Wiki EMR and Record Request

[maine4me]

We bill for a hospitalist group who uses the hospital EMR for documentation. Often we receive record requests from insurance companies asking for records other than those from our providers. For example, they want the ER report, nurses notes, labs, xrays, etc. Since the EMR is a shared record is it appropriate for us to send records other than for those physicians in our practice?

I just am not sure which way to go with this.

 

[martinni1974]

Are the records being requested to facilitate payment on your claim? There are instances when the ER documentation for example is required to process a decision on a service you billed for your physican i.e.; patient presented to ER with chest pain and your physician placed them in observation at midnight. Sometimes there is a need to review the ER course of treatment to decide if your physician's billing/decision falls under a variety of regulations. Maybe they are looking to see if the stay should have been inpatient and not observation or vice versa. This is just one example.

The HIPPA release the patient signs at the hospital usually covers this area as there are many providers involved in their care that they may not even know about.

In my opinion I feel if what is being requested is somehow tied to the service your physician initiated or provided, then releasing that info to the ins company would fall under the proper HIPPA regulation for facilitating payment of claims.

Ask questions and find out why they are requesting said medical records.

Good Luck!