Medical Record Chapter: Meeting the CMS Hospital CoPs, Access, and OCR Security Requirements

Laura A. Dixon
From: Sep 05, 2025 - To: Dec 31, 2025
Recorded Webinar
  

Description

This program will cover in detail the CMS regulations and interpretive guidelines for medical records for Acute and Critical Access hospitals. There will also be a brief discussion of the Interoperability and Patient Access Rules. The law affects healthcare providers and effectively grants patients immediate access to health information in their electronic medical record – without charge. Certain records are excluded, and the rule establishes exceptions to “information blocking.’ This rule and the implications for healthcare providers will be discussed.

This program will revisit information on HIPAA from the Office of Civil Rights, including the difference between patient access versus when an authorization is needed. Other topics to be discussed include the security of health information and the OCR Security Risk Assessment.

Learning Objectives:-

  • Recall that CMS has specific informed consent requirements.
  • Describe when a history and physical must be done and what is required by CMS.
  • Explain CMS standards on verbal orders, preprinted orders, standing orders, and protocols.
  • Describe when and the circumstances under which healthcare providers can “block” patients'/others' access to health information.
  • Recall the requirement to conduct a HIPAA Security Risk Assessment.

Agenda:-

  • Introduction
  • Deficiencies regarding medical records
  • Patient rights to access medical records
  • Recent fines against hospitals
  • OCR rights of patients and access to records
  • HIPAA Access vs. Authorization
  • Interoperability and Patient Access Rule
  • Requirements for “Information blocking”
  • Conditions of Participation
    • MR services
    • Staffing
    • Retention of medical records
    • Security and risk assessments
    • Confidentiality and release of records
    • Content of record
    • Order sets
    • Rubber stamps
    • Verbal orders
    • Standing orders
    • History and physicals
    • Informed consent
    • Discharge summary
    • Electronic notifications
  • Critical Access Hospitals – clinical records CoPs
  • Breach notification
  • OCR – Risk Assessment
  • Copy/Paste – OIG and CMS positions
  • Texting of orders – CMS update

Appendix and Resources.

Training Options

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Recording
   $199  

Transcript (Pdf)
   $199  

DVD
   $209  

Recording & DVD
   $369  

Recording & Transcript (Pdf)
   $359  

DVD & Transcript (Pdf)
   $369  



* Or more than 6 attendee call us at +1 (855) 437-0705 or mail us at cs@ineducator.com

* For Cheque and ACH payment call us at +1 (855) 437-0705 or mail us at cs@ineducator.com

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