Charging Physicians for Chart Summaries

Question: I am incurring a lot of expense and time personally reviewing patient charts and narrating patient summaries in response to other physicians’ requests for copies of patient records. Can I charge the other physicians for the processing time involved for my staff to retrieve and copy the patient records, as well my time to review the patients’ charts and narrate written summaries for the requesting physicians? Does HIPAA or some other rules set limits of what I can charge?

Answer: Well, first, why are you providing summaries instead of just sending the relevant part of the chart? That will save a ton of time and is allowed under HIPAA unless there is some reason to believe that handing over the whole record will somehow harm the patient.

Rules about what you can charge for copies of records are state-based. HIPAA simply says any costs must be based on what it actually costs the practice to make the copies, including administrative costs for retrieval. Its language, and most state regulatory language, focuses primarily on providing records to patients, not other providers. It is my impression that most physicians offer charts free to other physicians.

It sure would be silly to charge physicians and then have referrals dry up. Here are related comments from the American Association of Family Physicians (AAFP):

Members of the AAFP’s Commission on Health Care Services were polled regarding whether they charge patients for copies of their medical records. The results showed that policies for charging patients and others for copies of patient records vary greatly depending on the reason for the request, the community standard, and contractual and regulatory requirements.

• Some commission members responding to the poll charge patients nominal fees for copies of their records. Fees vary from 10 cents to 25 cents per page to a flat fee of $10 for up to 25 pages with a charge of 25 cents per page thereafter.

• Most of those polled provide a copy of a patient’s medical record to another physician at no charge when the patient changes physicians. However, most physicians responding to the poll have office policies to discourage excessive “doctor shopping/switching,” usually by charging patients who request their records be copied and sent to other physicians multiple times.

• A different set of rules may apply when records are copied for attorneys or health plans. It is common to charge $30 to $50 per chart or a flat fee of $10 for up to 25 pages with a charge of 25 cents per page thereafter.

• State laws and contractual agreements with managed care organizations (MCOs) may limit what a physician can charge for copying records. For example, workers’ compensation programs require extensive documentation as a condition of payment, and MCOs request patient records for medical review or to evaluate referral requests.