Author Topic: Proof for HIPAA  (Read 9229 times)

Michele

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Re: Proof for HIPAA
« Reply #15 on: January 30, 2010, 10:40:52 AM »
Do you work for the Dr (in his office)?  Or are you a billing service?  Just curious.  Anyway, the injection should be documented in the patient's chart and I'm surprised (disappointed) that the provider thinks it's ok not to chart it. 

I'm curious to see Linda's answer on this. 

I think you are in a very unfortunate situation if this is your job.  But I also think this cannot be the only area the dr is not following the rules.  Since you are very aware that it's not documented, you cannot bill it.  A superbill is not a patient's chart.  It doesn't contain enough info to be considered documentation.

Michele
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Annacate

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Re: Proof for HIPAA
« Reply #16 on: January 30, 2010, 11:40:13 AM »
Thanks Michelle. I have really been struggling with this knowing that I will have to make  a decision about my employment.  I appreciate your imput on this and WILL NOT send claims if there is no documentation. So far it has been just the medical assisant not charting injections but the doctor is charting adequantly as far as I can see. However, the doctor will not stand behind me in this.  I am currently trying to get my coding certification by March and maybe I can then find a coding position.  It is very unfortunate that the doctor I work for does not realize I am just trying to help her when I tell her about these issues, instead she thinks I am telling her what to do and told me I was trying to make extra jobs for the MA. Again, thanks for your imput.     

Steve Verno CMBS, CEMCS

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Re: Proof for HIPAA
« Reply #17 on: February 02, 2010, 05:30:34 PM »
A superbill is NOT a medical record. 

I went to a doctor, he presented a superbill with a level 1 visit circled.  His biller changed it to a level 2 visit.  Ive submitted 2 certified requests for a copy of the medical record and have been ignored.  My next letters wll go to the Office of Civil Rights, OIG, and Department of Health. 

Another doctor insists on billing me for cre he didnt provide.  My request for a copy of the medical record resulted in getting a superbill. In his phone call, he also insisted that the superbill was sufficient. He's now under investigation for fraud and he may lose his license.  He was warned 3 times he never provided what he circled on the superbill.  He just sent the account to his collection agency which could result in a lawsuit and federal investigations. 

Anything billed must be supported by the documentation in the medical record.  Your State medical record law may specify further requirements.  Medical Record Rule:  If it isnt documented in the chart, it doesnt exist AND you document the chart as if it were evidence in court. 
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blhoffman

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Re: Proof for HIPAA
« Reply #18 on: April 09, 2010, 09:06:33 AM »
I know this is a little late to the party but I would like to post this in response to the original question.

In the large health insurance agencies I've worked for we had to take somthing similiar to this every six months. Same concept but different company. So I would like to continue it for compliance reasons. I plan to use this company.

http://www.hipaaexams.com/index.html


annaevans

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Re: Proof for HIPAA
« Reply #19 on: June 26, 2010, 11:30:22 PM »
I know this question was started in April however, I did find some interesting resource that might help the original person about demonstrating HIPAA compliance for her home based business. Now I have not looked at the actual manual but American Medical Billing Association (AMBA)has a manual for members not sure about non members for $69.00 with sample. Try this URL for a direct link to it www.ambanet.net/compl_manual.htm Not sure if this is what your looking for but maybe it could be of some use in your journey. Thanks, Anna Evans
Anna Evans
Simplicity Billing Solutions, LLC

Pay_My_Claims

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Re: Proof for HIPAA
« Reply #20 on: June 27, 2010, 09:09:17 AM »
I know this question was started in April however, I did find some interesting resource that might help the original person about demonstrating HIPAA compliance for her home based business. Now I have not looked at the actual manual but American Medical Billing Association (AMBA)has a manual for members not sure about non members for $69.00 with sample. Try this URL for a direct link to it www.ambanet.net/compl_manual.htm Not sure if this is what your looking for but maybe it could be of some use in your journey. Thanks, Anna Evans

Its not sold to non-members, and you can obtain a lot of that same information from the OIG website.

PMRNC

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Re: Proof for HIPAA
« Reply #21 on: June 27, 2010, 01:17:13 PM »
Here is MY opinion on samples downloaded on the internet..  They are just A GUIDE.  I've seen too many billing companies get burned because they downloaded some simple 3 page contract and thought that was all they needed. NOT true. My contract went from 4 pages to 13.. I will challenge anyone with a contract with less than 5 pages.. I will find a ton of loopholes. ..yes that's a challenge, bring it on. It is why I don't give out samples like that because in my opinion it is IRRESPONSIBLE for anyone to send these through email or put out to download.  First of all a compliance manual is UNIQUE to your business, in addition to adhering to federal guidelines, there are state guidelines and there are guidelines you need that are specific to the running of YOUR company. How can you download a sample compliance plan, put in your name and stick it on a shelf? It's ridiculous actually! It's irresponsible, nevermind you just paid for information given to you for free and MEANT for you to modify it.. PLUS you have to adhere to those guidelines. Putting it on paper is the easy part.. ADHERING and following that compliance plan is imperative!!  Do you know how many times a biller might ask about a provider who wants to know if he can waive a copay, or do other things.. the first place a biller has to look BEFORE asking this question is the compliance plan of the provider, the policies procedures, the financial policies of the practice they are working for.. YOUR answers are there..that's what they are there for. If your provider doesn't have one.. wow..get on them about it.. get them compliant.  90% of questions I see should never be posted because the answers are within the compliance guides or the policies and procedures.  A billing company should have one of each. It's your guideline, it's where you go to find out if your doing something wrong, it's your guideline to figuring out what to do when there is a problem.

DO NOT RELY ON downloaded contracts, samples of compliance plans. Please don't. I'm telling you this to save you a lot of trouble!
Linda Walker
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blhoffman

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Re: Proof for HIPAA
« Reply #22 on: June 28, 2010, 02:30:11 PM »
I'm glad you posted this information PMRNC. Everyone here had really good information on contracts and compliance plans. All things I keep making note of in my very big book of things to do and know.  ;D

The poster asked about HIPAA certification which is something ENTIRELY different then contracts and compliance plans. It is certification that you are aware of the HIPAA Law. To the poster, I have gone through HIPAA training over 10 times. I have a link to the a certification class that is basically the same as all the other's I have taken over the years, at companies I have worked for, and hope it is helpful.

Keep the passion flowing everyone  ;D

PMRNC

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Re: Proof for HIPAA
« Reply #23 on: June 28, 2010, 04:17:59 PM »
HIPAA yes is a separate thing, however HIPAA should be included in the "compliance plan" But again, downloading samples and guides is not enough, My compliance plan is in a large 5'' binder and HIPAA is in there in it's own section, if I were to have downloaded it and set it on my shelf would have been useful. I think you actually LEARN more and BECOME HIPAA compliant by doing your own so that you know what is in there is how it is in your business.
Linda Walker
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One Stop Resources, Education and Networking for Medical Billers
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oneround

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Re: Proof for HIPAA
« Reply #24 on: June 28, 2010, 05:17:10 PM »
We implement P&P's and HIPAA into our overall compliance plan and training even though we include all we still place even emphesis on all sections because each and all are equal.  Not only do we train that an effective compliance plan reinforces an employees' sense of right and wrong but also demonstrates a companies commitment to honestly and integerity.  I always advise my peers that as with any risk downloading material has its pros and cons and if you decide to alter any material to your advantage make sure to have your legal counsel review and approve before implementing.  If looking for compliance guidance I like constantly reviewing the OIG website because in all OIG program guidances, the first of all its elements calls for 'The development and distribution of written standards of conduct and well as written P&P's that promote committment to compliance'.   Now with that said and done does this make you compliant?  No!  Does having a library in ones house make them a scholar?  No!  You must be able to practivce what you preach, be committed, maintain resources and continue, continue,continue, continue and KEEP continuing your compliance education and training.  Remember, the worst thing about not having a compliance program is having a compliance program and not following it.

For compliance education and insite I recommend the book compliance 101 as well as popping in every now and then on the HCCA Compliance fourm
Michael A. Reynolds, CPC, CCP-P, CPMB, OS
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Corporate Compliance
Sharp HealthCare

medauthor

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Re: Proof for HIPAA
« Reply #25 on: June 28, 2010, 09:22:35 PM »
Quote
I will challenge anyone with a contract with less than 5 pages.. I will find a ton of loopholes. ..yes that's a challenge, bring it on.

My contract is 2 pages and was approved by the NJ Department of Banking and Insurance..... 
Michelle Rimmer, CHI, CPMB
President-Professional Medical Billers Association
Owner-ABA Therapy Billing Services
Author, 'Medical Billing 101' and 'Coding Basics: Understanding Medical Collections

Pay_My_Claims

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Re: Proof for HIPAA
« Reply #26 on: June 28, 2010, 09:27:34 PM »
@ Michelle, haha mines is 3!!

medauthor

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Re: Proof for HIPAA
« Reply #27 on: June 28, 2010, 09:28:37 PM »
Quote
@ Michelle, haha mines is 3!!

ahhhhh...too long  ;)
Michelle Rimmer, CHI, CPMB
President-Professional Medical Billers Association
Owner-ABA Therapy Billing Services
Author, 'Medical Billing 101' and 'Coding Basics: Understanding Medical Collections

PMRNC

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Re: Proof for HIPAA
« Reply #28 on: June 28, 2010, 11:45:20 PM »
Quote
My contract is 2 pages  and was approved by the NJ Department of Banking and Insurance....

Yes a copy of your contract is required by the Dept of NJ, however they do NOT review nor can they review them for legalities / contract terms, they are not allowed to. They are there to make sure your business is valid and registered, they do NOT certify. They really only want to see you HAVE a contract. 
Linda Walker
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Pay_My_Claims

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Re: Proof for HIPAA
« Reply #29 on: June 29, 2010, 05:17:52 AM »
all kidding aside, your contract is very important. i agree one should not use another person's contract as it may not be sufficient for the services they render. I do however disagree on the length of their contract. I read someones contract and it was filled with so much legal jargon it made me sick. when i first joined the forums i heard the same "WARNING WARNING WARNING" on a lot of issues including the contract. There are NO IRON CLAD CONTRACTS, no matter how lengthy or short, contracts get broken every day, and people are in litigation every day. A lawyer will take your case knowing he can't win, just to get your money!!! For those that hate Chiro's as crooked, nothing is more crooked than a LAWYER!!!  You can have a basic contract and an attorney can redo that contract in legal terms and its EXACTLY the same contract you had, just "fancied" up. Nobody has a contract without a loop-hole. I have seen issues come up in this forum that may not be included in my contract. I don't have a lengthy one, but I have multiple contracts. My contract may be 3 pages for 1 provider, and then 4 for the next. What my contact covers basically is the technical legal issues. The addendum covers the services I will provide.  Some providers will have me do the invoicing while others will not, so its not listed as a job duty I will perform. I would say to anyone who is looking at their contract thinking it is too short and not good enough to remember QUALITY beats Quantity every single time.  Having a contract put in legal terms lengthens it, not necessarily strengthens it.