Certified Electronic Health Records Specialist (CEHRS) Practice Exam

Under what conditions can protected health information be released without patient consent?

1. If the information is outdated

2. For Treatment, Payment, and Operations

3. If it is beneficial to the patient's health

4. If requested by a family member

The correct answer is: For Treatment, Payment, and Operations

Protected health information (PHI) can be released without patient consent under certain circumstances that are essential for the continuity of care and operations of healthcare entities. The correct response relates to the provisions that allow PHI to be disclosed for Treatment, Payment, and Operations (TPO). This category includes necessary communications within the healthcare system: for treatment, healthcare providers can share information if it helps ensure the patient receives appropriate and effective care. When it comes to payment, PHI may be disclosed to health insurance companies for billing purposes, enabling healthcare providers to submit claims and receive reimbursement. Operations refer to various administrative and quality-related activities which also require access to health information, such as conducting audits, managing healthcare benefits, and improving patient care processes. The other options do not align with HIPAA regulations for releasing PHI without consent. Outdated information does not justify its release, nor does general benefit to a patient’s health without ensuring their rights are protected. Also, without proper legal authority or a patient’s explicit consent, family members generally do not have the right to access another person's medical information. Thus, TPO is the recognized framework under which PHI can be disclosed without needing patient consent.