Medical record retrieval becomes necessary when the records are needed for personal reasons of patients, insurance purposes and legal purposes. The medical records are kept in medical facilities, hospital record departments and physician offices, and these entities incur costs finding the appropriate records and copying them. The HIPAA Act allows medical record custodians to charge a “reasonable, cost-based fee” when fulfilling a request for medical records. State laws define which persons/entities are considered healthcare providers, and have clear regulation regarding their scopes of practice and service in each state. However, very often patients find that the record retrieval process is quite expensive.
A recent Forbes.com highlighted this fact saying that you may have to pay $111.68 for the copy of a 100-page paper medical record file in Georgia, or $218.70 for 150 pages in Minnesota. These heavy costs may limit patients from gaining easy access to their medical records. As the article points out, a patient earning Georgia’s minimum wage of $5.15 will have to work for more than 21 hours to pay for a copy of his/her medical record.
The HIPAA directives were written primarily for paper records, whereas electronic health records are the norm today. This creates confusion as regards the actual fees that can be charged. The “reasonable” and “cost-based” fee that providers can charge are only for recovering certain specific expenses such as paper and toner; postage to mail copies to the patients, photocopying/scanning costs, summary preparation and so on. Costs such as search and retrieval time or the expense of maintaining a data storage system cannot be charged from the patient. Unfortunately, state laws still keep paper records as the basis and around 42 states specify their medical record retrieval and copying fees, and these per-page rates differ widely. It can range from zero dollars in Kentucky (a state which mandates that patients can receive at least one copy of their records free) to as much as $700. The wide variation in costs among states does not actually make the charged amount reasonable and cost-based.
In this EHR age, it is estimated that 97% of hospitals and 83% physicians in the US use electronic health record systems. Surely, retrieval of medical records must be easier and less expensive in this scenario. For this, the government can provide clear guidance as regards the fees that can be charged and make the fees more consistent across the country. Indeed, the OCR (Department of Health and Human Services Office of Civil Rights) issued new guidance to healthcare providers that they charge a flat fee of $6.50 for electronic health records, irrespective of the size. This fee includes labor, supplies, and postage.
This amount is not a cap on EHR fees but an option given for providers. Other options providers have are to:
- Calculate their actual costs for copying a patient’s record
- Calculate and charge their average cost to copy the records
Other clarifications made by the guidance include:
- The broad scope of information to which people have access
- The medium by which this information can be provided
- The right of a person to direct a copy of their medical record to a third party of their choice.
- Only specific costs such as labor for copying, materials for creating the electronic or paper copy, and postage charges can be imposed as copy fees.
Even though this guidance has been provided, many state laws and healthcare providers have established their own per-page copy fees. There are states that allow providers to charge copy fees for the costs in relation to data verification and maintaining storage. Some impose fees for search and retrieval as well (for which these regulations clearly prohibit charges). This has led to considerable confusion among the healthcare providers, lawyers, medical record retrieval companies, and the public regarding the rules to access medical records. State regulations need to be updated to prevent such confusion and ensure clear and direct access rights.
As providers of medical review services, we know how important it is for patients and lawyers to gain speedy access to the medical chart. Higher costs can prove to be a major impediment in this regard. Though patient portals are offered by many providers now, they can give only less information than a complete medical record. Unrestricted access to their medical records will enable patients to correct errors if any, obtain informed second opinions, and if required share their care details with others. That is the way to ensure patient empowerment and patient-centered care in the true sense, apart from ensuring the much needed quick access to relevant medical records for legal purposes.