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Practice Management Q&As


What to charge for copying records

Q. According to some states' laws and HIPAA, it's permissible to charge a "reasonable" fee for copying and mailing patient charts. How much is considered reasonable? Also, how should I respond to a patient's demand that we hand over records for free because they're "his" records.

A. If you're dealing with a difficult patient-particularly one with a complaint about his care-give him the copies at no charge. It's not worth the risk of antagonizing someone who may be contemplating a lawsuit.

Under HIPAA, you have 30 days to comply with requests for records. Charges are limited to your actual costs. Your state may limit the maximum you may charge per page and for time spent retrieving and photocopying (for instance, Minnesota allows a maximum charge of $1.13 per page and $14.81 for time), so check with your state medical society.

One practice: two med-mal carriers?

Q. A new physician just joined me in practice with the intention of becoming my partner in the future. However, we have different professional liability insurance carriers. Is this a problem? I suggested that we both use the same company, but he refuses because my premiums are more expensive than his.

A. There are two drawbacks to having different carriers. First, neither carrier may be willing to ensure the corporate entity itself. That means the corporation-and, in particular, its receivables-would not be protected from a judgment against it. Generally, med-mal companies will insure the corporation only if they insure all the doctors, or at least most of them.

Second, let's say you and your partner participated in the care of a patient who later sues both of you for malpractice. When there are two different carriers involved, there's likely be a dispute over which one has the primary obligation to provide the defense.

You both should ask your respective carriers about these issues, and see what they suggest. Perhaps you could persuade your partner to get on board with your carrier by offering to split the difference between the two premiums.

When a part-timer becomes a full-timer

Q. I recently converted a part-time employee who's been with us 10 years to a full-time schedule. I think it would be unfair not to consider her years of service in determining how much paid time off she's now entitled to. But I'm afraid this may upset employees who've worked full time for years. What should I do?

A. First check to see if your employee handbook spells out the number of full-time years of service necessary to receive the number of vacation days you'd like to give her. If it does, stick with that number-and find some other way to compensate this valuable staffer.

If your policy does not contain such a provision, give her as many paid days off as you think she's earned. If anyone complains, explain that this benefit is based on merit as well as length of service.

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