Charging for medical records: Patients vs. lawyers

Lawyer requests for medical records are not limited by HIPAA cost-based fees


By Ryan S. Stark, Esq., partner, attorney at law
Page, Wolfberg & Wirth, LLC"

I get this question frequently: How much can we charge attorneys when they request a copy of a patient’s medical records? When it comes to requests from attorneys, you are not limited by HIPAA’s reasonable, cost-based fee.

Patient requests for medical records

When it comes to requests from patients, or their personal representatives, HIPAA limits you to charging the patient a reasonable, cost-based fee for the medical records request. You can only charge patients for the cost of:

1.    Labor.

2.    Supplies (e.g., paper, or if you give the patient a CD or USB drive).

3.    Postage if you mail the record.

You may not charge a retrieval fee. The Office for Civil Rights specifically outlines the fees you may charge to the patient when the request comes from a patient, or the patient’s personal representative.

Requests from attorneys for patient medical records

You might be surprised to learn that requests from attorneys are not subject to the reasonable, cost-based rate under HIPAA. Generally, you can charge an attorney whatever your state law permits you to charge for requests for medical records – even if that fee would exceed the HIPAA cost-based rate.

In a common scenario, an attorney represents a patient that your agency transported, and the attorney wants a copy of their client’s patient care report. For example, let’s say the patient you transported was in a motor vehicle accident and she is now suing the other driver for her injuries. The patient’s attorney would want a copy of the patient’s trip report to prove those injuries.

Typically, the attorney sends a request on their letterhead asking for a copy of the patient’s medical record, and the request includes an authorization signed by the patient permitting you to release the record to her attorney.

In this case, because the request came directly from the attorney, you may charge the attorney what you are permitted to charge under your state law for medical record requests. In other words, you are not limited to a reasonable cost-based fee.

Who is requesting patient medical records?

In contrast, if the request comes directly from the patient, and the patient directs you to provide her records to her attorney, then you are limited to the HIPAA cost-based fee. Or, if the patient is simply asking you to send a copy of her records to her, then you can only charge the patient a cost-based fee for that record. Here, the request is coming from the patient.

You also have discretion with medical record fees

Some agencies choose not to charge patients or attorneys anything for medical record requests. Or, some agencies only charge attorneys, but not patients. That’s OK. HIPAA does not require agencies to charge a fee for medical records, and HIPAA does not require that you waive fees for attorneys if you waive fees for patients. HIPAA simply limits the fees you can charge to patients when patients, or their authorized personal representatives, make the request for medical records.
 

Ryan Stark is an attorney with Page, Wolfberg & Wirth, LLC, The National EMS Industry Law Firm. He co-authored the critically acclaimed Ambulance Service Guide to HIPAA Compliance and HIPAATV 2.0 Training Video. He can be reached at www.pwwemslaw.com or at 877-EMS-LAW1.

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