Medical Billing Legal Corner

Local Health Care Regulations

Photocopying Fees for Patient Records

Most states set limits regarding the highest fees that providers may charge for releasing copies of patient records. This matrix provides the basic details regarding these laws and hyperlinks to the relevant state statutes. As you will note, state statues vary not only with regard to the permissible fees, but also as to whether certain requestors (e.g., attorneys) can be charged higher fees, whether an additional search fee can be assessed, etc. In some situations, a provider’s violation of these statutes can result in fines and other penalties.

Publication Date: 07/2008
Copyright 2008.

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Insurance Prompt Payment Laws

Many healthcare providers suffer from health insurance reimbursement delays, which can have dramatic adverse effects upon their cash flow. Collective efforts of both federal and state legislatures have resulted in the enactment and enforcement of prompt payment laws that require payers to adjudicate claims and render appropriate reimbursement within certain timelines. Healthcare providers must be fully aware of the prompt payment laws of their respective states so that they may effectively enforce their statutory rights and demand appropriate remedies.

Publication Date: 01/2008
Copyright 2008.

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Notification of Actual or Likely Data Breach

Widespread security breaches and identity theft have prompted legislatures across the nation to enact data breach notification laws. These laws impose notification obligations that are triggered when a medical office or other entity discovers that its computerized records containing personal information have been accessed by an unauthorized third party. Many of these laws impose very serious penalties on non-compliant entities, so it is important that you understand the law(s) that apply to your practice.

Refund, Deduction and Recoupment of Overpayments

Insurance overpayment recoupment and overpayment refund disputes are now commonplace in modern medicine. The majority of states have enacted refund and recoupment laws that govern a payer’s ability to demand a refund or to recoup previous overpayments. Since payers are becoming more aggressive in demanding repayment, it is important that you understand your rights under state law.

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