Richards Laboratories, Inc. - HIPAA Contact Person:
Marcy Zabriskie (801)785-2500 extension 128
According to the Standards for Privacy of Individually Identifiable Health Information
Richards Laboratories, Inc. is required by law to maintain the privacy of protected health
information. As a laboratory we are committed to protecting the privacy of individually identifiable
health information generated, utilized, and maintained at all of our laboratory locations.
Richards Laboratories is involved in an ongoing pursuit to comply with any and all government
regulations regarding clinical laboratories.
DEFINITION OF HEALTH INFORMATION
Health information is any information, oral or recorded, in any form or medium that is
created or received by a covered entity. Health information would include anything that
relates to past, present or future physical or mental health or conditions of an individual.
DEFINITION OF INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION
Individually identifiable health information is information that either identifies a person, or
offers a reasonable basis to believe it could be used to identify an individual.
Examples: name, address, birth date, social security number, insurance number, etc.
DEFINITION OF PROTECTED HEALTH INFORMATION (PHI)
45 CFR Part 164.501 defines Protected health information as:
(1) Except as provided in paragraph (2) of this definition, that is:
(i) Transmitted by electronic media;
(ii) Maintained in any medium described in the definition of electronic media...
(iii) Transmitted or maintained in any other form or medium.
(2) Protected health information excludes individually identifiable health information in:
(i) Education records covered by the Family Educational Rights and Privacy Act...
(ii) Records described in 20 U.S.C.1232g(a)(4)(B)(iv); and
(iii) Employment records held by a covered entity in it’s role as employer.
Protected health information (PHI) is individually identifiable health information that is
transmitted by electronic media, maintained in electronic media, or transmitted or maintained
in any other form or media.
Examples: report forms, log sheets, reimbursement forms, etc.
HIPAA - Clinical Laboratory Compliance Plan
As outlined in the Federal Register / Vol. 63, No. 163 the Office of the Inspector General (OIG)
of the Department of Health and Human Services (HHS) and other Federal agencies charged with
responsibility for enforcement of Federal law have emphasized the importance of voluntarily
developing and implementing a Clinical Laboratory Compliance Plan.
In response to this request, Richards Laboratories has developed and implemented a Compliance
Plan relating to the billing of Medicare / Medicaid and private insurance companies based on
claims submitted by the physician offices to which we provide microbiological services.
As a clinical laboratory, we embrace the opportunity to participate in a nationwide effort to
reduce fraud and abuse in national health care programs. With that resolve in mind, we have
endeavored to create a compliance plan fulfilling all federal guidelines. This plan specifically
establishes guidelines and protocol followed by Richards Laboratories in regard to billing
procedures, documentation of records, record-keeping, and other procedures based on
reimbursement rules and federal anti-fraud laws.
HIPAA - Reimbursement Claims
We are relying on the following when we submit reimbursement requests to Medicare / Medicaid
and private insurance companies for tests that our laboratory has performed for your patients:
∙ Accuracy of information for patient tests to be submitted for reimbursement from
Medicare / Medicaid and private insurance companies on the Richards
Laboratories Medicare / Medicaid / Insurance Billing Form (Please See the
∙ That the physician or other authorized individual has determined that the tests
requested and performed are covered, reasonable, and necessary for the
beneficiary, given his or her clinical condition. Tests submitted for Medicare
reimbursement must meet federal guidelines of necessity.
HIPAA - Note Regarding Routine Testing
As a matter of federal compliance it is our obligation, as a laboratory providing service to your
office, to inform you that Medicare generally does not cover routine screening tests.