Q. Do I have the right as a Medicare beneficiary to access the UB-04 form that a hospital submits as a bill for payment to Medicare? May I access and receive a copy of my coding abstract? I understand that these documents are part of the electronic data that is part of my record, which is considered part of the designated record set.
A. The Privacy Rule gives you the right to access records in the designated record set. This is defined as information used by a covered entity to make decisions about individuals. For providers, the designated record set includes medical and billing records. For health plans, the designated record set includes enrollment, payment, claims adjudication, and case management records.
The UB-04 form is a billing record, so it is part of the designated record set to which you have access.
The coding summary is an administrative record and may not be considered part of your medical record. If the covered entity defines the medical record to exclude administrative records, such as coding summaries, the covered entity may deny your request to access your coding summary. However, codes that were submitted for billing will appear on the UB-04.
Mary D. Brandt, MBA, RHIA, CHE, CHPS, answered this question in the December issue of the HCPro, Inc. newsletter Briefings on HIPAA .