Medical Billing Forum

Starting a Medical Billing Business => Starting Your Own Medical Billing Business => Topic started by: jyoung65 on April 20, 2012, 11:22:48 AM

Title: HIPPA Statement
Post by: jyoung65 on April 20, 2012, 11:22:48 AM

I have a prospect requesting a HIPPA statement, before they give me their logins and passwords to their Medicaid and Medicare accts. I need to know where I can find a HIPPA statement for our industry. They want me to audit their Medicare and Medicaid billing. I'm not sure what to charge for this service. Can any give me some suggestions on what to charge and how to charge for this service? I really appreciate any suggestions.

Thanks :)
Title: Re: HIPPA Statement
Post by: PMRNC on April 20, 2012, 06:00:43 PM
It's not just a statement. You need a HIPAA Business Associate's Agreement.

When you say you are auditing the Medicare and Medicaid Billing, what type of audit are you doing, can you be more specific?  I normally bill for services like that at an hourly rate.
Title: Re: HIPPA Statement
Post by: jyoung65 on April 21, 2012, 09:22:42 AM
The practice would like a audit to assure that their biller is billing services correct. The correct cpt & icd-9 codes and also to assure that Medicaid and Medicare are paying the correct reimbursement. And if the denial are valid. What do you look for when you conduct an audit?  Thanks
Title: Re: HIPPA Statement
Post by: PMRNC on April 22, 2012, 11:03:01 AM
If I am doing an audit such as that, I like to first find out the exact responsibilities of the biller as well as their credentials. For example you say you are looking to make sure they are using correct codes, for me I would first find out if coding were a responsibility of the biller and if so are they properly trained/certified. This makes a difference even before beginning the audit.   Then I have the following reports run by carrier:  payments, adjustments, denials/rejections, and aging report.  Then I gather the report for all CPT codes billed (by carrier) as well.     If you are doing an audit to determine proper coding, you will most likely need all patient charts for the audit and I'm assuming you are a correctly trained and/or certified coder. Also I would caution you on the removal of patient charts from the provider's office. I never conduct any audit with records removed from the office due to liability issues. These type of audit's I do IN their office and is billed hourly in addition to any travel/accommodations that might be needed.  I also have a separate  contract and it specifically states there will be limited to no contact with the current biller in regards to the audit (that can bias the audit)  Hope this helps.