Patient rights & compliance

Patient Bill of Rights

Barclay Surgery Center recognizes the right of each patient to participate in decision-making concerning their medical treatment, including the right to give informed consent or informed refusal of care.

Patient rights include the right to:

1. Be informed about Patient Rights before the surgical procedure begins. The patient may appoint a representative to receive this information.
2. Exercise Patient Rights without regard to age, race, gender, national origin, religion, culture, disability, economic status, or source of payment for care.
3. Considerate, respectful, and dignified care, provided in a safe environment, free from all forms of abuse, neglect, harassment or reprisal.
4. Access protective and advocacy services or have these services accessed on the patient's behalf.
5. Assessment and management of pain.
6. Know the name of the physician with primary responsibility for coordinating the patient's care, and the names and professional relationships of other physicians and healthcare providers who will provide care.
7. Change providers if other qualified providers are available.
8. Know whether the physicians hold financial interest in the surgery center.
9. Know whether the physician(s) providing care does not carry malpractice coverage.
10. Receive sufficient information about proposed treatment(s) and procedure(s) to give informed consent for treatment(s), or refuse treatment(s) and procedures. Excluding emergency situations, information includes: a description of the treatment(s) and procedure(s), the clinically significant associated risks, alternate courses of treatment or non-treatment, the risks associated with each, the name of the person who will provide treatment(s) and/or perform the procedure(s).
11. Participate in the development and implementation of the clinical plan of care and actively participate in decisions regarding clinical care. As permitted by law, this includes the right to request and/or refuse treatments and procedures.
12. Know the surgery center's policy and state regulations about Advance Directives and request Advance Directive forms in keeping with State regulatory agency requirements.
13. Privacy about clinical care, treatment(s) and procedure(s). Case discussion, consultation, examination, and treatment are confidential. Patients have the right to know the reason for the presence and authorize the presence of all individuals participating in or delivering care.
14. Confidential treatment of all communications and records pertaining to care at the Surgery Center. The patient gives written permission to release clinical information to those not directly providing care.
15. Receive information as best understood by the patient. Communication with the patient is effective and provided to facilitate the patient's understanding. Written information is appropriate to the age, understanding, and language of the patient. Communications are specific to the patient's vision, speech, hearing, and cognitive status.
16. Access clinical record information within a reasonable time.
17. Know the surgery center's grievance process, should there be a concern regarding care received. Information about the grievance process includes: surgery center contact information, regulatory agency contact information, written notice of the grievance determination or outcome that contains steps taken to investigate the grievance, the results of the findings, and investigation completion date.
18. Know surgery center contact information, the State or Federal agency to whom complaints can be reported, and contact information for the Office of the Medicare Beneficiary Ombudsman.
19. Know whether surgery center physicians propose or perform experiments, research, clinical trials, or medical education affecting or involving care or treatment. The patient has the right to refuse participation or discontinue participation without compromising access to care, treatment, or services.
20. Full support and respect of all patient rights if the patient participates in research projects. This includes the patient's right to grant informed consent as related to the research project. Information given to participants is recorded in the clinical record or research file.
21. Receive instructions from the physician(s) or delegate about care after discharge from the surgery center.
22. Examine and receive an explanation of charges and costs, regardless of payment source.
23. Have all Patient Rights apply to the person delegated legal responsibility to make clinical care decisions on behalf of the patient.

Patient responsibilities include the responsibility to:

1. Provide accurate and complete information concerning current and past states of health, present complaints, hospitalizations, medications (including over the counter products and dietary supplements), allergies and sensitivities, and any other pertinent health information.
2. Understand and/or ask questions about care and services delivered, and about instructions following care and treatment.
3. Follow the treatment plan and care instructions or accept accountability if the treatment plan and care instructions are not followed.
4. Keep appointments or notify the surgery center if unable to keep the appointment.
5. Leave valuables with a family member/representative.
6. Be accompanied at discharge by a responsible adult.
7. Inform the surgery center staff of a living will, medical power of attorney, or other directive that could affect care.
8. Accept personal financial responsibility for any charges not covered by insurance.
9. Show respect for other patients and surgery center staff.
10. Tell us if there is a problem with care.
11. It is the responsibility of a parent or guardian to remain at the surgery center for the duration of a pediatric patient's stay.

Feedback about our services

If you have concerns about how these rights were administered, contact us at Barclay Surgery Center, 375 Barclay Circle, Rochester Hills, MI 48307, (248) 491-8894.

You may also contact any of the following:

State of Michigan Facility Complaints
Michigan Department of Licensing and Regulatory Affairs (LARA), Bureau of Survey and Certification (BSC)
Toll-Free Complaint Hotline: 1-800-882-6006 · Online: lara.state.mi.us
Mail: Bureau of Survey and Certification – Complaint Intake Section, P.O. Box 30838, Lansing, MI 48909

Medicare / CMS Complaints
Centers for Medicare & Medicaid Services (CMS)
Phone: 1-800-MEDICARE (1-800-633-4227) · TTY: 1-877-486-2048
Online: medicare.gov/my/medicare-complaint

Medicare Beneficiary Ombudsman (MBO)
Call 1-800-633-4227 and ask the representative to submit your unresolved complaint directly to the Ombudsman.
Ombudsman resources · Your Medicare rights & help

Office of Civil Rights
U.S. Department of Health and Human Services, 200 Independence Avenue, SW, Room 509 F, HHH Building, Washington, D.C. 20201
ocrportal.hhs.gov
Phone: 1-800-368-1019, TDD 1-800-527-7697

AAAHC Accreditation Complaints
Accreditation Association for Ambulatory Health Care (AAAHC)
Phone: 847-853-6060 · Fax: 847-853-9028 · Email: Complaints@aaahc.org
Mail: AAAHC Accreditation Services, 3 Parkway North, Suite 201, Deerfield, IL 60015
Online: aaahc.org

Notice of Privacy Practices

Effective date: October 1, 2024

This notice describes how medical information about you may be used and disclosed, and how you can gain access to it. Please review it carefully.

Protected health information (PHI) about you is maintained as a written and/or electronic record of your visits with us. Barclay Surgery Center is required by law to maintain the confidentiality of your PHI and to follow specific rules when using or disclosing this information.

Your rights under the Privacy Rule

1. Receive a copy of this Notice of Privacy Practices.
2. Authorize (or decline) uses of your PHI beyond treatment, payment, and healthcare operations.
3. Request an alternative, confidential means of communication.
4. Inspect and obtain a copy of your PHI, including in electronic format if maintained electronically.
5. Request a restriction on use or disclosure of your PHI.
6. Request an amendment to your PHI.
7. Request an accounting of disclosures made outside our practice.
8. Receive written notice in the event of a breach of your unsecured PHI.

How we may use or disclose your information

We may use and disclose PHI for treatment (coordinating your care with other providers), payment (billing your insurer), and healthcare operations (quality review, audits, business planning). We may also use PHI to send appointment reminders or share treatment alternatives, and — unless you object — with family members involved in your care. Other permitted disclosures include those required by law, for public health and safety, in response to court orders or subpoenas, and to health oversight agencies.

Filing a privacy complaint

Contact our Privacy Officer at Barclay Surgery Center, 375 Barclay Circle, Rochester Hills, MI 48307, (248) 491-8894. We will not retaliate against you for filing a complaint.

You may also contact: Michigan Department of Licensing and Regulatory Affairs, Bureau of Survey and Certification, P.O. Box 30838, Lansing, MI 48909 · Hotline 1-800-882-6006. Or the U.S. Dept. of Health and Human Services Office for Civil Rights: ocrportal.hhs.gov · 1-800-368-1019.

Note: this is a summary. The full Notice of Privacy Practices is available at the front desk and on request.

Good Faith Estimate

Under the No Surprises Act, health care facilities must give patients who don't have insurance, or who are not using insurance, an estimate of expected charges for medical items and services.

1. A Good Faith Estimate will be provided prior to your scheduled service, upon request or when a service is scheduled.
2. If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
3. Keep a copy of your Good Faith Estimate for your records.

For questions or more information about your right to a Good Faith Estimate, visit cms.gov/nosurprises or call 1-800-985-3059.

Patient Medical Record Request Form

Use this form to authorize family members, friends, or other third parties to access your Protected Health Information (PHI) from Barclay Surgery Center, or to request a copy of your own records. Authorizations remain valid for six (6) months unless you specify a shorter period.

Download the Medical Record Request Form (PDF)

Submit your completed form

Email: info@barclay-asc.com — note that email sent from a personal address may not be secure; be mindful of this when transmitting PHI.

Fax: (248) 247-6610 (records line)

Mail: Barclay Surgery Center, Attn: Medical Records, 375 Barclay Circle, Rochester Hills, MI 48307

Ownership Disclosure

As required by CMS for Medicare-certified ambulatory surgery centers, Barclay Surgery Center discloses the following ownership information:

Barclay Surgery Center is physician owned. Ownership interests are held by physicians who are members of its medical staff and provide medical or surgical services at the Center.

A complete list of physician owners and their respective interests is available upon request at the Center or by contacting us at (248) 491-8894.

Language Assistive Services

Barclay Surgery Center complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. If you require language assistance, these services are available to you free of charge.

Call (248) 491-8894 (TTY: 711).