As a patient, you have the right to access your medical records and billing. However, some medical billing offices may be hesitant to provide an itemized bill. Fortunately, there are steps you can take to file a HIPAA complaint if you are not getting the information you need.
Step 1: Speak with the Billing Office
The first step is to speak directly with the billing office. Tell them you request an itemized bill with CPT codes, per your rights under HIPAA. Be polite but firm in your request. If they refuse, ask to speak to a supervisor.
Getting the itemized bill with CPT codes, which are billing codes assigned to every action taken in a medical office or facility, is essential. By knowing the CPT codes, you can search online for the Medicare-approved price for each code, and be able to confront the medical facility with a price you’re willing to pay.
Document Your Conversations
Keep a record of your conversations with the billing office, including the date, time, name of the person you spoke with, and a call reference number. This can be helpful if you need to escalate the issue.
Know Your Rights Under HIPAA
Under HIPAA, you have the right to access your medical records, including billing information.
Billing offices don’t always make it easy to get itemized bills with CPT codes. This is because the price changes, according to who’s paying. Sound’s unfair? It is. But, it also means that prices are negotiable.
If the billing office is not complying with your request, they’re violating federal law. Most people think that HIPAA is just for security complaints, such as when a medical office breaches notification rules or there’s a health information privacy complaint.
However, there are other things HIPAA does, too. This includes making sure that patients have access to their records. According to the HIPPA Privacy Rule, section 45 CFR 164.501 we have the right to our “personal health information,” including billing records. HIPAA rules and reporting HIPAA violations are about more than just your medical files being tampered with.
Step 2: File a HIPAA Complaint
If you don’t receive your itemized bill with CPT codes within 30 days of your request, you can file a HIPAA complaint with the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR).
You can file a HIPAA complaint:
- online at ocrportal.hhs.gov
- or by calling 1-800-368-1019, TDD: 1-800-537-7697.
You have 180 days after making your request to file a complaint. When filing a complaint, provide as much detail as possible, including the provider’s name, the dates of service, and a description of the issue.
Step 3: Follow-Up
After filing a complaint, you should receive a response from the OCR within 180 days. If the OCR finds that a violation has occurred, they may take action to address the issue. It’s important to follow up with the billing office after filing a complaint to ensure that they provide the necessary information.
In conclusion, if you are having trouble obtaining an itemized bill with CPT codes from a medical billing office, there are steps you can take to file a HIPAA complaint. By being informed of your rights, documenting your conversations, and following the appropriate procedures, you can ensure your rights to your medical billing and records information are protected.