Notice of Privacy Practices
Effective 01/01/2020, Revised 01/01/2020
Acknowledgement of Receipt of this Notice
Who Will Follow this Notice
Our Responsibility Regarding Protected Health Information
Your ‘protected health information’ is individually identifiable health information. This includes demographics such as age, address, email address, and relates to your past, present, or future physical or mental health or condition and related health care services. We are required by law to do the following:
Make sure that your protected health information is kept private.
Give you this notice of our legal duties and privacy practices related to the use and disclosures of your protected health information.
Follow the terms of the notice currently in effect.
Communicate any changes in the notice to you.
We reserve the right to change this notice. Its effective date is at the top of the first page and at the bottom of the last page. We reserve the right to make the revised or changed notice effective for health information we already have about your child as well as any information we receive in the future. You may obtain a Notice of Privacy Practices by calling the phone number at the top of this notice.
Our System
Radiant Kids Therapy works with several agencies and referral sources. Your health information will be shared in the following manner:
Treatment
We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes disclosure to your physician or other health care providers who becomes involved in your care.
Within our office for administrative activities, quality assessment, oversight and peer review.
With our billing personnel and as necessary to obtain payment for your health care services.
With your insurance company or other payers as required for payment.
With the referring agency and case manager.
With any other provider, school and/or agency with your written request. You may request written or verbal information sharing in writing. Your request should include a specified period of time for information sharing.
Required by Law
Health Oversight
Legal Proceedings
Parental Access
For Health Care Operations
Contacting You
Individuals Involved in Your Care
Research
Uses and Disclosures of Protected Health Information Requiring Your Permission
Your Rights Regarding Your Health Information
You may exercise the following rights by submitting a written request to the Radiant Kids Therapy office.
You may inspect and obtain a copy of your protected health information that we keep as a part of medical and billing
records.
You may ask us not to use or disclose any part of your health information for treatment, payment, or health care operations.
Your request must be made in writing. This request will be honored if we mutually agree that the restriction will not harm your child.
You may request that we communicate with you using alternative means or at an alternative location. We will not ask you the reason for your request.
We will accommodate reasonable requests, when possible.
If you believe that the information we have about your child is incorrect or incomplete, you may request an amendment to your protected health information as long as we are responsible for and maintain this information.
Federal Privacy Laws
Changes to the Notice of Privacy Practices
Questions and Complaints
PAYMENT FOR SERVICES AGREEMENT
Services to be Provided
Radiant Kids Therapy will provide therapy services for your child (patient) in accordance with the orders provided by the patients physician. It is understood that licensed therapists employed by Radiant Kids Therapy will complete the services provided. The responsibly party gives permission for the patient to receive therapy services provided by Radiant Kids Therapy.
Insurance Benefits
Radiant Kids Therapy will verify the patients benefits, file the claims for services provided with contracted insurance carriers, and notify the responsible party of their financial responsibility. The responsible party understands that the verification of benefits and authorization is not a guarantee of payment and that they are responsible for all charges not paid by the insurance company.
Assignment of Insurance Benefits
The responsible party authorizes any insurance carrier that provides insurance coverage for the patient, to make direct payments to Radiant Kids Therapy for all services rendered. The responsible party will accurately inform Radiant Kids Therapy of the patients insurance coverage and provide information regarding coverage changes within 5 working days of the change.
Release of Information for Reimbursement
The responsible party authorizes the release of information pertaining to the patients diagnosis and course of treatment to Radiant Kids Therapy by the patients physician and any other therapy service providers involved in the patients care. The responsibly party also authorizes the release of information to the patients physician and any other agencies related to reimbursement issues.