Quick HIPAA Follow-up Question

[mommiegeek]

Does HIPAA still apply if the services were received prior to April 2003, but the account was not turned over to a CA until after April 2003?

[mommiegeek]

bumpage

[VonRath]

As I understand it, yes.

 

Experts?

[whitsend]

The date of service doesn't matter with HIPAA. HIPAA applies to what is done with the information after April 2003.

 

Giving information to a CA is allowed under the "payment" exclusion. OCR has stated that this even applies after payment has been made. Some people have had success with the HIPAA letter, but if the healthcare provider doesn't cooperate then you have no means to make them remove it. You can't sue and if you file a complaint with OCR, well they have already said it is allowed.

 

There are many here who dissagree with me on this and we have had discusions on this several times. I'm sure someone will tell me I don't know the HIPAA rules, but I am a HIPAA Privacy Officer and deal with them every day.

 

Just my $.02

 

whitsend

[mrskippy]

What if:

 

Health care provider refuses to verify debt?

Health care provider refuses payment?

Health care provider orders all activity handled through CA?

Health care provder incorrectly billed insurance?

 

Also, CA is listing account twice on Equifax. Experian removed for HIPPA purposes, but Equifax isn't budging.

[Why Chat]

What if:

 

Health care provider refuses to verify debt?

OC's are sunject to being sued under the rules for reporting in the FCRA

Health care provider refuses payment?

If you have made a copy, front and back of the money order or certified check with the restrictive endorsement, and it is returned to you by the OC, file a  complaint with your State authorities that regulate the HC profession of your OC,and your State AG on unfair business practices  and violations of the fair billing act

Health care provider orders all activity handled through CA?

HIPAA violation, document the paper trail and file a complaint with the OCR

Health care provder incorrectly billed insurance?

Insert "b" and violation of health care billing pratices laws in most States

 

Also, CA is listing account twice on Equifax. Experian removed for HIPPA purposes, but Equifax isn't budging.

 

No credit repair technique can work miracles,with Eq. you need to file an FTC complaint and include the print out with a redispute, fax it and mail it, repeat several times if neccessary, (with Eq it is almost ALWAYS neccessary)

 

As to the original post.

If the date of service was prior to the effective date of HIPAA (04/2003) the no HIPAA release was signed and you can use the HIPAA letter. PLEASE REMEMBER- this only works if there is NOTHING OWED.

[swedishhands]

WhyChat you are a saint!!! I got a letter ready and I a waiting on my husband to get a money order - will be sending it CRRR to dentist early next week.

 

My husband and I want to make sure we got everything just right... How -exactly - do we restrict endorsement on the money order??? Will writing on the back of money order "For deposit only to the account of dentist name" work? I am hopping onto your site now just in case I missed it!!!

 

Thanks again - you and Sassy are a dream come true!!!

 

Mel

[SassyinAz]

Health care providers aren't usually furnishers and can't be sued if not reporting, further, the information HAS to be inaccurate and the only cause a consumer has to enforce furnisher responsibilities under the FCRA is under 623( and that is AFTER a dispute has been initiated.

 

Health care providers are allowed to use CA's, most of them do as a commonly accepted business practice -- Hipaa regulations don't and can't prevent the practice nor does the FCRA. What would you file a complaint with the regulatory agency or for unfair business practices when they are allowed to do it. There is no violation of the FCBA because it isn't applicable to medical bills.

 

It isn't a Hipaa violation for the CA to accept payment or for the health care provider to require they be used -- that's what they pay them for!

 

Better find the health care billing practice laws and find the violation first and/or read milkmom's story, nothing requires insurance be billed at all.

 

CA listing twice, dispute one or the other as a duplicate. Why do you think Exp removed for Hipaa purposes?

 

BTW Whit, I keep pondering that, the OCR is wrong because the FDCPA allows reporting of the CA's experience with the consumer ONLY, so it would be correct if the CA were paid and reporting its experience with the consumer -- if the OC is paid but not reporting (as is true with most medical collection TL's), allowing the CA to report information that wasn't its own experience with the consumer would be contrary to the FDCPA which we both know the Hipaa regulations say it doesn't do. And, as you well know, WhyChat's Hipaa series is based on the OC/HCP having been paid thus eliminating the payment purpose.

 

Glad to see you back posting, I hope you've never been told you don't know the Hipaa regulations, I've enjoyed all of our discussions and frequently link several of them because they are good threads and important for an overall understanding which I think is very important before making threats to do anything and for understanding all your options, FDCPA/FCRA/Hipaa -- not just limited to WhyChat's series. Previous to the above realization, I thought the OCR interpretation as given to you was a reasonable one.

 

Don't feel so picked on, if you bother checking, you'll see that I frequently post the opinion the OCR has given you on the interpretation of payment history being included as a payment purpose, as I believe it isn't fair to those contemplating using the Hipaa series which results in an OCR complaint to not know the same, especially with a consumer having no ability to enforce the Hipaa regulations.

 

Sassy

[mrskippy]

nothing requires insurance be billed at all

 

So you're saying they can charge you $600 or $700, never send it to insurance and than demand payment without billing insurance -- for covered services? Seems that would be illegal to me.

 

I disputed with Equifax that the health care provider improperly billed the insurance in my latest dispute. They agreed that this would obviously impact the amount owed, as it should.

 

It also would be illegal for your medical provider to do a $100 procedure and demand $50 when there is only a $10 co-pay.

 

Medical providers have negotiated rates with insurance companies. For example the insurer and medical provider agree the $100 procedure is only worth $50. Your copay is still $10 and insurance pays $40. They can't bill you for the other $40.

 

I had a sonogram/ultrasound to check for stomach cancer and ulcers. Procedure cost me $0. Hospital got some pissy pissy amount (10 to 25 percent of cost) from the insurance company. End of story.

 

In the case of my disputed dentist bill, insurer was billed wrong. They only paid 50 percent. The other 20-30 percent they would have paid was tacked on to my bill. This probably added $75 to my bill. Technically I only owe about $100. Collection agency says I owe 2-3 times that, based on a bill almost twice as much to begin with.

[SassyinAz]

nothing requires insurance be billed at all

 

So you're saying they can charge you $600 or $700, never send it to insurance and than demand payment without billing insurance -- for covered services? Seems that would be illegal to me.

 

Seemed that way to me too, till milkmom was served and was having the same problem finding what law required them to bill.

 

Here's her thread:

 

http://www.creditboards.com/phpBB2/viewtop...t=sassy+milkmom

 

Sassy

[whitsend]

Sassy,

 

I've been busy but I still lurk some and I am starting back on my credit repair after a few months off.

 

BTW Whit, I keep pondering that, the OCR is wrong because the FDCPA allows reporting of the CA's experience with the consumer ONLY, so it would be correct if the CA were paid and reporting its experience with the consumer -- if the OC is paid but not reporting (as is true with most medical collection TL's), allowing the CA to report information that wasn't its own experience with the consumer would be contrary to the FDCPA which we both know the Hipaa regulations say it doesn't do. And, as you well know, WhyChat's Hipaa series is based on the OC/HCP having been paid thus eliminating the payment purpose.

 

I'm not real familiar with the FDCPA, so could you point me to where this is in the FDCPA? Also, this would be a violation of the FDCPA not HIPAA. Could this be used with other CAs as well? (Pay the OC then the CA can't update it to paid, a balance owed is incorrect, so they should delete)

 

 

Skippy,

 

So you're saying they can charge you $600 or $700, never send it to insurance and than demand payment without billing insurance -- for covered services? Seems that would be illegal to me.

 

Technically insurance is a reimbursement to you. The medical provider bills the insurance company as a courtesy to the patient, or because of the contract they have with the ins. co. It is not illegal (in Louisiana, I'm not sure in all states) but if they have a provider contract with the ins. co. they would be in violation with that contract and you would have to work through you ins. co. I know of some physicians that don't accept any insurance. All their patients pay when the service is rendered and if they have ins the patient files their own claim. If they don't pay, the Dr. doesn't see them, if the patient doesn't like this arrangement, they can go to a different physician. (NOTE: This doesn't apply to emergency service at a hospital)