UTMB HANDBOOK OF OPERATING PROCEDURES

Section 9 Clinical Policies Subject 9.2 Patient Records Policy 9.2.17 Release of Information to External Review Organizations (On Site and Telephone)

02/15/95 - Originated 09/01/04 - Reviewed w/ changes - Reviewed w/o changes Patient Financial Services - Author

Release of Information to External Organizations for Continued Stay Review (OnSite and Telephone)

Audience

The information in this document is for use by all UTMB personnel, especially Nursing Service, Utilization Review (UR) and Care Management.

Policy

Requests for patient information from an insurance company, external review agency, third party administrator (including WCI agents, adjustors, care managers, external UR Nurses) will be coordinated through Utilization Review, Care Management and the appropriate UTMB employee; and limited to that specific patient(s) per request.

Guidelines

UTMB employees are required to review the identification of all external review organizations, insurance carriers, rehabilitation programs and other proprietary agencies who present to campus. All nursing unit personnel are responsible for screening visitors who appear in a patient care area. Each patient or legal representative must sign the Agreements, Authorizations and Irrevocable Assignments form (#2001) prior to or during admission. The signed authorization form is sent to the inpatient nursing unit for inclusion in the patient’s medical record. For on site review, the reviewer is to schedule an appointment with Utilization Review or Care Management. When the reviewer arrives on campus, they are to check in with the information desk located in John Sealy Towers. The Information Desk staff will notify the Utilization Review or Care Management. The UR nurse or Care Manager will escort the reviewer to the appropriate unit. The reviewer will be introduced to the Charge Nurse and be given the patient’s chart. The reviewer is to stay on the unit to review the chart. The UR nurse or Care Manager does not need to stay with the reviewer. Authorization forms obtained in the Emergency Department or ambulatory clinics for outpatient care are directed to Health

Guidelines (cont’d)

Information Management (HIM). All requests for continued stay information during an inpatient stay are directed to and coordinated by the Admitting Department. Approvals for discharge-related items, including on-site evaluations for nursing home placement and rehabilitation placements must be coordinated with the Department of Care Management and any appropriate UTMB employee. All requests for information post discharge are directed to and managed by HIM.

TDCJ Inquiries	Inquiries related to offenders under the care and custody of the Texas Department of Criminal Justice Hospital are processed by HIM.
Reference	Texas Occupations Code, Chapter 159