oversight activities (such as fraud and abuse
investigations),
For judicial and administrative proceedings (such as in response to a court
order),
For law enforcement purposes (such as providing limited information to
locate a missing person),
For research studies that meet all privacy law requirements (such as
research related to the prevention of disease or disability),
To avoid a serious and imminent threat to health or safety,
To contact you about new or changed benefits under Medicare, and
To create a collection of information that can no longer be traced back to you.

By law, Medicare must have your written permission (an “authorization”) to
use or give out your personal medical information for any purpose that isn’t
set out in this notice. You may take back (“revoke”) your written permission at
any time, except if Medicare has already acted based on your permission.

By law, you have the right to:

See and get a copy of your personal medical information held by Medicare.
Have your personal medical information amended if you believe that it is
wrong or if information is missing, and Medicare agrees. If Medicare
disagrees, you may have a statement of your disagreement added to your
personal medical information.
Get a listing of those getting your personal medical information from
Medicare. The listing won’t cover your personal medical information that was
given to you or your personal representative, that was given out to pay for
your health care or for Medicare operations, or that was given out for law
enforcement purposes.
Ask Medicare to communicate with you in a different manner or at a different
place (for example, by sending materials to a P.O. Box instead of your home
address).
Ask Medicare to limit how your personal medical information is used and
given out to pay your claims and run the Medicare program. Please note that
Medicare may not be able to agree to your request.
Get a separate paper copy of this notice.

Look at our Medicare Privacy Practices (HIPAA) FAQs for more information
on:
Exercising your rights set out in this notice.
Filing a complaint, if you believe the Original Medicare Plan has violated
these privacy rights. Filing a complaint won’t affect your benefits under
Medicare.
You can also call 1-800-MEDICARE (1-800-633-4227) to get this
information. Ask to speak to a Customer Service Representative about
Medicare’s privacy notice. TTY users should call 1-877-486-2048.

You may file a complaint with the Secretary of the Department of Health and
Human Services. Visit www.hhs.gov/ocr/hipaa or contact the Office for Civil
Rights at 1-866-627-7748. TTY users should call 1-800-537-7697.

By law, Medicare is required to follow the terms in this privacy notice.
Medicare has the right to change the way your personal medical information
is used and given out. If Medicare makes any changes to the way your
personal medical information is used and given out, you will get a new
notice by mail within 60 days of the change.

The Notice of Privacy Practices for the Original Medicare Plan became
effective April 14, 2003.

How to Get Personal Information Over the Phone

For more information,please visit our Medicare Privacy Practices (HIPAA)
FAQs.


Page Last Updated: January 23, 2007



Copyright Forever Home Health, Inc.  All rights reserved.
Notice of Privacy Practices for the Original Medicare Plan
Home Health Patient Rights:
  • right to choose your
    home health agency
  • right to have your
    property treated with
    respect
  • the right to have your
    family or guardian to
    act for you if you are
    unable
  • the right to complain
    to the agency or the
    State Survey Agency
    about your treatment
    or care if it not
    provided, or staff
    shows disrespect for
    you or your property
  • the right to be given a
    copy of your plan of
    care, so you can ask
    questions about the
    type of services and
    staff the home health
    agency plans to
    provide to you and
    how often you can
    expect those services