Charging for records sent to providers

MnTwins29

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Hi - in my role as a privacy officer for a large system, I have encountered multiple complaints about practices charging patients or our providers for records sent to our providers when patients either transfer to our facilities or present to the office/facility for the first time. As a patient, I encountered this - my former physician office was going to charge me 75 cents per page and not send an electronic copy of my record there when I moved to my new location and new provider. This was because I made the request, not the physician office. Rather than correct them, I just had the office request them as it was quicker and resulted in no charge. I thought that was just that particular practice, but it turns out that isn't the case. So, I am wondering why offices would do this and risk a complaint investigation, especially now that OCR is focusing on patient access.

Thank you,
Lance
 

SharonCollachi

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75 cents a page is a hefty cost, and not sending an electronic copy of the record if one exists is illegal, but other than that, why would a practice not charge for records? We had a patient who wanted all of their records... all 12 inches thick of their records, going back ten years. The reason they wanted it doesn't matter, as they are entitled to it, but they happened to say their new doctor wanted it. I asked them if their new doctor specifically asked for ten years of records and they said no, they hadn't. I know we don't want ten years of records on new patients; six months will do.
 

MnTwins29

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75 cents a page is a hefty cost, and not sending an electronic copy of the record if one exists is illegal, but other than that, why would a practice not charge for records? We had a patient who wanted all of their records... all 12 inches thick of their records, going back ten years. The reason they wanted it doesn't matter, as they are entitled to it, but they happened to say their new doctor wanted it. I asked them if their new doctor specifically asked for ten years of records and they said no, they hadn't. I know we don't want ten years of records on new patients; six months will do.
The big question I would have for your scenario - did the patient request the records be sent to themselves or to the new doctor's office? I have a feeling that was a ruse (the doctor "wanted it") , and asking the questions in that case was certainly valid. I have no issue with this type of process - my question was more general in nature and the example I used was that - an example. When I made my request, I stated it was going to the new MD office, it was for treatment and to send it directly there. When they still stated the charge, I was even willing to pay the $6.50 fee for electronic transfer just to get it done. Nope, had to be by paper and 75 cents per page. Then, when my new MD office made the request after I explained the situation, guess how they obtained the records from my old doctor? Yup, electronically!
 

SharonCollachi

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From the Department of Health and Human Services (the entity charged with interpreting HIPAA):


  • Requests for Electronic Copies–
  • Where an individual requests an electronic copy of PHI that a covered entity maintains only on paper, the covered entity is required to provide the individual with an electronic copy if it is readily producible electronically (e.g., the covered entity can readily scan the paper record into an electronic format) and in the electronic format requested if readily producible in that format, or if not, in a readable alternative electronic format or hard copy format as agreed to by the covered entity and the individual.

  • Where an individual requests an electronic copy of PHI that a covered entity maintains electronically, the covered entity must provide the individual with access to the information in the requested electronic form and format, if it is readily producible in that form and format. When the PHI is not readily producible in the electronic form and format requested, then the covered entity must provide access to an agreed upon alternative readable electronic format. See 45 CFR 164.524(c)(2)(ii). This means that, while a covered entity is not required to purchase new software or equipment in order to accommodate every possible individual request, the covered entity must have the capability to provide some form of electronic copy of PHI maintained electronically.; It is only if the individual declines to accept any of the electronic formats readily producible by the covered entity that the covered entity may satisfy the request for access by providing the individual with a readable hard copy of the PHI.

For full article: https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/access/index.html

Clearly, your doctor's office violated your HIPAA rights. In California, I would start with a complaint to the medical board. Then my next complaint would be to DHHS.

I know that as a privacy officer you probably already know all this, but other readers may not.
 
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