Facing an Insurance Audit? Here is What You Need to Know

A closer look at the importance of maintaining medical records for HIPAA Privacy Laws and how shredding helps to achieve that.

Fewer things evoke more havoc in the professional setting than an audit. As anyone who’s experienced one knows, it’s all about checking and double checking your work to ensure everything is done right, and up to code. Better yet, having strong record-keeping in place and bulletproof processes will make these types of requests less stressful to endure overall.

For the healthcare industry, where rules and regulations are very strict, an audit can mean large fines – or worse. In this space, insurance audits are common and physicians must know their rights if they want to remain confident – audit or not.

Here is a closer look at the importance of maintaining medical records for HIPAA privacy laws and how shredding helps to achieve that.

When it comes to insurers auditing for information, a healthcare provider might be asked to provide medical records, investigated for overpayments, or be asked to provide other proof and data.

Whichever request comes through, it’s critical that healthcare facilities take it seriously and respond in a timely manner. This should be done with the help of an attorney and correspondences should always be well documented for a paper trail.

To avoid possible penalties and the accumulation of interest, get to work right away. That doesn’t mean pay up right away either. Knowing your rights and the rules in the state which you operate is important. Get familiar with all statutes of limitations too, because some pay back requests may no longer be warranted depending on how far back they date.

Another important factor to consider is data retention and destruction rules. Some files may have timelines of expiration in accordance with HIPAA and others might need to be safely destroyed to eliminate liabilities.

In the audit process, when keeping back-ups and sending medical records has to happen, it creates more paper and a greater need to shred. These documents are confidential and personal. As a health provider the responsibility falls on you to ensure they remain protected and are handled appropriately.

Even with electronic health records (EHRs) taking over today, there is still a need to ensure that medical records – paper or digital are destroyed and that there is no possibility of reconstructing the information. Don’t put your practice or your patients on the line. Get compliant today.

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