Copying fees and sensitive chart entries

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.