A place to report HIPAA problems: AMA form gives doctors an outlet

The AMA's HIPAA complaint form is the best tool doctors have to let organized medicine, and CMS, know what's going wrong with the new transaction and code set standards.

Posted Jan. 5, 2004.

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If HIPAA is causing you pain, there's a place to complain. That place, on the AMA's Web site, is labeled -- logically enough -- the link. It's easy to fill out, and it's anonymous. You can explain any problem you're running into now that the Oct. 16 deadline has passed for submitting HIPAA-compliant claims electronically. The site went up as soon as that deadline hit, even though the Centers for Medicare & Medicaid Services gave physicians an extension to get their claims compliant with the Health Insurance Portability and Accountability Act.

The CMS has its own complaint form, but it's not expecting a stampede of angry physicians. The form is hard to find on the agency's site, and it requires you to give your name in case CMS needs to follow up with an investigation. You also have to register online with an e-mail address.

So CMS is relying heavily on the AMA -- and the more than 30 county, state and specialty societies that link to the AMA's form -- to supply it with information about where HIPAA troubles lie. AMA staff already have met with CMS to discuss the form and share the early findings.

By filling out the complaint form, physicians can give the AMA and CMS valuable information to pinpoint the sources of HIPAA-related problems. What each is looking for in particular is patterns -- whether complaints are coming from a certain geographic area, or whether they're being directed against a certain entity.

So far, the AMA has found physicians complaining most about clearinghouses, physician practice software vendors and other intermediaries failing to deliver HIPAA-complaint claims to health plans, resulting in delayed payments.

The CMS has power to enforce HIPAA; how it does so was not supplied in the legislation. That shouldn't discourage you from filling out the AMA form, though. CMS can't enforce anything if it doesn't know where the problems are. And even if the CMS can't put the hammer down right away, the AMA plans to take information from the form to confront any person or company that is a large source of complaints.

That way, the AMA can find out, and share with the nation's physicians, why there's a problem, and what will be done to fix it -- or even whether there's something physicians are unwittingly doing that's causing a problem.

Of course, this is not the first form of its kind the AMA has offered. It started with a health plan complaint form, which other state and specialty societies also link to as a means of gathering information about unfair business practices. What both forms have in common is a means for physicians to gather strength in numbers to speak out against problems and abuses that affect their daily practice lives.

No one ever said the transition to HIPAA standards would be easy, but there are ways of making it easier. The HIPAA complaint form is one of them. Rather than suffer in silence, physicians should take advantage of the opportunity to make their complaints known. If you don't want to use the online form, the AMA (and CMS) give you the option of mailing in a form.

The AMA and CMS tend to look at one complaint as indicative of problems experienced by perhaps 10, 20 or 50 other physicians, but the source of any problem may not feel the same way. The more physicians who share their problems, the better it will be for everyone trying to adapt to life under HIPAA.

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External links

AMA's HIPAA complaint form (link)

Centers for Medicare & Medicaid Services' HIPAA complaint form (link)

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