- Section 1 Introduction
- Introduction
- Federal Government Administration
- Fundamentals of Medicare: State Responsibilities
- Fundamentals of Medicare: Participating Providers
- Voluntary and Involuntary Termination of Provider Agreement
- Disclosure of Health Insurance Information
- Privacy Act
- National Provider Identifier
- Legacy Provider Numbers/Provider Transaction Access Numbers (PTANs)
- Medicare Administrative Contractors
- Fundamentals of Medicare: Information References
- Acronyms
- Fundamentals of Medicare: Glossary of Terms
- Section 2 Medicare Basics
- The History of Medicare
- What Is the Medicare Program and How Is It Funded?
- Medicare Eligibility and Premiums
- The Social Security Administration and Medicare Enrollment
- The Medicare Card
- Medicare Part A
- Inpatient Hospital Care
- Skilled Nursing Facility Inpatient Care
- Home Health Care Benefit
- The Hospice Benefit
- Medicare Part B Medical Insurance
- Fundamentals of Medicare - Medicare Program Exclusions
- Medicare Advantage Organizations
- Medicare Secondary Payer
- Supplemental Insurance
- Coordination of Benefits Trading Partners
- Section 3 Fraud and Abuse
- Section 4 Getting Ready to Bill Medicare
Section 1: Introduction
Disclosure of Health Insurance Information
Providers have restrictions on the information that they may disclose. The CMS IOM, Publication 100, Medicare General Information, Eligibility and Entitlement Manual, Chapter 6, Sections 10.1 through 10.4, provides detailed information concerning the disclosure of health insurance information. SSA rules and regulations should be followed when the need arises to disclose information.
For a listing of these rules and regulations, contact the SSA or visit the Official Social Security website.
Information furnished specifically for purposes of a claim under the health insurance program is subject to these rules and regulations. Such information includes the individual’s MBI number, facts regarding his/her entitlement to health insurance benefits, and medical and other information obtained from SSA or an intermediary.
Although the patient receives benefits under the health insurance program, the following information contained in the hospital record is not subject to these rules and regulations (e.g., name, date of birth, sex, marital status, address, and medical records).
The hospital’s own records, however, are subject to the requirements in the “Conditions of Participation” that patients’ medical records be kept confidential (20 CFR Part 405.1026). These records may also be subject to state or local laws governing disclosure.
When a hospital receives a request for information about a Medicare beneficiary, a Medicare claim, or related information that it may not disclose, the inquirer should be referred to the appropriate intermediary for further consideration of the request.
Revised 1/2021