Billing Service has Denied Online Access

by Liz
(California)

I have a potential new client who has contacted me to use our billing services. He recently gave his current billing service notice as he was unsatisfied with their work. They immediately removed his online access to their billing software that he had been using all along to look at his accounts, etc. I didn't think this was legal. Is there some law that you can reference for me that talks about who these records actually belong to, the Dr or the billing service, and if it is legal for them to not let him have access any longer?


They told him that he could call if he needed something and they would give it to him but now they will not answer the phone or return his calls. I would like to help him if I can.
Thanks

Response:

Liz,
I can understand his urgency in getting his patient data as it dramatically affects his ability to get claims filed.

I’ll qualify this by saying I’m not an authority on the legal aspects of this - it’s just my opinion and understanding with regard to HIPAA.

Everyone interprets HIPAA requirements differently but I understand the billing service to be a “Business Associate” as determined by HIPAA and/or the Department of Health and Human Services (DHHS). A Business Associate performs certain functions on behalf of the covered entity - or in this case the provider.

You may want to ask the physician if he had a Business Associate agreement and/or service contract with the billing service. This may have some language or requirements that can provide some leverage.

I think HIPAA and the DHHS requires (I don’t know exactly where its located) the business associate - or billing service in this case - to cooperate with the provider to provide access to the patient information. Unfortunately if there wasn’t a Business Associate agreement it may be harder to enforce. Here’s the HHS site that discusses Business Associates.

I think the provider certainly has a legal right to access this information and receive a copy. But he may have to get a lawyer involved to get it resolved - which could take a while.

But you and your potential client would probably like to resolve this as quickly and easily as possible. Unfortunately to do this requires the cooperation of the old billing service. Another thought if the billing service is using an online medical claim software service, the physician (or someone on his behalf) may be able to arrange access if you can explain the situation.

You may want to consider contacting the service (if the physician authorizes you to) and see if you have any success. It would certainly make you look like a hero and almost certainly land you the client.

Another thought here is I wonder if the doctor owed the billing service money. This could be one reason they are not responsive. But there’s not really anything you can do about that.

One thought if this doctor does end up being a client and you can get a copy of the patient data. Depending on the practice management software you use, converting and importing the patient data can be an expensive undertaking. This assumes of course you can get a software copy of the data. Someone would have to convert the database (usually the software vendor) so that it could be imported into your software. Just be aware of this when pricing you services and make sure the client doesn't expect you to bear this cost.

This is one of those situations that scares doctors from outsourcing their billing and gives legitimate and conscientious billing services a bad name due to their behavior.

Good luck - I hope you and your potential client can get the patient info soon and you can get started with a new client.

Thanks,

Gina

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Aug 13, 2011
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thanks Gina
by: Liz

I also found some info on the AMA site. They have a white page that talks about who owns the data. This white sheet was written jointly by the AMA and the HBMA (Helthcare Billing & Management Assoctiation). I gave the potential client this documentation to help him in his negotiation as well as a referral to a very respected man in HBMA who could also call the billing company and explain the law to them.

Companies that behave like this make it harder for all of us to be trusted and respected as professionals.

I hope I end up being the "hero" and landing the client but at the very least, I learned something new for the next time this happens.

Thanks again for your input and help.

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