5.3 Psychiatric Rating Scales
217
protecting the transmission and confidentiality of patient infor-
mation, and all units under HIPAA must comply with such rules.
Two rules were finalized in February 2003: the Transaction
Rule and the Privacy Rule (see Tables 5.2-4 and 5.2-5). The
Transaction Rule facilitates transferring health information
effectively and efficiently by means of regulations created by the
HHS that established a uniform set of formats, code sets, and
data requirements. The Privacy Rule, administered by the Office
of Civil Rights (OCR) at HHS, protects the confidentiality of
patient information. This means that a patient’s medical infor-
mation belongs to the patient and that the patient has the right
to access it, with the exception of psychotherapy notes, which
are deemed as property of the psychotherapist who wrote them.
In 2003, the Privacy Rule was executed. Under the Privacy Rule,
there are certain guidelines by which every practice must abide:
1. Every practicemust establishwritten privacy procedures.These
include administrative, physical, and technical safeguards that
establish who has access to the patient’s information, how this
information is used within the facility, and when the informa-
tion will and will not be disclosed to others.
2. Every practice must take steps to make sure that its business
associates protect the privacy of medical records and other
health information.
3. Every practice must train employees to comply with the rule.
4. Every practice must have a designated person to serve as a
privacy officer. If it is an individual practice or private prac-
tice, this person can be the physician.
5. Every practice must establish complaint procedures for
patients who wish to ask or to complain about the privacy of
their records.
Table 5.2-4
Transaction Rule Code Sets
Health care information: The Transactions Rule defines standards
and establishes code sets and forms to be used for electronic
transaction that involve the following health care information:
Claims or equivalent encounter information
Eligibility inquiries
Referral certification and authorization
Claims status inquiries
Enrollment and disenrollment information
Payment and remittance advice
Health plan premium payments
Coordination of benefits
Code sets: Under the Transaction Rule, the following code sets
are required for filing claims with Medicare:
Procedure codes
American Medical Association Current Procedural
Terminology codes
Healthcare Common Procedure Coding System codes
Diagnosis codes
International Classification of Disease,
10th edition, clinical
modification, codes
Drugs and biologicals
National Drug Codes
Dental codes
Code on dental procedures
Nomenclature for dental services
Adapted from Jaffe E. HIPAA basics for psychiatrists.
Psych Pract Manage
Care.
2002;8:15.
Table 5.2-5
Patient’s Rights under the Privacy Rule
Physician must give the patient a written notice of his or her
privacy rights, the privacy policies of the practice, and how
patient information is used, kept, and disclosed. A written
acknowledgment should be taken from the patient verifying
that he or she seen such notice.
Patients should be able to obtain copies of their medical records
and to request revisions to those records within a stated
amount of time (usually 30 days). Patients do not have the
right to see psychotherapy notes.
Physicians must provide the patient with a history of most
disclosures of his or her medical history on request. There are
some exceptions. The APA Committee on Confidentiality has
developed a model document for this requirement.
Physicians must obtain authorization from the patient for
disclosure of information other than for treatment, payment,
and health care operations (these three are considered to
be routine uses, for which consent is not required). The
APA Committee on Confidentiality has developed a model
document for this requirement.
Patients may request another means of communication of their
protected information (i.e., request that the physician contact
them at a specific phone number or address).
Physicians cannot generally limit treatment to obtaining patient
authorization for disclosure of the patient’s information for
nonroutine uses.
Patients have the right to complain about Privacy Rule violations
to the physician, their health plan, or to the secretary of HHS.
APA, American Psychiatric Association; HHS, Department of Health and
Human Services.
(Adapted from Jaffe E. HIPAA basics for psychiatrists.
Psych Pract Manage
Care.
2002;8:15.)
The OCR at HHS is responsible for making sure that Privacy
Rule is enforced; however, it is not clear as to how it will be done.
One method expressed by the government is a complaint-driven
system in which the OCR will respond to complaints made by
patients concerning confidentiality violations or denied access
to records, all of which are covered under HIPAA. In such cases,
OCR may follow up and audit compliance.
The APA’s Committee on Confidentiality, along with legal
experts, has developed a set of sample forms. They are part of the
APA’s HIPAA educational packet, which can be obtained on the
APA web site
/). On the web site, there are also
recommendations for enabling physicians to comply with HIPAA.
R
eferences
Dougall N, Lambert P, Maxwell M, Dawson A, Sinnott R, McCafferty S, Springbett
A. Deaths by suicide and their relationship with general and psychiatric hospital
discharge: 30-year record linkage study.
Br J Psychiatry
. 2014;204(4).
Simon RI. Clinical Psychiatry and the Law. American Psychiatric Pub; 2003.
▲▲
5.3 Psychiatric Rating
Scales
The term
psychiatric rating scales
encompasses a variety of
questionnaires, interviews, checklists, outcome assessments,
and other instruments that are available to inform psychiatric
practice, research, and administration. Psychiatrists must keep
up with major developments in rating scales for several reasons.
Most critically, many such scales are useful in psychiatric practice
