Medical Records Copying Fees: Avoid Violation, Pinpoint the Right Rule

QUESTION: When a state has a cap on the allowed records copying rate, is there ever a situation that justifies exceeding the maximum allowance? Sometimes, the request for the records is for a long-term patient, so there are a lot of pages to copy. Would this case permit charging more than the allowed max charge amount?

Question from Fairfax, Virginia subscriber

ANSWER: To avoid violating the numerous rules that apply to fees for copies of patients’ records, you must consider several areas before even checking your state allowance.

1.Requesting Source: If the request is from a payer, you first should check your contract. You may be contractually limited based on your negotiated rate with the health plan. For instance, Humana limits the medical records copying cap to $15.

If the request comes from the patient, federal HIPAA law applies, instead of state laws. HIPAA does not have a cap but cautions that the medical records copying fee must be reasonable and cost based.

Amount of Work: Look at what costs you incur for providing copies. If you are on electronic records, you don’t have the cost of printing out pages. It’s just the time in providing a bunch of documents. HIPAA does not allow fees for searching for and retrieving the personal health information even if state law authorizes such costs. Check if your state rules have an exception of when you can go over the cap.

This is where healthcare attorney Jennifer Searfoss, Esq., CPOM, CHCI, CMCS, can help. During her upcoming online training session “Stop $85,000 Penalty: Comply with New Medical Records Fees Rule,” she’ll show you exactly how to know who you can charge for copying medical records requests, how much the new regulations allow you to charge, and what you can include (or exclude) in those fees so you stop a HIPAA probe before it starts.