HIPAA copy charges for medical records

Healthcare Financial Management, Dec, 2003 by Rose T. Dunn

* Charge the patient the cost to copy, and charge the client healthcare organization the difference (including retrieval costs, invoicing costs, and managerial oversight)

* Begin charging other healthcare providers who traditionally received free copies, such as hospitals and physician offices (unlikely, but possible)

* Charge the client healthcare organization for copies previously provided free or at a reduced rate

* Set a flat monthly rate for unreimbursed services

* Require healthcare organization staff to handle HIPAA-related requests

As with any process change, providers should consider the relative merits of outsourcing. If the activity is not outsourced, monitoring the revenue impact will be important for budgeting purposes even though this revenue source may be minor compared with other sources of revenue. Discussing outsourcing options with qualified firms may disclose that, even with charge-back provisions, the firms may be more cost-effective and process-efficient than the in-house efforts.

Processing Requests Internally

Each organization needs to assess the advantages of handling the release-of-information activities internally. From a HIPAA standpoint, doing so would enable an organization to more closely control the release processes, meet the timeliness requirement mandated by HIPAA, and avoid involving a third party in the activities.

From a labor consideration, one full-time equivalent (FTE) employee probably can handle about 15 to 20 requests per working day. Conservatively, 0.5 to 0.75 hours would be required to perform each request that requires retrieval and copying.

Efficiencies are gained with electronic access to online documents. Although off-site storage, paper-records systems, and uncontrolled incomplete records can hinder timely processing, some requests require only a master patient index look-up or a reprint of a report stored electronically or are rejected due to inadequate identifying information or an unacceptable authorization, thereby requiring less response time.

Organizations that provide all the equipment for the copy service incur much of the expense. A healthcare organization that is pulling the records for a copy service to copy and bill is losing payment for the majority of the labor effort involved in processing a request.

On the other hand, from a staffing standpoint, providing this function in-house will mean hiring additional FTEs, adding to the department's expenses. Furthermore, it turnaround time was a consideration when the organization outsourced this function in the past, HIPAA's deadlines for completing release-of-information requests should be considered. Assessing whether your HIM department has adequate staffing and management oversight available to maintain timely responses to requests is imperative.

Providers can offset some direct costs under HIPAA through the revenues received for providing copies, but indirect costs will not be subsidized under HIPAA's restrictive "individual" covenant. Further, organizations should expect that "non-individual" requests, which can continue to be charged the state-mandated rates, will decline because some of those requesters will place the burden of obtaining a copy of the record on the individual.