Louisiana Administrative Code
Title 37 - INSURANCE Part
Part XIII - Regulations
Chapter 25 - Regulation 49-Billing Audit Guidelines
Section XIII-2515 - Confidentiality and Authorizations

Universal Citation: LA Admin Code XIII-2515

Current through Register Vol. 50, No. 9, September 20, 2024

A. All parties to a billing audit shall comply with all federal and state laws and any contractual agreements regarding the confidentiality of patient information.

B. The release of medical records requires authorization from the patient. Such authorization shall be provided for in the condition of admission, or equivalent statement, procured by the hospital or ambulatory surgical center upon admission of the patient. If no such statement is obtained, an authorization for a billing audit shall be required. Authorization need not be specific to the insurer or auditor conducting the audit.

C. Such authorization shall be obtained by the billing audit firm or payer and shall include:

1. the name of the payer, and if applicable, the name of the audit firm that is to receive the information;

2. the name of the institution that is to release the information;

3. the full name, birth date, and address of the patient whose records are to be released;

4. the extent or nature of the information to be released, with inclusive dates of treatment; and

5. the provider's patient account number; and

6. the signature of the patient or his legal representative and the date the consent is signed.

D. A patient's assignment of benefits shall include a presumption of authorization to review records.

E. The audit coordinator or medical records representative shall confirm for the audit representative that a condition of admission statement is available for the particular audit that needs scheduling.

F. The provider will inform the requestor, on a timely basis, if there are any federal or state laws prohibiting or restricting review of the medical record and if there are institutional confidentiality policies and procedure affecting the review. These institutional confidentiality policies shall not be specifically oriented in order to delay an external audit.

AUTHORITY NOTE: Promulgated in accordance with Act 664 of the 1993 Regular Legislative Session and R.S. 22:12.

Disclaimer: These regulations may not be the most recent version. Louisiana may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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