Medical Records and the Law

CHAPTER 2Medical Records andManaged CareChapter Objectives• Define utilization management and utilization review organization.• Explain the role of patient information with respect to the utilizationmanagement process.• Compare and contrast the following: HMO, PPO, IPA, GPWW,consolidated medical group, PHO, MSO, foundation model IDS,physician ownership model IDS, PBM, and disease managementorganization.• Identify the characteristics of the managed care industry thathave changed the nature of patient records.• Describe the changes in medical records standards made in responseto the growth of managed care—whether instituted bylegislatures, accreditation organizations, or health informationmanagers.• Describe the information protected by the HIPAA Privacy Ruleand explain how privacy rules affect health plans.IntroductionAlthough the medical record originally developed as a business recordof individual healthcare providers (primarily hospitals and physicians),it is now a document that supplies health information critical to continuityof care, is subjected to substantial state and federal regulation, andis “owned” as much, if not more, by the patient as by the provider.19