Medicare_Carriers_Manual / 10020 / 10020

Why This Topic Matters

It helps readers understand the privacy framework governing how Medicare carrier-held information may be accessed, shared, tracked, and corrected. That makes it important for compliance teams and Medicare administrative staff who work with personal and medical records.

Article Sections

1. The Privacy Act of 1974

   Introduces the privacy framework applicable to carriers and explains the broad categories of individual rights and carrier responsibilities covered in the section.

2. Definition of "Individual"

   Defines the scope of who is treated as an individual under the policy and addresses related access considerations for certain parties and business entities.

3. Informing Individuals of Rights

   Describes how individuals are notified of their rights when information is requested in connection with Medicare claims.

4. Method of Accessing Individual Records—General

   Discusses procedures for requesting, reviewing, and obtaining copies of records, including timing and administrative handling.

5. Methods of Accessing Individual Medical Records

   Covers how medical records may be disclosed through direct or designated professional review channels and when referral may occur.

6. Disclosure of Medical Information Relating to Minors

   Addresses access requests involving minors and the role of designated health professionals in the review process.

7. Disclosure to Third Parties

   Outlines the overall framework for releasing information to others, including disclosures with consent and categories of disclosures without consent.

8. Accounting for Disclosure

   Explains when disclosure accounting is required, what the accounting must support, and how records are maintained.

9. Reviewing and Correcting Records

   Describes the process for reviewing records at an individual's request and handling corrections or appeals.

10. Penalties

    Summarizes potential penalties associated with improper disclosure of protected information.

11. Providers, Physicians, Suppliers and the Privacy Act

    Discusses how privacy obligations apply to provider and supplier records and to release of eligibility-related information in certain situations.