RULES CONCERNING CHARGING
FOR RECORDS, X-RAYS, ETC.
The rules concerning how much you may charge for providing copies of your records or x-rays to various entities are surprisingly complex. The following is my summary of the primary statutes and rules governing this issue.
When a patient requests a copy of their own records or requests that a copy of their records be sent to any third party such as their attorney.
Minn. Stat. § 144.292, subd. 6 (a) provides: “When a patient requests a copy of the patient’s record for purposes of reviewing current medical care, the provider must not charge a fee.” The statute does not define what constitutes “reviewing current medical care.”
Minn. Stat. § 144.292, subd. 6 (d) provides: “A provider or its representative must not charge a fee to provide copies of records requested by a patient or the patient’s authorized representative if the request for copies of records is for purposes of appealing a denial of Social Security disability income or Social Security disability benefits. … For the purpose of further appeals, a patient may receive no more than two medical record updates without charge, but only for medical record information previously not provided.”
The HITECH amendments to HIPAA provide that you may charge your patients “a reasonable, cost-based fee, provided that the fee includes only the cost of: (i) Copying, including the cost of supplies for and labor of copying, …; (ii) Postage, … and (iii) Preparing an explanation or summary of the protected health information, if agreed to by the individual. …” The rules clarifying this federal statute indicate that the amount you charge your patients for medical records must be limited to an amount where you do not lose money providing copies but you do not profit from it either. The labor charge should be what you pay your staff solely for the time it takes to make the copies (you cannot charge for creating the records, maintaining the records, retrieving the records in order to copy them, putting them in an envelope, mailing them, etc.). For example, if it takes your staff person 5 minutes to run the copies through your copier and you pay him or her $15.00 per hour, under HITECH you are limited to charging $1.25 for the labor. With regard to the consumable charges, you may charge the exact amount you incur in providing the copies. For example, if you provide the records on a CD or flash drive, you may charge what you paid to purchase the CD or flash drive; if you make paper copies, you may charge the 1-2 cents per page it costs you to make copies on your copier.
When records are requested by another provider.
Minn. Stat. § 144.293, subd. 3 provides: “A patient’s health record, including, but not limited to, laboratory reports, x-rays, prescriptions, and other technical information used in assessing the patient’s condition, …, shall promptly be furnished to another provider upon the written request of the patient. … The patient shall be responsible for the reasonable costs of furnishing the information.” Because this statute provides that the patient, not the requesting provider, shall be responsible for the cost of providing the information without specifying what those costs may be, the provisions relating to charges that may be assessed to patients discussed above apply. In most situations, a provider requests records from another provider for the purpose of reviewing current care. Therefore, in most situations, it is probably inappropriate to charge the patient for providing records, including x-rays, to another provider.
Minn. Stat. § 148.104 provides that chiropractors must cooperate with investigations and provide copies of patient records if requested. You may not charge the Board for providing copies of records.
When anyone else requests records.
The following provisions apply when you provide records to insurers, employers, defense attorneys, your patient’s attorney, etc.
The HITECH limits on charges do not apply unless the patient is the requesting party and instructs you to send a copy of their records to any third-party, such as their attorney. Then you may only charge the “reasonable cost-based fee” discussed above. If the letter requesting the records is signed by anyone other than your patient, the HITECH limits do not apply.
The amount you may charge depends upon whether your records relate to a current claim for workers’ compensation benefits.
Minn. Rule 5219.0200 provides: “This chapter governs reimbursement for copies of existing medical records related to a current claim for [workers’] compensation … when requested by any person or business entity from a health care provider ….” Minn. Rule 5219.0300, subp. 2 provides: “… a charge is reasonable if the total charge for each submission following a request does not exceed the sum of $10 as a retrieval fee and 75 cents per page.” This rule does not provide for annual adjustments.
In all other situations, the amount you may charge is governed by Minn. Stat. § 144.292, subd. 6 (b) which provides: “When a provider or its representative makes copies of patient records upon a patient’s request under this section, the provider or its representative may charge the patient or the patient’s representative no more than 75 cents per page, plus $10 for time spent retrieving and copying the records, unless other law or a rule or contract provide for a lower maximum charge. This limitation does not apply to x-rays. The provider may charge a patient no more than the actual cost of reproducing x-rays, plus no more than $10 for the time spent retrieving and copying the x-rays.” These limits were first enacted in 1992 and have been increased annually by the percentage change in the Consumer Price Index for all Urban Consumers, Minneapolis-St. Paul. The rates for 2016 were $17.68 as a retrieval fee, and $1.33 per page as a copy charge. The rates are adjusted in March each year (after the change in the CPI-U has been calculated). I just looked and it appears the rates for 2017 have not yet been updated on the website. You may verify the current rates by going to www.health.state.mn.us and searching for “maximum charges.” The 2017 update should be posted soon.
Records provided in support of your bill.
In workers’ compensation cases, Minn. Rule 5219.0300, subp. 1 provides: “For the first copy of the appropriate record …, when provided by the health care provider to the payer …, to substantiate the service being billed, a charge not to exceed 75 cents per page is reasonable. This amount applies whether the record is provided with the billing, under separate cover, or in response to a request by the payer for an appropriate record which has not been submitted with the bill.”
No such provision exists outside of workers’ compensation.
If you charge for providing copies of your records to anyone, you must charge, collect and pay sales tax.
If you mail your records to anyone, and may charge for the copies, you may also charge for the actual cost of postage.
Certified copies of records.
If you are asked to certify that the records you are providing are all of the records in your possession, you may charge any actual expense you incur by having your certification notarized.
This information was provided by:
David C. Wulff | Law Office of David C. Wulff