Chris Nuland: The accurate information about medical-record fees

For about the last two years, the Florida Board of Medicine (BOM) has been evaluating a rule change that would simplify the fees charged by physicians for the reproduction of medical records.

While the proposed rule change is not inherently controversial, many Florida personal injury attorneys are trying to make a controversy out of it and attempting to reduce their business expenses involved in personal injury claims.

The issue attorneys have with the BOM proposal is that it eliminates a confusing tiered pricing mechanism and would instead permit all requestors, including attorneys, to be billed $1 per page, which is the same amount that hospitals may charge for medical records.

Currently, the rule says that patients are to pay $1 per page for the first 25 pages, but only 25 cents per page thereafter, an amount that has not been increased in almost 30 years.   With respect to attorneys, the rule now states “other entities” may be charged $1 per page regardless of the number of pages.

Attorneys fall into the “other entities” category, since they are not patients.  However, some attorneys argue they are acting on behalf of the patient by submitting an authorization signed by the patient and should therefore get the lower “patient” rate.

This logic is flawed because the Health Insurance Portability and Accountability Act (HIPAA) requires all requestors, other than the patient, to submit an authorization before a record can be released.   When an authorization does not come directly from the patient, record releases must be cleared for HIPAA compliance, adding a layer of cost to the process.

In an effort to get the lower rate, attorneys have filed a wave of class-action lawsuits in Florida costing medical providers and their contractors hundreds of thousands of dollars in attorneys’ fees and further confusing what should be a simple process.

In an effort to address the attorney argument, the BOM proposed language that would make the rate for ALL requestors $1 per page.  While this is not the only solution, it mirrors the amount charged by hospitals and complies with both HIPAA and the Health Information Technology for Economic and Clinical Health (HITECH) Act, both of which already limit what you can charge a patient to a “reasonable cost-based fee.”

If the BOM passes the proposed rule, patients will continue to be charged the lower of the HIPAA/HITECH reasonable cost-based fee or the flat $1 per page.  In other words, if the BOM proposal passes, the fee charged to patients will not change and, in fact, the fee charged to others will continue to be $1 per page.

The BOM proposal would merely confirm that anyone other than the patient may be billed $1 per page, regardless of whether the records are requested from a hospital or physician.

Chris Nuland, represents more than eight physician organizations, including the Florida Chapters of the American College of Physicians and the American College of Surgeons. Column courtesy of Context Florida.

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