The Truth About HIPAA “Medical Hacks” and Denied Claims

By Devin Partida, Editor-in-Chief,
Twitter: @rehackmagazine

Medical professionals prioritize giving people high-quality care and ensuring those patients get paid for that treatment via successful insurance claims. When a person deals with too many denials, their insurance plan becomes largely useless. That’s because the company providing coverage rules that the treatment does not meet the specifications requiring them to pay.

Denied claims can become a patient’s worst nightmare, especially when the care they need is lifesaving, but so pricey they cannot afford it without insurance reimbursement.

It’s not surprising, then, that a “medical hack” started making the rounds on social media. It claimed that patients could go through a relatively simple process to circumvent claim denial notices.

What Does the Information Promise?
The medical hack centers on asking people to contact a Health Insurance Portability and Accountability Act (HIPAA) compliance/privacy officer. After getting in touch with that person, the hack instructs the patient to ask for the name and credentials of everyone who accessed the record. The social media post then claims that patients almost always get their denied claims reversed.

Why? Supposedly, the HIPAA compliance officer would rather reverse the original outcome than admit to the person contacting them that low-paid high-school graduates most often decide whether to approve care. The implication is that patients may think medical specialists have the final say with their claims, but the people who actually do didn’t achieve high levels of education.

What’s True?
Snopes picked apart this internet information to see where it stands. It classified the content as a mixture of truth and fiction. Firstly, although health care organizations are required to have people on hand to explain HIPAA details to patients, they do not have either of the job titles mentioned in the post.

Indeed, it is a person’s right to know who accessed their medical records. However, the individual who has those details does not have to provide the credentials of each party that saw the patient’s records. On a related note, research conducted by the Snopes team did not indicate that the person who makes claims decisions must have medical expertise.

The final step of the information in the widely circulated internet meme told readers they should treat that outcome as a HIPAA violation if they do not receive the requested details. It also listed the point of contact as the Office of Civil Rights. That is the correct place to report suspected HIPAA violations, but you should not expect a claims decision reversal to come about from making such allegations.

Another fact-checking site pointed out that it’s the Employee Retirement Income Security Act (ERISA) — not HIPAA — that allows people to request details about the parties that played roles in undesirable decisions about insurance claims. That tidbit emphasizes why internet users should not believe everything they read online. Information often sounds accurate but isn’t as reliable as you’d hope.

Reducing Denied Claims
Statistics indicate that of the $3 trillion worth of claims submitted in 2018, approximately $262 billion of them resulted in denials. Getting to the bottom of insurance claims not approved for payment is not a straightforward matter.

It starts by ensuring patients understand if providers fall in or outside of their insurance networks. Next, patients must provide accurate information when registering with various health care providers.

Facilities can also take a data-driven approach to determine the root causes of denials. Knowing those specifics can help medical staff members know where to make changes in their workflows to potentially reduce claim denials. For example, are coding errors to blame? Perhaps internal slowdowns make facilities miss filing deadlines too often. If so, they need to look at how to streamline their system or become more aware of time-sensitive aspects.

Increasing Health Information Literacy
It’s also worth pointing out that health misinformation is a global problem not restricted to one country or platform. The people who spread it don’t necessarily do so out of malice. Many want to help others. You’ve probably shared social media information without fact-checking it too.

It’s too labor-intensive to verify and write rebuttals to every incorrect piece of health information you find online. However, you can be a responsible member of the medical community by clarifying things when patients ask questions about what they saw on social media or elsewhere. Put yourself in their shoes and remember how easy it is to get overwhelmed by the health care system.

No Hidden Tricks
Part of the viral post dissected above asserts they “do not want you to know this.” The reality is that there are no secrets available for the select few who know about them to take advantage of. Decreasing denial rates for insurance claims is a multifaceted effort.