( 4) An awareness of the issues surrounding reimbursement and insurance fraud.
2. The Member should consult with the ethics committee as soon as reasonably practicable. The Chief of Staff and CMO / VPMA will oversee this process.
3. The Chief of Staff and CMO / VPMA may review the case at the conclusion of the treatment episode to assure that appropriate technical and professional standards have been met.
RULE 4-1
Occurrence Reports
An occurrence report regarding a Member, APP, or other practitioner, including a resident, will be forwarded from the quality department to the peer review coordinator to initiate the Peer Review Process. Resident concerns will be forwarded to the appropriate Program Director or their designee. The resident care concerns may also be reviewed by peer review in regards to the sufficiency of oversight provided by the responsible Member.
RULE 4-2 A.
B.
C.
Confidentiality of Medical Staff Records
Applicability. As provided in the Medical Staff Bylaws, all records maintained by or on behalf of the Medical Staff, including the records and minutes of all meetings of Medical Staff committees, Departments, Sections and the credentials and peer review files for Members, APPs, and other practitioners, shall remain confidential and privileged to the extent allowed by law.
Location of Records. All Medical Staff records shall be maintained by Medical Staff Services. Additional quality improvement records are secured in Quality Services, Utilization Management, Trauma Services and Emergency Services. These records will be kept in locked file cabinets or in a secure electronic format under the direction of the Department head of these areas.
Access to Records. All requests under this section for Medical Staff records shall be made to the Medical Staff Services Director, who shall allow access to the records as provided in this Rule. Unless otherwise stated, a person permitted access under this Rule shall be given a reasonable opportunity to inspect the records and make notes, but may not remove or make copies of records. Those individuals may only review information they provided, filled out on our behalf or they were a part of the committee / department at the time of the information they wish to review.
1. Access for Official Hospital or Medical Staff Functions. Medical Staff officers, Department and Section Chiefs, Members of the Board of Governors, the Medical Staff Services staff, the CEO, and the CMO / VPMA shall have access to Medical Staff records to the extent necessary to perform official functions as follows:
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