• Revenue Cycle Management
  • COVID-19
  • Reimbursement
  • Diabetes Awareness Month
  • Risk Management
  • Patient Retention
  • Staffing
  • Medical Economics® 100th Anniversary
  • Coding and documentation
  • Business of Endocrinology
  • Telehealth
  • Physicians Financial News
  • Cybersecurity
  • Cardiovascular Clinical Consult
  • Locum Tenens, brought to you by LocumLife®
  • Weight Management
  • Business of Women's Health
  • Practice Efficiency
  • Finance and Wealth
  • EHRs
  • Remote Patient Monitoring
  • Sponsored Webinars
  • Medical Technology
  • Billing and collections
  • Acute Pain Management
  • Exclusive Content
  • Value-based Care
  • Business of Pediatrics
  • Concierge Medicine 2.0 by Castle Connolly Private Health Partners
  • Practice Growth
  • Concierge Medicine
  • Business of Cardiology
  • Implementing the Topcon Ocular Telehealth Platform
  • Malpractice
  • Influenza
  • Sexual Health
  • Chronic Conditions
  • Technology
  • Legal and Policy
  • Money
  • Opinion
  • Vaccines
  • Practice Management
  • Patient Relations
  • Careers

Copying fees and sensitive chart entries

Article

I plan to cut my hours in preparation for retirement and I expect many of my patients to leave the practice. If I'm required to respond to multiple record requests, may I charge a reasonable fee for copying and sending large records? Also, how should I handle any "delicate" and possibly inflammatory entries in charts?

Q: I plan to cut my hours in preparation for retirement and I expect many of my patients to leave the practice. If I'm required to respond to multiple record requests, may I charge a reasonable fee for copying and sending large records? Also, how should I handle any "delicate" and possibly inflammatory entries in charts?

A: Regarding your first question, you may charge a reasonable fee for responding to any record requests. To be HIPAA compliant, the fee should reflect actual copying costs (including supplies and labor) and postage (if you're mailing the records). You may also charge a reasonable fee-as defined by state law, typically-for any commentary or summary you prepare. But these chart additions can be legally sensitive, so talk to a lawyer if you're in doubt.

The second question you raise is more difficult. Generally, you can't deny access to any part of a medical record under HIPAA, with certain exceptions: psychotherapy notes (unless the requesting doctor has obtained prior patient authorization); information compiled in anticipation of legal proceedings; CLIA information; research records during the course of a study; or records obtained from someone other than a healthcare provider, under a promise of confidentiality.

There are two other exceptions, as well: (1) if in your professional judgment it's reasonably likely that a disclosure will endanger physical safety or the life of the patient or of someone else, or (2) if the information refers to another person, and you deem it reasonably likely that disclosure will result in substantial harm to that person. (In each case, your judgment is subject to review-by the practice's HIPAA officer, for instance.)

But you'll find no protection for indelicate entries. Although many state laws permit doctors to redact portions of the medical record, HIPAA doesn't recognize this right.

Related Videos
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health