1) If it is part of the payors Quality Assurance, the payor is allowed to audit a providers records as long as both the payor and the provider have a relationship with the patient. I don't have the citation in front of me, but I can find it. It is listed, in the 8/14/02 revisions, under "Use and Disclosure of PHI". If the payor has a BA Agreement with an auditor, the auditor has a right to look at anything the payor has would have a right to look at.
2) The payor would not be a BA of the provider. In order to be a BA the payor would need to be "using and disclosing PHI on behalf of" the provider. They are not doing that. They are using and disclosing PHI on their own behalf.
Just my opinion.
Deborah Campbell
Compliance Coordinator
Dominion Dental Services, Inc.
115 South Union Street, Suite 300
Alexandria, Virginia 22314
Phn: (703) 518-5000 ext. 3035
Fax: (703) 518-8849
Toll Free: 888-518-5338
Email: [EMAIL PROTECTED]
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-----Original Message-----
From: Vikas Budhiraja [mailto:[EMAIL PROTECTED]]
Sent: Thursday, March 13, 2003 4:05 PM
To: WEDI SNIP Privacy Workgroup List
Subject: A tricky BA Questions
I have been encountered with a tricky BA question and hope someone can
provide some insight.
Insurance companies engage certain agencies to audit provider records to
verify if what the hospital billed was correct and if the insurance company
has overpaid. Since these audit agencies are engaged by the Insurance
Companies they will be the BA of the Insurance companies. However, they are
going to a provider facility to verify the records, My questions are:
1. Are they allowed to do this under the HIPAA law? If yes, what type of
relationship will they have with the provider?
2. If a payer engages an agency to audit provider records does the payer
become the BA of the provider?
Regards,
Vikas
---
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---The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time.
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