Payment for records release

[Guest guest]

Here is a post I sent out a year ago to the AAFP list.

Locke, MD

From: Locke's in Colorado Sent: Thursday, April 21, 2005 11:13 PMTo: Practice Management IssuesSubject: RE: [practicemgt] Payment for records release

I imagine it varies by state, but here is our Colorado statute...see the end for the recommendations of the CDPHE.

Note that the regulations are NOT for private providers. It is only for hospitals...however, many private practices (like ours) base our guidelines off the state guidelines for hospitals.

Based on the info below, it sounds like the charge you received was within the acceptable amount if the chart was fairly large.However, it would seem that the doc should be billing the patient who requested the chart be sent, not your office.

“Reasonable cost” not to exceed $14.00 for the first 10 or fewer pages.

$.50 per page for pages 11-40

$.33 per page for every additional page

Cheers

Locke, MD

============================================

http://www.dora.state.co.us/medical/Policy40-7.htm

Policy: 40-7

Title: Guidelines Pertaining to the Release and Retention of Medical RecordsDate Issued: February 10, 2000Date(s) Revised: August 9, 2001 (paragraph 6 revised); 11/08/01 (paragraph 10 added); 5/15/03 (paragraph 10 revised); 1/13/05 (entire policy revised)Reference: PURPOSE: To provide guidelines to physicians and medical offices with respect to the Colorado Board of Medical Examiners' expectations regarding patient record release and retention.

POLICY: The Colorado Board of Medical Examiners (Board) has adopted the attached guidelines pertaining to the release and retention of medical records.

Medical Records Release

1. Colorado statute (25-1-802 C.R.S.) makes clear that records shall be available to the patient upon submission of a written authorization/request. There are no exceptions for circumstances such as the patient's failure to pay an outstanding bill for clinical services, failure to follow treatment instructions, or failure to return for follow-up care.

2. The statute does make an exception for psychiatric or psychological illnesses. (See §25-1-802 C.R.S.) Therefore, not all provisions of this policy apply to requests for copies of medical records related to psychiatric or psychological illnesses.

3. Disclosure of information concerning drug or alcohol problems may be restricted by the Federal confidentiality statute (42 C.F.R. Part 2) in some instances. The statute defines specific consent requirements such as purpose of disclosure, limitation of information released, right to revocation, expiration date of release, and signature of patient.

4. A valid request for release of records must be in writing. It should clearly identify the patient and be signed and dated by the patient or the patient's authorized representative.

5. The Board has concluded that except where medical urgency otherwise requires a more prompt response, thirty days is "reasonable notice" when records have been requested.

6. Physicians may charge a reasonable fee for copying of records and may ask for payment in advance. The Board notes that the Colorado Department of Public Health and Environment (CDPHE) has published rules setting forth reasonable costs for copies of medical records in licensed facilities. The Board considers these rules to be reasonable guidelines for physicians providing copies of medical records. It is customary when a patient is transferring care for physicians to provide copies of records to another physician's office free of charge.

7. Items such as x-rays, fetal monitor strips and electrocardiograms, which may not at the time of the request be physically in the medical record, are nonetheless considered part of the medical record. If these are specifically requested, then they must be copied and provided to the patient. The physician may charge the requesting party the cost of copying these records in advance.

8. In those instances where a patient cannot, or chooses not to, pay the fee for copying of medical records identified in paragraphs 6 and 7 above, the physician at a minimum must make the records available to the patient for inspection or otherwise provide access to the records.

9. Unless a summary of the case has already been prepared and is part of the medical record (e.g. a hospital summary at the time of discharge), a physician is not obligated to provide one.

10. This policy does not supercede state and federal law. A physician must provide patient records in compliance with state and federal law.

11. The Board advises physicians to consult with their medical liability insurance carrier regarding any guidelines it may have for record release.

Retention of Records

1. The Board recognizes that it is impractical in most cases to maintain records indefinitely. Consequently, the Board has surveyed the rules and guidelines of other state medical boards and insurance liability carriers to develop the following guidelines for records retention.

2. The Board recommends retaining all patient records for a minimum of 7 years after the last date of treatment, or 7 years after the patient reaches age 18 - whichever occurs later.

3. At the time of discontinuation of practice, patients should be notified and instructed to submit a written authorization/release if they wish their records transferred to another physician. Records should be retained after discontinuation of practice using the guidelines above.

* The Board recommends sending letters to patients seen in the last 3 years notifying them of discontinuance of practice;

* The physician may want to place a notice in the newspaper announcing discontinuance of practice;

* If all records are being transferred to another physician, patients should be notified as above.

4. In the event of a physician's death, the estate should retain the records utilizing the guidelines above.

5. In case of litigation or Board investigation, records must be retained until resolution of the matter.

6. When records are destroyed, it should be done in a manner that maintains patient confidentiality.

7. The Board advises physicians to consult with their medical liability insurance carrier regarding any guidelines it may have for record retention.

==========================================================

Here is our fees for copying...although we rarely charge it...and certainly not for faxing a copy to another doc.

http://www.alpinemedical.md/FeesCommon.htm

AMG follows State of Colorado's DPHE guidelines for reasonable fees of health facilitiesDepart of Public Health and Environment -- Health Facilities Division (HFD)Standards for Hospitals and Health Facilities

Summary of 6 C.C.R. 1011-1, Chapter 2, Part 5.2.3.4...

http://www.cdphe.state.co.us/op/regs/healthfacilities/10110102generallicensuresstandards.pdf

“Reasonable cost” not to exceed $14.00 for the first 10 or fewer pages.

$.50 per page for pages 11-40

$.33 per page for every additional page

The per-page fee for records copied from microfilm shall be $1.50 per page

Actual postage or shipping costs and applicable sales tax, if any, also may be charged.

6 C.C.R. 1011-1, Chapter 2, Part 5.2.3.4 http://www.cdphe.state.co.us/op/regs/healthfacilities/10110102generallicensuresstandards.pdf-- The discharged patient or representative shall pay for the reasonable cost of obtaining a copy of his/her patient record, not to exceed $14.00 for the first ten or fewer pages, $.50 per page for pages 11-40, and $.33 per page for every additional page. Actual postage or shipping costs and applicable sales tax, if any, also may be charged. The per page fee for records copied from microfilm shall be $1.50 per page. No fees shall be charged by a health care provider of patient records for requests for medical records received from another health care provider or to an individual regulated pursuant to Section 25-1-802(1) solely for the purpose of providing continuing medical care to a patient.For one or more specific classes of records or services, institutions may charge additional sums upon presenting a justification therefore acceptable to the Department.

=========================================

I believe the rules are based on the ruling below.

http://www.cdphe.state.co.us/op/bh/minutes/2001minutes/bhmay01minfin.pdf

MOTION CARRIED 6-3

PUBLIC RULEMAKING HEARING: Proposed repeal of Rule 5.3, Chapter II, Standards for Hospitals and Health Facilities, re: patient access to records in the custody of individual health care providers – Marge Block, Health Facilities Division

Staff Comments: Marge Block, Health Facilities Division, reviewed the proposal to repeal Standards for Hospitals and Health Facilities, Chapter II, section 5.3, initially discussed with the Board in March. She stated that this request is based on legal advice from the Attorney General’s Office that the department’s licensure authority does not extend to individual practitioners and that the department lacks the requisite authority for rulemaking under Section 25-1- 802, CRS. Therefore, the department is requesting that the rules pertaining to patient access to records in the custody of individual health care providers be repealed. Ms. Block pointed out that the statute does require that patients have access to their medical records and that costs be reasonable and the statute remains in effect.

MOVED by Mr. Cook, seconded by Ms. Zenon, to adopt the proposed rule as amended as follows, along with statement of basis and purpose, specific statutory authority and regulatory analysis: “The discharged patient or representative shall pay for the reasonable cost of obtaining a copy of his/her patient record not to exceed $14.00 for the first ten or fewer pages, $.50 per page for pages 11-40 and $.33 per page for every additional page. Actual postage or shipping costs and applicable sales tax also may be charged. The per page fee for records copied from microfilm shall be $1.50 per page. No fees shall be charged by a health care provider for a request for medical records received from another health care provider or to an individual regulated pursuant to Section 25-1-802(1) solely for the purpose of providing continuing care to the patient. For one or more specific classes of records or services, institutions may charge additional sums upon presenting a justification therefor acceptable to the department.”

Public Comments:

Dean, Colorado Legal Services, commented that his understanding is that the issue is not lack of authority, but because the department does not license individual practitioners, the department lacks the ability to enforce the regulations. He said he thinks there is clear authority for the regulation under Section 25-1-108 CRS, Powers and Duties of the State Board of Health. He commented that patients’ access to medical records is meaningless if any amount can be charged to get copies of those records. He said the intent of the patient records act is to protect patients and their access to these records and that is why the department has authority. Regarding the question of enforcement, he said it is his understanding that the department sends a letter if a complaint is received. He said that without some ceiling, it is a monopolistic market and the individual would have to go to court to establish that the fee is unreasonable. Dr. Barkett asked Ann Hause, First Assistant Attorney General, to comment regarding the proposed repeal. Ms. Hause commented that she agrees with the department’s request to repeal the regulations. She said there is not statutory authority for the department to oversee providers – the department has the ability to license and regulate health care facilities but it does not have regulatory authority over individual providers.

MOVED by Ms. Mulch, seconded by , to repeal section 5.3, Chapter II, Standards for Hospitals and Health Facilities, regarding patient access to records in the custody of individual health care providers, along with statement of basis and purpose, specific statutory authority and regulatory analysis.

From: J. Farris, M.D. Sent: Thursday, April 21, 2005 10:38 PMTo: Practice Management IssuesSubject: [practicemgt] Payment for records release

My office (in Kansas) requested records for patients that just moved to this area. Their previous doc (in Colorado) has charged me $30 for their records. Is this legal? I thought you couldn't charge other offices for records, or is this just a courtesy? I know we can charge ins companies or other 3rd parties, and I do. If this charge is legal, can it be passed directly on to the patient?

J. Farris, M.D.

Parsons Family Medicine, LLC

Parsons, KS

--- You are currently subscribed to practicemgt as: lockek@... To unsubscribe or to manage your settings, please go to http://members.aafp.org/members/cgi-bin/myaafp.pl?op=subscriptions & type=lists --- You are currently subscribed to practicemgt as: lockek@... To unsubscribe or to manage your settings, please go to http://members.aafp.org/members/cgi-bin/myaafp.pl?op=subscriptions & type=lists