How MRM Calculates Charges & Achieves Compliance with State & Federal Laws
Are businesses allowed to charge for providing copies of medical records?
The Privacy Rule permits a covered entity and their business associate to impose a reasonable, cost-based fee to provide the individual (or the individuals’ personal representative) with a copy of the individual’s PHI. The fee may include only the cost of certain labor, supplies, and postage.
What types of labor CAN be included in the charges?
- Labor for copying may include:
- * Photocopying paper PHI
- * Scanning paper PHI into an electronic format
- * Converting electronic format in one format to the format request by or agreed to by the individual.
- * Transferring (e.g., uploading, downloading, attaching, burning) electronic PHI from a covered entity's system to a web-based portal (where the PHI is not already maintained in or accessible through the portal), portable media, e-mail, app, personal health record, or other manner of delivery of the PHI.
- * Creating and executing a mailing or e-mail with the responsive PHI
What types of labor CANNOT be included?
Reviewing the request for access.
Searching for, retrieving, and otherwise preparing the responsive information for copying. This includes labor to locate the appropriate designated record sets about the individual, to review the records to identify the PHI that is responsive to the request and to ensure the information relates to the correct individual, and to segregate, collect, compile, and otherwise prepare the responsive information for copying.
What labor is included in MRM’s charges?
MRM’s labor costs for copying paper records includes only the labor for scanning the paper record into PDF format. MRM typically scans the entire paper record unless otherwise instructed. For electronic medical records, it is important to understand that the data provided to MRM is typically in varying formats that require MRM’s data management team to manipulate and convert the data into a format that individuals can use. Only the labor for the data management team is included in MRM’s charges for that conversion process. Once paper records and electronic medical records have been converted, they are transferred to the individual via the requested delivery method by MRM’s medical release specialists. The “HIPAA Compliant Electronic Transfer” process includes uploading & encrypting the data, and then executing e-mails. The “USB Drive” transfer process includes downloading & encrypting the data and executing a mailing via certified mail. Only the labor for the medical release specialists in executing that process is included in the charges.
How can businesses calculate the limited fee that can be charged to individuals?
1. Actual costs method: A covered entity may calculate actual labor costs to fulfill the request, as long as the labor included is only for copying (and/or creating a summary or explanation if the individual chooses to receive a summary or explanation) and the labor rates used are reasonable for such activity. The covered entity may add to the actual labor costs any applicable supply (e.g., paper, or CD or USB drive) or postage costs
2. Average costs method: In lieu of calculating labor costs individually for each request, a covered entity can develop a schedule of costs for labor based on average labor costs to fulfill standard types of access requests, as long as the types of labor costs included are the ones which the Privacy Rule permits to be included in a fee (e.g., labor costs for copying but not for search and retrieval) and are reasonable. Covered entities may add to that amount any applicable supply (e.g., paper, or CD or USB drive) or postage costs.
3. Flat fee for electronic copies of PHI maintained electronically: A covered entity may charge individuals a flat fee for all requests for electronic copies of PHI maintained electronically, provided the fee does not exceed $6.50, inclusive of all labor, supplies, and any applicable postage. Charging a flat fee not to exceed $6.50 is therefore an option for entities that do not want to go through the process of calculating actual or average allowable costs for requests for electronic copies of PHI maintained electronically.
Is $6.50 the maximum amount that can be charged?
No. For any request from an individual, a covered entity (or business associate operating on its behalf) may calculate the allowable fees for providing individuals with copies of their PHI: (1) by calculating actual allowable costs to fulfill each request; or (2) by using a schedule of costs based on average allowable labor costs to fulfill standard requests.
What method does MRM use to calculate charges?
What method does MRM use to calculate charges?
MRM processes over 2,300 patient record requests each month for more than 1,400 practices. These requests involve various types of protected health information (PHI), including both paper and electronic medical records in multiple formats. Given the high volume of requests, it is impractical for MRM to calculate the actual cost of each individual request. Instead, MRM uses an average cost approach to fulfill standard request types and record formats, as permitted by The Privacy Rule. While the actual cost method could potentially result in higher charges for certain records, such as lengthy paper records or records combining paper and electronic formats, MRM's use of average costs ensures that charges remain reasonable for all individuals.
Additionally, MRM consults with healthcare legal counsel to navigate the complexities of state and federal laws related to medical record copying fees. This helps MRM stay informed about evolving regulations and ensures compliance with any laws that may limit or prohibit charges.
Here is a link to the HHS.gov Website that has more information about allowable charges for copies of medical records: