Wiki Need expert advice

[Timothy S]

Hi,

I have a question about an incident. If a coder takes an adjustment of $1,000 instead of $10.00 which might be by mistake or by will, does it comes under HIPAA violation or compliance issue. Please suggest and providing documentation to support your view is highly appreciable.

 

[mitchellde]

I am not sure what are referring to by an adjustment. Are you saying the coder wrote off 1000 of a patient Acct? For what reason? you need to provide additional information. This could be a serious issue or an innocent mistake.

 

[Timothy S]

The coder wrote off $1000 in patient account instead of $10.00 for an adjustment which he got approval from provider. Will this comes under HIPAA violation?

 

[mitchellde]

It will depend on the reason for the adjustment, but yes it could be a HIPAA violation. It states in HIPAA that knowing you are to collect a certain amount of copay or deductible and failing to make the attempt to do so can constitute a violation.

 

[kamikidd]

Hi there.

I am not sure that this is a HIPAA violation per se. HIPAA violations tend to be of a privacy nature or by using non-standing billing codes (this typically applies to the payor side rather than to billing entities.

Depending on the circumstances surrounding this adjustment, you may have a cash control issue. Worse case scenario, this entry created a credit-balance which was refunded to the patient.

If this adjustment was intentional, then you have a theft/embezzlement situation which would be compliance/HR's responsibility. If this was an honest mistake (which is could easily have been), then it is a training/QA issue which is operations' responsibility.

Hope this helps!
Helen

 

[Timothy S]

thank you so much for your help