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Demanding HIPAA Compliance When Submitting Medical Records

Repeated submissions of medical records to carriers is a frustrating, often unnecessary, burden on medical providers. Unfortunately, when carriers are unable to locate mailed medical records, medical providers have little recourse other than duplicating the time consuming process of copying, preparing and shipping an often voluminous file.

From a practical standpoint, medical billing professionals will need to comply for requests for resubmission of lost documentation in order to get paid. However, providers may want to deal with "repeat offenders" by seeking an internal investigation into the carrier's own security/privacy protocols.

"One of my favorite letters from AppealLettersOnline.com is the HIPAA audit letter.  It’s amazing how quickly payers find those lost appeals and medical records after receiving this letter.  The appeal coordinators from our Patient Financial Services Department and Care Management use AppealLettersOnline.com with a lot of success," states Theresa Halbritter, Coordinator, Appeals for West Virginia University Healthcare.  Halbritter recently spoke at the Kentucky Healthcare Financial Management Association (HFMA) meeting and included information about using AppealLettersOnline.com for effective appeals. . .

Continue reading this article at AppealLettersOnline.com

AppealLettersOnline.com Featured Appeal Letters

AppealLettersOnline.com has updated a number of state-specific appeal letters this month:

Alaska Benefit Disclosure
Alaska Prompt Pay
Alaska Interest Payment
Alaska Workers Comp Prompt Pay
Alabama External Review Law
Alabama Utilization Review Law
California Appeal Review
Connecticut Prompt Pay
Connecticut Fee Disclosure Law
Connecticut Utilization Review
Georgia Workers Comp Prompt Pay
Georgia Medical Necessity
Idaho Workers Comp Prompt Pay
Idaho Workers Comp Payment Inquiry
Idaho External Review Law
Illinois Workers Com Prompt Payment
Illinois Workers Comp Payment Inquiry  

Access the appeal letters at AppealLettersOnline.com

Using Florida Laws to Appeal Denials and Obtain Quality Appeal Reviews

Appeal Solutions has developed an appeals training program specifically for Florida medical billers.  Using Florida Laws to Appeal Denials and Obtain Quality Appeal Review is a 90-minute presentation specific to Florida insurance claim review laws.  Tammy Tipton, President of Appeal Solutions, will discuss how to assert your rights when insurers deny or underpay medical claims.  Level I and Level II appeal responses will be discussed and legal protections related to appeal review will be explained.  Some of the appeal letters to be discussed include the following:

• Incorrect verification of benefits

• Florida laws specific to access to care, peer review, newborn coverage requirements, direct access and clinical trial coverage and how to demand compliance with mandatory coverage laws.

• Coding appeals and demanding a review by a certified coder and release of coding criteria.

• Medical necessity appeal review and Florida law on peer review requirements.

• Getting action on unnecessarily stalled claims.

• How To Respond to Refund/Recoupment Response letters.

Cost of the presentation varies and can be conducted via webinar or on-site with your revenue cycle and/or billing personnel.  Sample appeal letters are part of the course material and can by customized for your specialty.  Please call Tammy Tipton at 888-399-4925 to schedule the presentation for your staff and discuss cost and format best suited to your needs.