by Kassie Toerner
The amount you can charge for supplying copies of medical records has changed, as the Office of Civil Rights (OCR) has issued guidance that clarifies allowable fees. Under the new rules, allowable fees differ for the release of records directly to the patient versus release of records to a third party.
Fees to release directly to the patient/individual
Chapter 45 of the Code of Federal Regulations Section 164.524 outlines individuals’ rights to access their protected health information (PHI). Below are highlights from the new rules.
Flat rate of $6.50 —The OCR has determined that a flat-fee of $6.50 is a reasonable cost for the release of medical records directly to a patient/individual. If the provider does not calculate a reasonable fee as outlined below, then the provider should charge the flat-rate of $6.50 to the individual for copies of their PHI.
Charging an individual more than $6.50
For any request from an individual, a provider (or business associate operating on its behalf) may calculate the allowable fees as follows:
- By calculating actual allowable costs to fulfill each request; or
- By using a schedule of costs based on average allowable labor costs to fulfill standard requests.
- Alternatively, in the case of requests for an electronic copy of PHI, covered entities may charge a flat fee not to exceed $6.50 (inclusive of all labor, supplies, and postage)
Charging a flat fee not to exceed $6.50 per request is an option for covered entities that do not want to go through the process of calculating actual or average allowable costs for requests for electronic copies of PHI.
Whether a covered entity chooses to use the average cost method or flat fee, the entity may receive an uncommon request that it had not considered when setting up its fee structure. In these cases, the entity may calculate actual costs as long as the costs are reasonable and only of the type permitted by the Privacy Rule.
A covered entity that chooses to calculate actual costs in these circumstances must — as in other cases — inform the individual in advance of the approximate fee that may be charged for providing the copy requested.
Health care providers are urged to err on the side of caution when determining fees for release of records directly to the patient. While the HHS has published the guidelines above, these rules are intended to increase patients’ access to their own records. This is demonstrated by language found in the HHS FAQs:
“ . . . while the Privacy Rule permits the limited fee described above, covered entities should provide individuals who request access to their information with copies of their PHI free of charge. While covered entities should forgo fees for all individuals, not charging fees for access is particularly vital in cases where the financial situation of an individual requesting access would make it difficult or impossible for the individual to afford the fee. Providing individuals with access to their health information is a necessary component of delivering and paying for health care.”
For more information, please see these FAQs along with Chapter 45 of the Code of Federal Regulations Section 164.524.
Fees to release records directly to a third-party
The new OCR flat-rate fee guidance does not apply to release of records to a third-party unless that release is directed by the individual/patient to the third-party (see FAQs).
For direct requests from a third-party, the covered entity should follow the Texas Medical Board (TMB) rules for release of PHI. Below is an excerpt from the TMB rules.
“(e) Allowable Charges
(1) Paper Format
(A) The physician responding to a request for such information in paper format shall be entitled to receive a reasonable, cost-based fee for providing the requested information.
(B) A reasonable fee for providing the requested records in paper format shall be a charge of no more than $25 for the first twenty pages and $.50 per page for every copy thereafter.
(2) Electronic Format
(A) The physician responding to a request for such information to be provided in electronic format shall be entitled to receive a reasonable, cost-based fee for providing the requested information in electronic format.
(B) A reasonable fee for providing the requested records in electronic format shall be a charge of no more than: $25 for 500 pages or less; $50 for more than 500 pages.
(3) Hybrid Records Format.
(A) The physician responding to a request for such information that is contained partially in electronic format and partially in paper format (“hybrid”), may provide the requested information in a hybrid format and shall be entitled to receive a reasonable, cost based fee for providing the requested information.
(B) A reasonable fee for providing the requested records in a hybrid format may be a combination of the fees as set forth in paragraphs (1) and (2) of this subsection.
(4) Other Charges.
(A) If an affidavit is requested, certifying that the information is a true and correct copy of the records, whether in paper, electronic or hybrid format, a reasonable fee of up to $15 may be charged for executing the affidavit.
(B) A physician may charge separate fees for medical and billing records requested.
(C) Allowable charges for copies of diagnostic imaging studies are set forth in §165.3 of this title (relating to Patient Access to Diagnostic Imaging Studies in Physician’s Office) and are separate from the charges set forth in this section.
(5) A reasonable fee for records provided in a paper, electronic or hybrid format may not include costs associated with searching for and retrieving the requested information, and shall include only the cost of:
(A) copying and labor, including, compiling, extracting, scanning, burning onto media, and distributing media;
(B) cost of supplies for creating the paper copy or electronic media (if the individual requests portable media) that are not prohibited by federal law;
(C) postage, when the individual has requested the copy or summary be mailed; and
(D) preparing a summary of the records when appropriate.”
For more information, please review the most recent version of the TMB rules Chapter 165.2 Medical Records Release and Charges and TMB FAQs for Consumers.
Release to patient with an outstanding bill
An entity may not withhold or deny an individual access to his or her PHI because the individual has not paid the bill for health care services provided.
While the Privacy Rule permits the fees as described, there are other limited circumstances under which a covered entity should not charge copying fees. For example,
- when records are requested by a health care provider for acute or emergency medical care; and
- when patients request records to support a disability or benefits application under: Aid to Families with Dependent Children, Medicaid, Medicare, Supplemental Social Security Income, and Federal Old-Age and Survivors Insurance, and Veteran’s Benefits.
For more on medical record release, please visit the TMLT website or contact the Risk Management Department. You can also visit the Cornell Legal Information Institute.