HIPAA Regulations & Practice Policy

Continental Psychiatric Services, P.C.

HIPAA Regulations & Practice Policy

INFORMATION ABOUT YOUR PROVIDER.

Your provider will share upon request his/ her professional background, education, training and credentials’ information. Please note that the providers’ information can also be found on our website at www.continentalpsychiatry.com.

BENEFITS AND RISKS.

Psychotherapy and psychiatric sessions provide an opportunity to understand yourself better by identifying any problems or difficulties you may be experiencing in regards to your overall emotional state and mental health. This type of treatment is a joint effort between you, the patient and your treating provider. The benefits that you may acquire during our treatment will also require substantial effort on your part, including active participation in your therapeutic process, honesty and willingness to change thoughts and behaviors. However, there is no guarantee that the therapy and the psychiatric sessions will result in some or all the benefits you expect to receive. Also, due to the varying nature, severity of problems and the individuality of each case, the provider is unable to predict the duration of treatment or to guarantee a specific outcome of the treatment.

TERMINATION OF TREATMENT.

The ending of your therapeutic and/ or psychiatric treatment is an important process and should be discussed with your provider. If your provider has not heard from you in 90 days since your last appointment, without being it discussed or planned during your last session with your provider, your records will indicate that you have been discharged. However, at any time you can call our office to reopen your case and schedule an appointment, upon your provider’s approval to continue treatment. Your provider might also discharge you from the practice at any moment, if he/ she feel that the treatment you are receiving is not the appropriate level of care for you.

PROFESSIONAL CONSULTATION AND COORDINATION OF CARE.

Your provider may choose to participate in clinical, ethical and legal consultation with appropriate professional contractors. During such consultations, no personal identifying information will be revealed. Also, to provide high quality care services, your provider might often need to coordinate your care with other medical professional staff, like your primary care physician, neurologist, cardiologist, etc. However, no medical information will be exchanged without your expressed written and signed consent.

MEDICAL RECORDS AND RECORD KEEPING.

Your medical records are sole property of Continental Psychiatric Services, P.C. When you request a copy of your medical records, the request must be made in writing and notarized. We reserve the right, according to New York State law, to provide you with a treatment summary in lieu of your actual medical records. The release of medical records directly to the patient can also be denied under specific circumstances. For more details regarding the release of the medical records, please refer to our “Practice Policy for Release of Medical Records to the Patient”. A copy of the policy may be available upon request. Your medical records are being kept for a total of 7 years, after which they will destroyed in a manner that preserves your confidentiality. Some medical records might be paperless/ electronic. The electronic medical records are also confidentiality protected and will also be destroyed in a manner that preserves your confidentiality.

CONFIDENTIALITY.

Your information is confidential and will not be released to a third party without your written and signed consent, except where it is required or permitted by law. These exceptions include, but are not limited to situations where you pose a threat of serious harm for yourself or others, to cases that involve child abuse, elder or dependant adult abuse, to cases in which the provider is court-ordered to testify or to produce medical records. For more details please refer to our “Notice of Private Practices”.

DELINQUENT ACCOUNTS.

Your account will become delinquent if the outstanding balance is not paid in full within 3 months from the date of the session that is not covered/ not paid. Should your account become delinquent, you agree to pay interest at 1.5% per month. If your account will be sent to the collection agency, you agree to pay the actual balance due plus any collection expenses.

PROVIDER AVAILABILITY.

You can leave a non-urgent message by calling anytime Nassau Psychiatric Services, P.C. at 516-280-9030. Please include in your message your name, the best phone number to call you back and a brief message concerning the nature of your call. Non-urgent calls are usually returned within 48 hours during normal workdays. Our office is open MONDAY to FRIDAY from 9.00 am until 8.00 pm, and every other SATURDAY from 9.30 am until 4.30 pm.

EMERGENCIES.

Please note that our providers do not handle emergencies in this private setting. Your provider is unable to personally provide a 24 hour crisis services. If you a have a medical emergency or an emergency involving your safety or the safety of others, please call 911 or proceed to the nearest emergency room.

YOUR PROVIDER’S ABSENCES.

Taking time off is a part of self-care. Your provider will periodically take time off for vacation and/or holiday, time off due to illness or a family emergency. If your scheduled appointment time will get affected by this, Continental Psychiatric Services, P.C. will contact you timely to notify you about the change and to reschedule the appointment for the next available time of your provider or to reschedule with our covering physicians.

PSYCHIATRIC SERVICES.

Your initial visit at Continental Psychiatric Services, P.C. will be an initial evaluation only, which will not guarantee the continuation of care by your provider. We can’t guarantee either that the same medications that you were prescribed by previous providers will be prescribed to you at Continental Psychiatric Services, P.C. During your initial session, your provider will discuss your diagnosis, prognosis, the recommended treatment, the risks and the benefits associated with the recommended treatment, alternative treatments, the risks and benefits of alternative treatments and the risks of forgoing treatment should you refuse treatment. Please note that Continental Psychiatric Services, P.C. reserves the right to discharge you from the practice at any moment, if we feel that we cannot provide the appropriate care for you and you need a higher level of care. Should that situation arise, your provider will help you transfer your case to an adequate medical setting according to your situation.

REFILLS POLICY.

Prescriptions for non-controlled substance medications are sent electronically at the time of your appointment with sufficient quantities and refills, if necessary, to last you until your next appointment. If by any chance you run out of medication before your next appointment, please call our office at least 2-3 days in advance. It might take up to 48 hours for any refills request to get processed. We WILL NOT refill your medications if you have not seen your provider for more than 90 days/ 3 months. You must schedule an appointment at least once every 3 months in order to continue receiving prescriptions for your psychiatric medications. Controlled substances prescriptions will only be prescribed for a 30-day supply. We DO NOT send 90-day/ 3-month supplies for Controlled Substances Medications to either local or mail-order pharmacies. We DO NOT send a 30-day refill without having an office visit with your prescribing provider. If you can’t keep your scheduled appointment, a 5-day emergency refill only will be send for controlled substances and you need to follow-up with your prescribing physician within the 5 days for an evaluation.

Payment Policy

We are committed to providing you with quality and affordable health care. Please read our payment policy, ask us any questions you may have, and sign in the space provided. A copy will be provided to you upon request.

Insurance. We participate in most insurance plans, including Medicare. If you are not insured by a plan we do business with, payment in full is expected at each visit. If you are insured by a plan we do business with but don’t have an up-to-date insurance policy, payment in full for each visit is required until we can verify your coverage. Knowing your insurance benefits is your responsibility. Please contact your insurance company with any questions you may have regarding your coverage.

Co-payments and deductibles. All co-payments and deductibles must be paid at the time of service. This arrangement is part of your contract with your insurance company. Failure on our part to collect co-payments and deductibles from patients can be considered insurance fraud. Please help us in upholding the law by paying your co-payments and deductibles at each visit.

Non-covered services. Please be aware that some – and perhaps all – of the services you receive may not be covered or not considered reasonable or necessary by Medicare or other insurers. You must pay for these services in full at the time of visit.

Proof of insurance. All patients must complete our patient information form before seeing the doctor. We must obtain a copy of your valid identification card or driver’s license and a current valid insurance card to provide proof of insurance. If you fail to provide us with the correct insurance information in a timely manner, you may be responsible for the balance of a claim.

Claims submission. We will submit your claims and assist you in any way we reasonably can to help get your claims paid. Your insurance company may need you to supply certain information directly. It is your responsibility to comply with their request. Please be aware that the balance of your claim is your responsibility whether or not your insurance company pays your claim. Your insurance benefit is a contract between you and your insurance company; we are not party to that contract.

Coverage changes. If your insurance changes, please notify us before your next visit so we can make the appropriate changes to help you receive your maximum benefits. If your insurance company does not pay your claim in 45 days, the balance will automatically be billed to you.

Nonpayment. If your account is over 90 days past due, you will receive a letter stating that you have 20 days to pay your account in full. Partial payments will not be accepted. Please be aware that if a balance remains unpaid, we may refer your account to a collection agency and you and/or your immediate family members may be discharged from this practice. If this is to occur, you will be notified by regular and certified mail that you have 30 days to find alternative medical care. During that 30-day period, our physician will only be able to treat you on an emergency basis.

Please note that for all checks returned by a bank for any reason, you will be charged an additional $35.00 fee, fee that cannot be waived or cannot be submitted to your insurance company for possible reimbursement.

Missed appointments. Please be advised that we are reserving your scheduled time especially for you. We really value your time and we aim to develop a positive therapeutic relationship. Our policy states that 24 hour notice is required for cancellation. If you do not show or cancel your appointment without 24 hour notice, there will be a fee of $50.00. These charges will be your responsibility and billed directly to you. Please help us to serve you better by keeping your regularly scheduled appointments. Your insurance company does not cover missed appointment fees. If you accumulate a total of three (3) consecutive missed appointments, you may not be able to reschedule future appointments with our group practice and you will be referred elsewhere for treatment.

Fees. Our practice is committed to providing the best treatment to our patients. Our prices are representative of the usual and customary charges for our area. If the provider is “Out-of-Network” with your insurance carrier, you will be fully responsible for the session fee. Payments are due upfront, as follows: CHILDREN (18 and under) and ADULTS M.D.: $350.00 initial appointment/ $250.00 follow-up appointments Therapist: $185 initial appointment/ $150.00 follow-up appointments The insurance company may reimburse you for part of our fees, so be sure to clarify any questions you might have with your insurance company prior to your appointment. We can provide you with a “Super Bill” (a receipt) that includes the information needed for your insurance company. There will be an hourly fee of $425.00 for filling out any legal/medical documents/forms. Since this duty is not related to providing medical care under your health insurance benefits, your health insurance company does not reimburse the doctor/therapist for the time spent filling out forms. Please note that we might require for the patient to schedule an appointment to go over the forms with the doctor, in order to cover any questions that the doctor might have in order to fill out the forms accurately.

Notice of Privacy Practices

The Health Information Portability and Accountability Act (HIPAA) establish rules on how your health information may be used and shared, and how it must be protected. We are obligated to follow the New York State Law when it is more protective of your privacy than the Federal Law. We understand that medical information about you is personal. We are committed to protecting your medical information. We create a record of the services rendered to you, to provide a high quality care and to comply with legal requirements. This notice applies to all your medical records that we maintain. We are required by law to: Keep your medical information private. Give you this notice of our legal duties and privacy practices with respect to your medical information. Follow the terms of the notice that is currently in effect. This notice of Privacy Practices describes: How and to what extent the privacy of your Protected Health Information is guaranteed. How your Protected Health Information may be used and shared. How you may access portions of your Protected Health Information and the procedure for doing so. Your Protected Health Information (PHI) includes any individual identifiable information created or received about you. Specifically it includes: Identification of symptoms, diagnosis, medicine, and your prognosis; Appointment times and dates with session summaries; Payment for services provided and payment received. Any notes taken during sessions are classified in a separate category with their confidentiality protected so that you must give written permission to release them. Use and Disclosure of your Protected Health Information (PHI) Without your specific, written and signed consent: We will not share with your insurance company or Employee Assistance Program the PHI required to obtain approval for treatment and billing for services rendered. We will not share your PHI with another therapist or treatment facility. We will not share your PHI with another individual, including family members, except if the client is a minor. We are required to report child or elder abuse and/or neglect to the proper authorities. This report may include your PHI, if necessary. We are required to take action, including the release of your PHI, if we believe that you or someone else is in risk of harm to themselves or others. We may share your PHI with individuals or companies who participate in the management of our practice; each of these people has agreed to follow the terms of our Notice of Privacy Practices. We may release your PHI in case of a medical emergency to medical staff. We may release your PHI without your specific written consent for these additional reasons: Public Health, Patient Directories, and Healthcare Oversight, when required by Law, Health/Safety Activities, Law Enforcement, Workers ’ Compensation, National Security, Judicial Proceedings, Coroner/Funeral Activities, Military Activities, Correctional Facilities, and Research. You have the right: To decide with the exception of those listed above, if your PHI is given out to a third party and to specify what information is given. You do this by completing and signing the Consent Release Information. You may revoke this consent at any time. To review and get copies or your PHI, your request must be in writing. There may be charges for copying and postage. Your request may be denied if it is determined that giving you your PHI may endanger your life or physical safety or that of another person. (For more details, please refer to our Practice Policy to Release Medical Records to Patients). To request that corrections or additions be made to your PHI if you believe that there is an error or a significant omission. You or another health professional may add information to your record, but nothing will be removed from your PHI record. Under HIPAA rules, your request does not require a change of anything in your health records. However, if we deny your request, we will provide you with a written explanation.

If we accept your request to change or add information, we will make reasonable efforts to tell others, including people you designate, of the change/addition when sharing your PHI in the future. To request additional limits on the use or disclosure of your PHI. However, as your provider, we are not required to agree to these additional limits if we have substantial reasons for not honoring your request. To obtain a list of the times we have shared your health information for reasons other than treatment, payment, healthcare operations, and other specific exceptions. To file a written complaint if you believe your privacy rights have been violated. Your complaint must be filed in writing, either on paper or electronically, by mail, fax, or email U.S. Department of Education, 32 Old Slip, 26th Floor, New York, NY 10005-2500; name the covered entity involved and describe the acts or omissions you believe violated the requirements of the Privacy Rule; be filed within 180 days of when you knew that the act or omission complained of occurred. OCR may extend the 180-day period if you can show “good cause.” Your decision to file a complaint will not be held against you in any way. However, it may be necessary for us to discuss whether it is appropriate for us to continue in a therapeutic relationship. To receive a copy of this document upon request; all requests must be made in writing to your therapeutic provider.

Our Legal Duty

We are required to agree to the terms of this notice. However, we reserve the right to change our privacy practices and the terms of this notice at any time, provided the changes are permitted by law or to meet any new requirements implemented by law for the benefit of your PHI. Before any important changes are made to the privacy practice, you will receive a revised notice that will be available to you on your first scheduled visit following the revisions. Any changes in these privacy practices and the new terms of this notice will take effect from the date of the revised forwarding of all mental health information we keep on file. I have read and I understand all items contained herein.