A Business Associate Agreement is signed before anyone touches protected health information.

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How we check our facts

Sources and method: how each figure on this site is checked

Sources and method in short: each figure on OffshoreMeds comes from a named public source that was opened and read before it was used, and the source is linked next to the figure. Where a source said less than a sentence claimed, the sentence was cut back to match. Our own prices and terms are labelled as ours. This page lists the sources, shows how the cost comparison is calculated and records corrections with their dates.

Facts last checked October 3, 2026.

The rules

The rules we follow

  • A figure from another organization is used only after we open its source and read the sentence it rests on. The source is linked next to the figure.
  • When a source says less than our sentence claimed, we cut the sentence back to match the source.
  • Prices and terms that are ours are labelled as ours. Prices are indicative until your written quote confirms the exact fee. Your own wages and savings will differ.
  • Rules that can limit offshore work are taken from the law or the regulator where we can read the original. This is general information, not legal advice. Review your payer contracts and the rules where you practice with your compliance advisor.
  • The site makes no claims about past clients, ratings or awards, because there is nothing of that kind to show.

Sources

Sources used on this site

Each source below was opened and read on the date shown for it or earlier. The As of column gives the source’s own date or edition.

Sources behind the figures and rules on this site
PublisherDocumentAs of
Publisher: US Bureau of Labor StatisticsDocument: Occupational Outlook Handbook: Medical Records SpecialistsAs of: May 2025
Publisher: US Bureau of Labor StatisticsDocument: Employer Costs for Employee CompensationAs of: June 2026
Publisher: US Bureau of Labor StatisticsDocument: JOLTS total separations rate, health care and social assistance (JTS620000000000000TSR)As of: 2025
Publisher: MGMADocument: Days in A/R holds steady for most practices, but payer pressure persists in 2026As of: July 2026
Publisher: American Academy of Family PhysiciansDocument: Practice financesAs of: current
Publisher: SHRMDocument: The real costs of recruitmentAs of: 2022
Publisher: Journal of AHIMADocument: In Pursuit of Comparable Coding Audit Benchmarks (Stanfill)As of: January 2019
Publisher: US Department of Health & Human ServicesDocument: Business Associates (45 CFR 164.502(e), 164.504(e))As of: current
Publisher: US Department of Health & Human ServicesDocument: Are we required to certify our compliance with the Security Rule?As of: current
Publisher: US Department of Health & Human ServicesDocument: Can a CSP store ePHI on servers outside the United States?As of: current
Publisher: CMSDocument: Medicare Part D application, 2025 contract year: Offshore Subcontract Information and AttestationAs of: 2025
Publisher: US Code (govinfo.gov)Document: 42 U.S.C. 1396a(a)(80): no Medicaid payments for items or services to entities outside the USAs of: current
Publisher: Sheppard Mullin (National Law Review)Document: Texas HHSC Uniform Managed Care Terms 4.11(c): no HHSC information moved or remotely accessed outside the USAs of: 2024
Publisher: CMSDocument: SMD letter 10-026: Medicaid payments to entities outside the USAs of: 2010
Publisher: CMSDocument: Medicare Claims Processing Manual, chapter 24, sections 30.1 (EDI enrollment) and 40.2.2.3 (billing services and clearinghouses)As of: chapter revision April 2025
Publisher: eCFRDocument: 42 CFR 424.73(b)(3): payment to an agent who furnishes billing and collection servicesAs of: current to October 2026
Publisher: eCFRDocument: 42 CFR 447.10(f): Medicaid payment to a business agent such as a billing serviceAs of: current to October 2026
Publisher: KFFDocument: Claims denials and appeals in ACA Marketplace plans in 2024As of: March 2026
Publisher: CAQHDocument: 2025 CAQH Index Executive Report: medical plan adoption of fully electronic transactionsAs of: December 2025
Publisher: Florida LegislatureDocument: Florida Statutes 408.051(3): security and storage of personal medical informationAs of: 2024 statutes
Publisher: Texas LegislatureDocument: SB 1188 (89th Legislature): new Health and Safety Code chapter 183, electronic health recordsAs of: 2025
Publisher: Community Behavioral Health (Philadelphia)Document: Provider Bulletin 26-05: changes to the provider agreement relating to use of offshore resourcesAs of: March 2026
Publisher: HHS Office of Inspector GeneralDocument: Offshore outsourcing of administrative functions by State Medicaid agencies (OEI-09-12-00530)As of: April 2014
Publisher: HHS Office of Inspector GeneralDocument: Compliance program guidance for third-party medical billing companies, 63 FR 70138As of: 1998
Publisher: eCFRDocument: 42 CFR 424.44: time limits for filing Medicare claimsAs of: current to October 2026
Publisher: eCFRDocument: 42 CFR 447.45(d)(1): Medicaid timely claims processingAs of: current to October 2026
Publisher: Cigna HealthcareDocument: When to file your claimsAs of: current (undated page)
Publisher: AetnaDocument: Provider manual state supplement (July 2026 edition), New York claims submission periodAs of: July 2026
Publisher: Texas Medicaid and Healthcare PartnershipDocument: Texas Medicaid provider procedures manual: claims filing deadlinesAs of: 2026
Publisher: Illinois Department of Healthcare and Family ServicesDocument: Timely filing: claim submittal for non-institutional providersAs of: current (undated page)
Publisher: CMSDocument: CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F), fact sheetAs of: January 2024
Publisher: eCFRDocument: 42 CFR 422.504(i): MA organization relationship with first tier, downstream and related entitiesAs of: current to October 2026
Publisher: eCFRDocument: 42 CFR 423.505(i): Part D sponsor relationship with first tier, downstream and related entitiesAs of: current to October 2026
Publisher: eCFRDocument: 45 CFR 164.308(a)(1): security management process, risk analysisAs of: current to October 2026
Publisher: eCFRDocument: 45 CFR 164.312: technical safeguards, unique user identification and audit controlsAs of: current to October 2026
Publisher: eCFRDocument: 45 CFR 164.404: notification to individualsAs of: current to October 2026
Publisher: eCFRDocument: 45 CFR 164.406: notification to the mediaAs of: current to October 2026
Publisher: eCFRDocument: 45 CFR 164.408: notification to the SecretaryAs of: current to October 2026
Publisher: eCFRDocument: 45 CFR 164.402: definitions of breach and unsecured protected health informationAs of: current to October 2026
Publisher: eCFRDocument: 45 CFR 160.402: basis for a civil money penaltyAs of: current to October 2026
Publisher: eCFRDocument: 45 CFR 160.404: amount of a civil money penaltyAs of: current to October 2026
Publisher: eCFRDocument: 45 CFR 102.3: adjusted civil monetary penalty amountsAs of: January 2026
Publisher: Federal Register (HHS)Document: Notification of enforcement discretion regarding HIPAA civil money penaltiesAs of: April 2019
Publisher: US Department of Health & Human ServicesDocument: Direct liability of business associates under HIPAA (fact sheet)As of: 2019
Publisher: US Department of Health & Human ServicesDocument: Breach notification ruleAs of: current
Publisher: Federal Register (HHS)Document: Modifications to the HIPAA Privacy, Security, Enforcement and Breach Notification Rules (78 FR 5566)As of: January 2013
Publisher: HHS Office of Inspector GeneralDocument: Updated Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care ProgramsAs of: May 2013
Publisher: HHS Office of Inspector GeneralDocument: LEIE quick tips and instructionsAs of: current
Publisher: US CodeDocument: 42 USC 1320a-7a (Social Security Act section 1128A)As of: 2024 edition
Publisher: eCFRDocument: 42 CFR 455.436: federal database checksAs of: current to October 2026
Publisher: eCFRDocument: 42 CFR 438.610: prohibited affiliationsAs of: current to October 2026
Publisher: CMSDocument: Medicare Managed Care Manual, chapter 21, section 50.6.8 (exclusion screening)As of: text effective July 2012
Publisher: Texas Medicaid and Healthcare PartnershipDocument: Texas Medicaid Provider Procedures Manual, volume 1, section 1.3.1As of: September 2026
Publisher: HHS Office of Inspector GeneralDocument: General Compliance Program GuidanceAs of: November 2023
Publisher: US Department of Health & Human ServicesDocument: Can business associates self-certify or be certified by a third party instead of a contract?As of: reviewed January 2023
Publisher: eCFRDocument: 45 CFR 164.314: organizational requirements (business associate contracts)As of: current to October 2026
Publisher: US CongressDocument: Public Law 116-321 (HITECH Act section 13412, recognized security practices)As of: January 2021
Publisher: Federal Register (HHS)Document: Considerations for implementing the HITECH Act, as amended (request for information)As of: April 2022
Publisher: US Department of Health & Human ServicesDocument: HIPAA Security Rule crosswalk to the NIST Cybersecurity FrameworkAs of: 2016
Publisher: NISTDocument: SP 800-66 Revision 2: implementing the HIPAA Security RuleAs of: February 2024
Publisher: AICPA & CIMADocument: System and Organization Controls: SOC suite of servicesAs of: current
Publisher: Journal of AccountancyDocument: Explaining the 3 faces of SOCAs of: June 2016
Publisher: ISODocument: ISO/IEC 27001:2022 information security management systemsAs of: 2022
Publisher: HITRUST AllianceDocument: HITRUST advisory HAA 2023-004: e1 assessment introductionAs of: January 2023
Publisher: Federal Register (HHS)Document: HIPAA Security Rule to strengthen the cybersecurity of electronic protected health information (NPRM, 90 FR 898)As of: January 2025
Publisher: US Department of Health & Human ServicesDocument: HIPAA Security Rule NPRM fact sheetAs of: December 2024
Publisher: reginfo.gov (OIRA)Document: Unified Agenda entry for RIN 0945-AA22, edition labelled 2026As of: 2026
Publisher: Federal RegisterDocument: Introduction to the Unified Agenda of Federal Regulatory and Deregulatory Actions, 2026As of: August 2026
Publisher: ISODocument: ISO: certificationAs of: current
Publisher: reginfo.gov (OIRA)Document: Unified Agenda entry for RIN 0945-AA22, Spring 2025 editionAs of: Spring 2025
Publisher: Ohio Department of MedicaidDocument: Medicaid provider agreement for managed care organizations, Article XIII (Rev. 7/2025)As of: July 2025
Publisher: Virginia Department of Medical Assistance ServicesDocument: Medallion 4.0 managed care contract, SFY23, sections 5.2 and 10.8As of: July 2022
Publisher: Virginia Department of Medical Assistance ServicesDocument: Cardinal Care managed care contract, January to June 2025 amendment, section 14As of: 2025
Publisher: TennCare (State of Tennessee)Document: TennCare business associate agreement form TC-0151 (Rev. 7/24), section 4.4.2, as attached to a TennCare contractAs of: July 2024 revision (the October 2025 revision carries the same section)
Publisher: eCFRDocument: 42 CFR 438.602(i): entities located outside of the U.S.As of: current to October 2026
Publisher: US Office of Personnel ManagementDocument: FEHB Program Carrier Letter 2026-04: offshore contractingAs of: August 2026
Publisher: HealthcodeDocument: About Healthcode: statistics blockAs of: page modified September 2026
Publisher: eCFRDocument: 45 CFR 160.103: definitions (workforce, business associate, subcontractor)As of: current to October 2026
Publisher: Federal Register (HHS)Document: Standards for privacy of individually identifiable health information, final rule (65 FR 82462)As of: December 2000
Publisher: Federal Register (HHS)Document: Standards for privacy of individually identifiable health information, final rule (67 FR 53182)As of: August 2002
Publisher: eCFRDocument: 42 CFR 2.11: definitions (records, qualified service organization, third-party payer)As of: current to October 2026
Publisher: eCFRDocument: 42 CFR 2.12 and 2.20: applicability and relationship to State lawAs of: current to October 2026
Publisher: eCFRDocument: 42 CFR 2.31 and 2.33: consent and uses and disclosures with consentAs of: current to October 2026
Publisher: eCFRDocument: 42 CFR 2.3 and 2.4: civil and criminal penalties, complaintsAs of: current to October 2026
Publisher: Federal Register (HHS)Document: Confidentiality of substance use disorder patient records, final rule (89 FR 12472)As of: February 2024
Publisher: US Department of Health & Human ServicesDocument: HHS OCR: Part 2 (confidentiality of substance use disorder patient records)As of: reviewed September 2026
Publisher: eCFRDocument: 42 CFR 423.568: standard timeframe for coverage determinationsAs of: current to October 2026
Publisher: eCFRDocument: 42 CFR 423.570 and 423.572: expediting and timeframe for expedited determinationsAs of: current to October 2026
Publisher: eCFRDocument: 42 CFR 423.582 and 423.590: redetermination request and timeframesAs of: current to October 2026
Publisher: eCFRDocument: 42 CFR 422.568: standard timeframe for organization determinations (Medicare Advantage)As of: current to October 2026
Publisher: Cornell Legal Information Institute (US Code)Document: 42 USC 1396r-8(d)(5): prior authorization programs for covered outpatient drugsAs of: current
Publisher: eCFRDocument: 42 CFR 438.3(s)(6): covered outpatient drug prior authorization in managed careAs of: current to October 2026
Publisher: Federal Register (CMS)Document: Interoperability and prior authorization final rule (CMS-0057-F), 89 FR 8758As of: February 2024
Publisher: eCFRDocument: 42 CFR 423.160: standards for electronic prescribing (including prior authorization transactions)As of: current to October 2026
Publisher: Federal Register (CMS)Document: CMS-0062-P: patient protection and affordable care act interoperability standards (proposed rule, 91 FR 19890)As of: April 2026
Publisher: US Department of Health & Human ServicesDocument: May a business associate block or terminate access to protected health information? (OCR FAQ 2074)As of: reviewed 2022
Publisher: US Department of Health & Human ServicesDocument: Sample business associate agreement provisionsAs of: reviewed 2013
Publisher: eCFRDocument: 45 CFR 164.524: access of individuals to protected health informationAs of: current to October 2026
Publisher: eCFRDocument: 45 CFR 164.528: accounting of disclosuresAs of: current to October 2026
Publisher: eCFRDocument: 45 CFR 164.316: documentation (Security Rule)As of: current to October 2026
Publisher: eCFRDocument: 42 CFR 424.80: prohibition of reassignment of claims by suppliersAs of: current to October 2026
Publisher: CMSDocument: Medicare Claims Processing Manual, chapter 1, section 30.2 (payment to an agent)As of: Rev. 13725, April 2026
Publisher: CMSDocument: Medicare Program Integrity Manual, chapter 10: enrollment sections 10.4 to 10.6, including 10.6.8 (billing agencies)As of: Rev. 13717, July 2026
Publisher: HHS Office of Inspector GeneralDocument: Compliance program guidance for individual and small group physician practices (65 FR 59434)As of: October 2000
Publisher: CMSDocument: Comprehensive Error Rate Testing (CERT) programAs of: page modified August 2026
Publisher: AAPCDocument: Medical coding credential verificationAs of: current
Publisher: AHIMADocument: Credential verification portalAs of: current
Publisher: eCFRDocument: 45 CFR 164.302: applicability (Security Rule)As of: current to October 2026
Publisher: eCFRDocument: 45 CFR 164.514: other requirements relating to uses and disclosures (minimum necessary)As of: current to October 2026
Publisher: eCFRDocument: 45 CFR 164.530: administrative requirements (training, sanctions)As of: current to October 2026
Publisher: US Department of Health & Human ServicesDocument: Security Series paper 1: Security 101 for covered entitiesAs of: revised 2007
Publisher: US Department of Health & Human ServicesDocument: OCR resolution agreement and corrective action plan: Doctors' Management ServicesAs of: reviewed October 2023
Publisher: eCFRDocument: 28 CFR Part 202: preventing access to U.S. sensitive personal data and government-related data by countries of concern or covered personsAs of: current to October 2026
Publisher: Federal Register (DOJ)Document: Preventing access to U.S. sensitive personal data and government-related data by countries of concern or covered persons, final rule (90 FR 1636)As of: January 2025
Publisher: DOJ National Security DivisionDocument: Data Security Program: frequently asked questionsAs of: updated September 2025
Publisher: DOJ National Security DivisionDocument: Data Security Program: compliance guideAs of: April 2025
Publisher: CISADocument: Security requirements for restricted transactions, E.O. 14117 implementationAs of: January 2025
Publisher: American Medical AssociationDocument: 2025 AMA Prior Authorization Physician Survey (1,000 practicing physicians)As of: May 2026
Publisher: eCFRDocument: 45 CFR 160.103: definition of State (includes Puerto Rico)As of: current to October 2026
Publisher: eCFRDocument: 45 CFR 164.410: notification by a business associate (60 calendar days)As of: current to October 2026
Publisher: eCFRDocument: 45 CFR 164.504(e): business associate contractsAs of: current to October 2026
Publisher: AJMC (Chou, Kumar, Rivera-Hernandez)Document: Medicare Advantage in the US mainland and Puerto RicoAs of: February 2026
Publisher: US Bureau of Labor StatisticsDocument: OEWS annual mean wage, medical records specialists, Puerto Rico (series OEUS720000000000029207204)As of: May 2025
Publisher: US Bureau of Labor StatisticsDocument: OEWS annual mean wage, medical records specialists, United States (series OEUN000000000000029207204)As of: May 2025
Publisher: Wellcare (California)Document: Offshore Subcontracting Attestation for Participating Provider, form 25-1301As of: December 2025
Publisher: Ontario Ministry of HealthDocument: Resources for physicians: claims submissionAs of: April 2026
Publisher: Government of Ontario (e-Laws)Document: Personal Health Information Protection Act, 2004, sections 6(1), 17(1) and 50(1)As of: current to September 2026
Publisher: Office of the Privacy Commissioner of CanadaDocument: Guidelines for processing personal data across bordersAs of: 2009
Publisher: Commission d'accès à l'information du QuébecDocument: Privacy impact assessment before communicating personal information outside QuebecAs of: current
Publisher: Job Bank, Government of CanadaDocument: Wages: medical administrative assistants (NOC 13112)As of: 2023-2024
Publisher: Information Commissioner's OfficeDocument: International transfers: a guideAs of: January 2026
Publisher: Information Commissioner's OfficeDocument: When is a contract needed between a controller and a processor?As of: current
Publisher: HealthcodeDocument: The Clearing ServiceAs of: current
Publisher: Clinical Coding & Schedule Development groupDocument: The CCSD ScheduleAs of: current
Publisher: Ontario Ministry of HealthDocument: OHIP billing number registration: registered third party billing agenciesAs of: November 2024
Publisher: Ontario Ministry of HealthDocument: INFOBulletin 4656: physicians submitting claims to OHIPAs of: August 2015
Publisher: Clinical Coding & Schedule Development groupDocument: Who needs a licence to use the CCSD ScheduleAs of: current
Publisher: eCFRDocument: 42 CFR 405.942 and 405.950: time to request and decide a redeterminationAs of: current to October 2026
Publisher: eCFRDocument: 42 CFR 405.962 and 405.970: time to request and decide a reconsiderationAs of: current to October 2026
Publisher: eCFRDocument: 42 CFR 405.1014 and 405.1016: time to request an ALJ hearing and OMHA's decision periodAs of: current to October 2026
Publisher: eCFRDocument: 42 CFR 405.1100, 405.1102 and 405.1132: Medicare Appeals Council review and escalation to courtAs of: current to October 2026
Publisher: eCFRDocument: 42 CFR 405.1130 and 405.1136: judicial review in federal district courtAs of: current to October 2026
Publisher: eCFRDocument: 42 CFR 405.1006: amount in controversy required for an ALJ hearing and judicial reviewAs of: current to October 2026
Publisher: eCFRDocument: 42 CFR 405.980: reopening of initial determinations and redeterminationsAs of: current to October 2026
Publisher: eCFRDocument: 42 CFR 405.910: appointed representativesAs of: current to October 2026
Publisher: eCFRDocument: 42 CFR 405.1018: submitting evidence before an ALJ hearingAs of: current to October 2026
Publisher: Federal RegisterDocument: Medicare Program; Medicare Appeals; Adjustment to the Amount in Controversy Threshold Amounts for Calendar Year 2025As of: September 2024
Publisher: Federal RegisterDocument: Medicare Program; Medicare Appeals; Adjustment to the Amount in Controversy Threshold Amounts for Calendar Year 2026 (90 FR 55869)As of: December 2025
Publisher: Federal RegisterDocument: Medicare Program; Medicare Appeals; Adjustment to the Amount in Controversy Threshold Amounts for Calendar Year 2027 (91 FR 58681)As of: September 2026
Publisher: eCFRDocument: 45 CFR 162.923: requirements for covered entities (standard transactions and business associates)As of: current to October 2026
Publisher: eCFRDocument: 45 CFR 162.925: additional requirements for health plansAs of: current to October 2026
Publisher: eCFRDocument: 45 CFR Part 162, subparts K to R: standards for claims, eligibility, referral authorization, claim status and remittanceAs of: current to October 2026
Publisher: eCFRDocument: 45 CFR 164.500(b): a clearinghouse's Privacy Rule duties when it acts as a business associateAs of: current to October 2026
Publisher: Federal Register (HHS)Document: Health insurance reform: standards for electronic transactions, final rule (65 FR 50312)As of: August 2000
Publisher: CMSDocument: Guidance letter GL-2022-03: business associates and the Administrative Simplification requirementsAs of: March 2022
Publisher: US Department of Health & Human ServicesDocument: Is a software vendor a business associate of a covered entity?As of: reviewed December 2022
Publisher: Federal Register (HHS)Document: Administrative Simplification: adoption of standards for health care claims attachments transactions (91 FR 14350)As of: March 2026
Publisher: eCFRDocument: 42 CFR 424.520: effective date of billing privilegesAs of: current to October 2026
Publisher: eCFRDocument: 42 CFR 424.521: request for payment (retrospective billing)As of: current to October 2026
Publisher: eCFRDocument: 42 CFR 424.516: responsibility for reporting changesAs of: current to October 2026
Publisher: eCFRDocument: 42 CFR 424.515: requirements for reporting and revalidationAs of: current to October 2026
Publisher: eCFRDocument: 42 CFR 424.535: revocation of enrollmentAs of: current to October 2026
Publisher: eCFRDocument: 42 CFR 424.540: deactivation of billing privilegesAs of: current to October 2026
Publisher: Federal Register (CMS)Document: Calendar year 2027 home health prospective payment system proposed rule (91 FR 41216)As of: July 2026
Publisher: CMSDocument: Revalidations (renewing your enrollment)As of: page modified July 2025
Publisher: CMSDocument: PECOS fact sheetAs of: December 2024
Publisher: eCFRDocument: 45 CFR 162.410: implementation specifications for covered health care providers (NPPES changes)As of: current to October 2026
Publisher: CAQH (DataSpring)Document: CAQH resources: attestation and directory confirmationAs of: current
Publisher: CAQH (DataSpring)Document: General terms of service (effective September 29, 2026)As of: September 2026
Publisher: Office of Management and Budget (reginfo.gov)Document: Information collection 202603-0938-001 (Form CMS-855I)As of: October 2026
Publisher: CMSDocument: Medicare Advantage Risk Adjustment Data Validation programAs of: page modified March 2026
Publisher: CMSDocument: Payment year 2024 RADV audit methods and instructionsAs of: August 2026
Publisher: eCFRDocument: 42 CFR 422.310: risk adjustment dataAs of: current to October 2026
Publisher: eCFRDocument: 42 CFR 422.311: RADV audits (report, appeal and burden of proof)As of: current to October 2026
Publisher: eCFRDocument: 42 CFR 422.504(l): certification of risk adjustment dataAs of: current to October 2026
Publisher: Federal Register (CMS)Document: Policy and technical changes to the Medicare Advantage and Part D programs for years 2020 and 2021, RADV final rule (88 FR 6643)As of: February 2023
Publisher: US District Court, Northern District of Texas (govinfo.gov)Document: Humana Inc. v. Becerra, order vacating and remanding the 2023 RADV ruleAs of: September 2025
Publisher: US Court of Appeals for the Fifth CircuitDocument: Opinions listingAs of: read October 17, 2026
Publisher: CMSDocument: Calendar year 2024 Medicare Advantage Rate AnnouncementAs of: March 2023
Publisher: CMSDocument: Calendar year 2025 Medicare Advantage Rate AnnouncementAs of: April 2024
Publisher: CMSDocument: Calendar year 2026 Medicare Advantage Rate AnnouncementAs of: April 2025
Publisher: CMSDocument: Calendar year 2027 Medicare Advantage Rate AnnouncementAs of: April 2026
Publisher: HHS Office of Inspector GeneralDocument: Medicare Advantage industry segment-specific compliance program guidanceAs of: 2026
Publisher: HHS Office of Inspector GeneralDocument: Audit A-07-24-01214: Medicare Advantage risk adjustment diagnosis codesAs of: September 2026
Publisher: HHS Office of Inspector GeneralDocument: Audit A-05-24-00010: Medicare Advantage risk adjustment diagnosis codesAs of: September 2026
Publisher: HHS Office of Inspector GeneralDocument: Audit A-03-22-00004: Medicare Advantage risk adjustment diagnosis codesAs of: March 2026
Publisher: HHS Office of Inspector GeneralDocument: Audit A-07-22-01207: Medicare Advantage risk adjustment diagnosis codesAs of: March 2026
Publisher: Information and Privacy Commissioner of OntarioDocument: Frequently asked questions: Personal Health Information Protection ActAs of: September 2015
Publisher: Information Commissioner's OfficeDocument: Are we making a restricted transfer?As of: January 2026
Publisher: Information Commissioner's OfficeDocument: Adequacy regulations: is the restricted transfer covered by adequacy regulations?As of: updated July 2026
Publisher: European Data Protection BoardDocument: Guidelines 05/2021 on the interplay between Article 3 and Chapter V of the GDPRAs of: February 2023
Publisher: European CommissionDocument: Adequacy decisionsAs of: page modified July 2026
Publisher: European CommissionDocument: Standard contractual clauses (SCC)As of: page modified June 2026
Publisher: EUR-LexDocument: Regulation (EU) 2016/679 (GDPR), Articles 28 and 44 to 49As of: current
Publisher: Office of the Australian Information CommissionerDocument: APP guidelines, chapter 8: cross-border disclosure of personal information (v1.3)As of: October 2025
Publisher: Australian Government (legislation.gov.au)Document: Privacy Act 1988: APP 8, section 16C and Schedule 1As of: compilation of June 2026
Publisher: Australian Government (legislation.gov.au)Document: Privacy Regulations 2025As of: in force November 2025
Publisher: Australian Government (legislation.gov.au)Document: My Health Records Act 2012, section 77As of: compilation of July 2026
Publisher: Office of the Privacy Commissioner (New Zealand)Document: Sending personal information overseasAs of: current
Publisher: Office of the Privacy Commissioner (New Zealand)Document: Working with third-party providers: understanding your privacy responsibilitiesAs of: November 2024

Method

How the cost comparison is calculated

The in-house figure starts from the BLS median wage for a US medical records specialist, $51,140. Benefits are scaled from the BLS benefit share of 30% of compensation, which adds $21,917. Rehiring multiplies the SHRM cost per hire, $4,700, by BLS annual turnover in health care, 34%, which adds $1,598. The total is $74,655 a year.

Workspace, hardware, software and supervisor time are left out, so the in-house cost is understated rather than overstated. The full comparison, with a percentage-of-collections example, is on the offshore medical billing cost page.

Limits

Sources our tools could not open

Three primary documents refuse automated downloads: the CMS Part D application, CMS letter SMD 10-026 and the Texas HHSC managed care contract. We read the first two through search-engine extracts and the third through a law firm’s published summary, which is the document linked where we cite it. Open each link yourself to confirm what it says.

Corrections

Corrections

When a published statement turns out to say more than its source, we correct it and record it here. The first corrections, all made on October 4, 2026, followed a line-by-line check of each source:

Corrections to published statements
WhereWhat changed
Where: Home page, security sectionWhat changed: A statement that Medicaid payments cannot go to entities outside the US was narrowed. The statute bars payments for items or services to such entities, and CMS says administrative outsourcing such as claims processing is not covered by that ban.
Where: Home page security section and HIPAA page (October 9, 2026)What changed: The Medicaid statement was corrected again after reading the CMS letter in full. The carve-out for outsourcing covers a State's own plan administration. CMS says the ban does reach payments to entities such as provider bank accounts or business agents located outside the US and its territories.
Where: Home page, servicesWhat changed: A denial-rate benchmark attributed to AAFP and MGMA now quotes AAFP only: it calls a rate below 5% more desirable than the industry average.
Where: Home page, cost sectionWhat changed: The annual turnover figure was corrected to match the BLS 2025 series.
Where: Home page, security sectionWhat changed: A statement that Medicare Advantage plans often pass the offshore requirement to providers was removed because we could not confirm it.

Later corrections are added to this table with their date. To report an error, book a call using the calendar on this page and tell us which page and which figure.

The terms behind each seat

One flat monthly fee per seat, never a percentage of collections. A Business Associate Agreement is signed before anyone touches protected health information. Clinical decisions stay with your US-licensed providers. See all OffshoreMeds services.

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