Fees for copying patient records: clarification

Ear, Nose & Throat Journal, Nov, 2007 by Kevin S. Kennedy, Steven F. Isenberg

Dear Editor:

I am writing concerning an article by Steven F. Isenberg, MD, in the Practice Management Clinic. (1) Dr. Isenberg mentioned that a fee can be charged for retrieval and duplication of patient records. One example was a $20 fee for this service.

The fees for retrieving medical records and the cost of copying and providing them to patients have become prohibitive and threaten my ability to continue in the private practice of otolaryngology. Dr. Isenberg's article makes tremendous sense. However, our main malpractice insurer in the state of Washington has indicated that there is a federal law that prohibits charging this tee to patients or to a patient's representative.

The following quote is from a "Risk Management Tip" from this company (Physicians insurance, Seattle): "As of July 1, 2005, the maximum charge for copying medical records is 91 cents per page for the first 30 pages and 69 cents per page thereafter. A $21 clerical searching and handling fee may be charged under state law, but federal law prohibits charging this fee to the patient or the patient's representative."

If there is a federal law that prohibits turning these fees over to patients or their representatives, it would be best to provide this information to your readers, since this article suggested that it is acceptable to charge this to patients.

Reference

(1.) Isenberg SF. Charging patients for medical records. Ear Nose Throat J 2007;86(5):271.

Kevin S. Kennedy, DO, FACS

Northwest Otolaryngology

Tacoma, Washington

Response

My article listed a "retrieval and handling fee" of $20. My research on the Web site of the United States Department of Health and Human Services revealed the following:

Question posed: "If patients request copies of their medical records as permitted by the Privacy Rule, are they required to pay for the copies?"

Answer: "The Privacy Rule permits the covered entity to impose reasonable, cost-based fees. The fee may include only the cost of copying (including supplies and labor) and postage, if the patient requests the copy to be mailed. If the patient has agreed to receive a summary or explanation of his or her protected health information, the covered entity may also charge a fee for preparation of the summary or explanation. The tee may not include costs associated with searching for and retrieving the requested information. See 45 CFR 164.524."

Therefore, even though it might be considered a question of semantics, you have a point. Listing "retrieval and handling fee" on the office form is probably not the best choice of words.

Steven E Isenberg, MD

Editor, Practice Management Clinic

Teaching Faculty, Community Hospital of Indianapolis

Associate Professor, Otolaryngology--Head and Neck Surgery

Indiana University School of Medicine

Indianapolis