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PacificSource - Partners
Billing and Coding Issues Concerns regarding questionable billing, coding and medical record documentation practices.
Health Insurance Portability and Accountability Act This Category should be selected if there is a concern with the improper use or disclosure of Protected Health Information. Protected Health Information is information that:
(1) is created or received by a health care provider, health plan, public health authority, employer, life insurer, school or university, or health care clearinghouse; and (2) relates to the past, present, or future physical or mental health or condition of an individual; the provision of health care to an individual; or the past, present, or future payment for the provision of health care to an individual; and (i) that identifies the individual; or (ii) for which there is a reasonable basis to believe the information can be used to identify the individual.
Physician Payment and Referral Concerns Concerns specifically related to physician payments/benefits and/or payment for referrals. (Examples include: paying a provider to refer patients to a facility, paying physicians more than fair market value for services provided, paying a provider without an executed contract, awarding a benefit to a physician that may violate the Stark regulations, etc.)
Violation of a Regulation Violation of any Medicare Advantage, Medicare Advantage Prescription Drug, Oregon Health Plan or state insurance regulation.
Suggestion  
Concern  
Inquiry  
Other If you feel that the definitions above do not describe the event, action or situation you are looking to report about, please use this header.