In a continuing effort to manage and control the cost of health care for our members, Blue Cross and Blue Shield of New Mexico (BCBSNM), has contracted with Viant, Inc. to perform hospital DRG Audits on behalf of the Health Plan.
The purpose of the audits is to determine the accuracy of the information submitted for reimbursement purposes. A comprehensive review of the medical record documentation will be performed by an AHIMA accredited coding professional to determine compliance with the American Hospital Association Coding Clinic Guidelines and the ICD 9 CM Official Coding Conventions.
Pursuant to the Health Insurance Portability and Accessibility Act (HIPAA), Viant, Inc. is a contracted Business Associate of BCBSNM. Title 45 of the Code of Federal Regulations (CFR) § 164.502(e), authorizes a covered entity to disclose protected health information (PHI) to Business Associates of other Covered Entities for facilitation of accurate payment.
In addition, the insured as part of their enrollment application with BCBSNM has agreed to allow BCBSNM and its agents to review their medical records. It is our opinion that no other patient authorization is required. There should be no cost associated with this request unless otherwise stipulated per the existing contractual agreement.
Hospitals will soon be receiving a notification letter and an example of a Medical Record Disclosure Request. If you do not receive a letter, email Michael J. Nelson or call 505- 816-2139.
