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 that you request an itemized bill with CPT codes, per your rights under HIPAA. Be polite but firm in your request. If they refuse to provide the bill, 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. Nine times out of ten, they’ll agree.
Document Your Conversations
Keep a record of your conversations with the billing office, including the date, time, and name of the person you spoke with. This can be helpful in case 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.
If the billing office is not complying with your request, they are 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.
But there are other things HIPAA does, too, and that 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 are unable to resolve the issue directly with the billing office, 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.hhr.gov or by calling 1-800-368-1019, TDD: 1-800-537-7697.
You can file a complaint online, by mail, or by phone. When filing a complaint, provide as much detail as possible, including the name of the provider, 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 that your rights to your medical billing and records information are being protected.