Every practice manager knows how important it is to provide patients with access to their medical records as required by the HIPAA laws. But what you may be less clear about is how to calculate fees for copies of medical records — and if you ask patients to pay too much, you could be hit with an $85,000 fine.
If you think these fines are just an empty threat from government officials, it’s important to know that several medical practices have already been fined. Therefore, as you create your medical record copying policies, you must know how to calculate the fees. Charge too little and you could be shorting your practice by having staff members spend time making copies for free. Charge too much, and you can be hit with fines — not to mention reactions from angry patients who don’t want to pay.
You have three options to choose from when calculating fees for copies of medical records so you are compensated for your time while staying compliant. Once you choose which method you plan to use, it’s essential to share the information with your entire team so your front desk can pass that information on to patients. If everyone is on the same page, you’ll face fewer complaints while still offsetting your costs when copying records.
Note that the below advice applies when patients request their own records and ask you to send or give the records to them directly. When you’re sending records to third parties, you have much more flexibility in setting your fees.
Method 1: Pinpoint Your Actual Costs
This method of tallying fees for copies of medical records will require the most time using a calculator, since you’ll have to get a few numbers to evaluate how much you’re spending to copy a patient’s record. Using this method, you’ll calculate the cost of fulfilling each request on a patient-by-patient basis, using the size of their records and the cost of your labor and supplies as a guide.
Labor: How much do you pay the employee who made the copies, and how much time did they spend? Keep in mind that you can’t factor in the amount of time the employee spends searching for and retrieving the records — only the time they spend copying and shipping.
Supplies: How much do you spend on supplies like paper, ink, CD-ROMs, USB drives, postage, and staples, and how much of those resources did you use making the copies?
Once you have these numbers, you can create a calculation of how much to charge the patient. For instance, your receptionist will be making the copies, and you pay them $18 per hour. Based on the size of the patient’s file, you expect it to take the receptionist 15 minutes to make the copies, print the shipping label, and apply postage to the mailer. Therefore, your labor cost in this example is $4.50 (one quarter of the receptionist’s hourly rate).
In this example, the patient’s record consists of 96 pages, and you pay two cents per piece of paper, your paper cost is $1.92. If you pay three cents per page in printer ink, the cost of the ink for this patient’s file is $2.88. Once you add the envelope (60 cents) and postage ($3.85), the cost of your supplies in this example is $9.25.
You’d add $9.25 to $4.50 and charge the patient $13.75 in this case.
Now that you understand how to calculate actual costs, it’s important to know the potential downsides of using this method. First, you must be able to inform patients of the cost ahead of time. If you aren’t sure who will be making the copies and how long it will take them, you may have trouble calculating the labor cost. And even if you do calculate it accurately, the estimate you give the patient may rely on your receptionist being in the office that day. If they call out sick and the practice manager (who earns much more per hour) has to make the copies, then you’ve shorted your practice money because the actual labor costs exceeded the estimate you gave the patient.
The other potential drawback for using this method is that the government indicates that the cost of labor must be “reasonable,” and notes that what is considered reasonable varies depending on “the level of skill needed to create and transmit the copy in the manner requested or agreed to by the individual.”
If, for instance, the physician is the only person in the office when the patient arrives to get their records, you cannot charge the patient the physician’s hourly rate, because that wouldn’t be “reasonable” based on how much skill is needed to make the copies.
Method 2: Establish Your Average Costs
If you want to avoid calculating labor and supply costs individually for each patient request, you can instead develop a schedule of fees for copies of medical records based on the average cost to fulfill standard types of requests.
Using this method, you can create a standard list of fees to show patients for record costs. To create this, you’ll review your last batch of patient record copy requests (for instance, the last 20 or so records that your patients requested) and evaluate the average cost of labor and supplies across those records. You can then determine a per-page cost of medical record copying fees that you’ll charge to patients.
As with the rules that applied to method 1 above, you can only calculate the average using the labor costs to copy and mail the pages, and not to search and retrieve the records. Plus, you can only charge a per-page cost if the records are maintained on paper and the patient requests paper copies. If you’re simply printing out electronic records or transferring them to another electronic format (like a CD), you cannot bill a per-page charge. Instead, you’ll move on to method 3…
Method 3: Charge a Flat Fee for Electronic Records
If you maintain your patients’ records in an electronic format, you can’t charge them per-page fees for copies of medical records, but you can charge a flat fee, as long as it doesn’t exceed $6.50, according to the Department of Health and Human Services (HHS). Your practice may want to create a list of flat fees based on the record size, such as $1.00 for up to 15 pages of electronic information transferred, $3.00 for up to 300 pages, and $6.50 for anything above 300 pages, as determined by your practice.
Keep State Laws in Mind
The above policies are outlined by HHS, but there may be cases where your state law differs from the federal guidelines. This is particularly important to note because some states require you to give patients at least one free copy of their medical records before charging them for subsequent requests, while other states limit you to charging maximum flat fees that are less than the $6.50 federal cap.
In most cases, the more stringent law is the one to follow — in other words, the lower price is the one you should go with. So, if your state requires you to only charge a $5.00 flat fee and the federal government allows you to charge $6.50, go with the $5.00 flat fee.
Check with your state medical society for state-specific laws that might supersede the federal guidance.
Charging fees for copies of medical records can be complicated, especially when you’re trying to figure out just what you can and can’t charge the patient for. That’s where Healthcare Training Leader’s online training session, Stop $85,000 Penalty: Comply With Medical Records Fees Rule, comes in. This 60-minute expert-led training walks you through what records you can charge for, and how much you can charge, to keep your practice HIPAA compliant. Sign up for this valuable training today.
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