Chapter 5 Reality Check Billing and Reimbursement

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James is very excited to work at his first health information management job at a large hospital in the suburbs. His job is an assistant release of information clerk (ROI). He works with patient release of information, provider release of information, and Federal Laws that impact healthcare and health records.

When James got to work it was like any other day, he was excited to learn all about his new position and actually be working in the field of his dreams! His team lead, Teresa, went on her lunch break at a time that is normally not that busy for the release of information office. At first, it was quiet. James read and re-read his notes and policies and procedures ready to answer any questions in her absence.

He heard a person shuffle up to the front counter. He was an older gentleman, quite well dressed and very tall. He said he was there to pick up his wife’s medical records. James went through the formalities and was able to find her records. But, for some reason, he had a funny feeling that he should not give him the records.

The release had been signed, and the patient did authorize her husband to pick up her records for her. Prior to James handing the gentleman the records, he asked for his ID to verify he was indeed the patient’s husband. The man said he left his wallet in his car, and he was late for an appointment. He made a big deal about it, and muttered it was ridiculous everything was signed and in order, he had every right to get her records. Without further thought, the man grabbed the manila envelope out of James’ hand and quickly left. James was quite distraught over this incident.

When Teresa returned from lunch she saw he was upset. After he told her what happened, her face dropped. “You are never supposed to give out patient records without a valid authorization AND photo ID.”

What would you do in his situation?

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