decisionhealth Newsletters, Part B News - 2012 Issue 3 (March)
Lodge HIPAA complaints against payers, clearinghouses for claims disruptions
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Article Overview
This article is for medical practices, billing staff, and revenue cycle professionals dealing with claims disruptions and delayed payment after the HIPAA 5010 transition. It outlines the role of CMS and the Office of E-Health Standards and Services in HIPAA enforcement, the kinds of parties that may be involved in a complaint, and the general steps to take before filing. The discussion focuses on escalation, documentation, and complaint filing considerations rather than on coding decisions or code selection.
Why This Topic Matters
When claims are stalled and routine outreach does not resolve the issue, knowing the proper complaint pathway can help practices document the problem and trigger review by the appropriate federal office.
Article Sections
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Claims disruptions and HIPAA complaint escalation
Introduces the payment and claims-processing problems discussed in the article and explains why formal complaint channels may be considered after other efforts fail.
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Steps to take before filing a complaint
Summarizes the preliminary actions described for identifying the source of the problem, contacting involved parties, and attempting to resolve the issue internally first.
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Tips for filing a HIPAA complaint
Covers the general filing approach, the need for detailed documentation, and what may happen after a complaint is submitted.
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Possible outcomes after CMS review
Describes the broad post-filing possibilities discussed in the article, including follow-up by the enforcing agency and potential response from the reported entity.
What You Will Learn
- When a HIPAA-related complaint may be appropriate for claims disruptions
- Which parties may be involved in claims-processing problems
- What preparatory steps to take before escalating an issue
- What general information a complaint should include
- What to expect after submitting a complaint to the enforcing agency
Who Should Read This
- Medical billing staff
- Revenue cycle managers
- Physician practices
- Practice administrators
- Compliance staff
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