decisionhealth Newsletters, Part B News - 2015 Issue 8 (August)
Patients can keep you from sending claims to insurers — but must pay themselves
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Article Overview
This article covers a patient’s right to ask that a visit not be billed to insurance when the patient pays in full, along with related HIPAA privacy and office-process considerations. It is aimed at coders, billing staff, practice managers, and compliance-focused providers who need to understand when such requests apply, how to document them, and what operational issues may arise with EHRs, referrals, and follow-up care.
Why This Topic Matters
Patient-directed restrictions can affect claim submission, documentation practices, staff handling, and EHR workflows. Understanding the scope of the HIPAA-related guidance helps practices respond consistently and maintain compliance.
Article Sections
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Ask Part B News Q&A
Introduces a patient question about keeping a visit off insurance and the general response under HIPAA-related guidance.
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Documentation and compliance considerations
Discusses the importance of documenting efforts, notifying patients, and retaining records to support compliance if a request is not fulfilled as originally intended.
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Staff training and patient education
Covers office protocols, staff preparedness, and how to explain related limitations and exceptions to patients.
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Written agreements and record-handling workflows
Addresses the use of written agreements and operational choices for managing encounter information in electronic or paper-based systems.
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Follow-up care and related encounters
Explains that restrictions may need to be recognized when later care relates to the same general condition or encounter history.
What You Will Learn
- How patient-requested restrictions are discussed in HIPAA-related guidance
- What documentation and workflow issues practices should consider
- How office staff and patients may be prepared for restriction requests
- What operational concerns can arise in EHR and referral processes
- How follow-up encounters can affect previously restricted information
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Compliance officers
- Healthcare providers
- Privacy and health information management staff
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