Home Forums Discussions General Discussion Insurance Participation Agreements

Well, I hope I don't open a can of worms on the ethics and morals of charging for transfer of records, although more and more I ma having problems with my staff's taking time and effort to transfer records to keep up with the doctor shoppers. Certainly, comments on that good or bad would be welcome.

But, I am writing here, because no one locally (my biller, my office manager or my practice consultant) seems to know, and I as a ignorant to all this physician don't even know what BC/BS considers a physician ID. My NPI and UPIn didn't seem to work nor did my Tax ID number.

Anyway, the issue is some insurance's participation agreements prohibit charging the patient for records under any circumstances. Medicaid, for one, does. (Certainly not a suprise). I am guessing that I have a participation agreement or I have signed some type of contract with every insurance provider which would cover all things pertinent to interactions with patients. Unfortunately, I do not know where to look for this agreement. I have gone online and, because I don't know what numbers BC/BS is asking for, I can't sign in. I can't find these agreements in my office, and I am embarrassed to say my managers don't know where they are.

My other huge question pertains to insurance companies such as BC/BS. A lot of my patients have BC/BS, but some are BC/BS Connecticut, some are Texas and some are Maine, etc. Do I have one contract with BC/BS overall or do I have a different one with each state? I must be credentialed with each.

Just to be clear, this is only in reference to the copying and faxing or mailing of records to patient transfers and not for consultants or other reasons such as patients in my practice just wanting a copy of his or her record.

BCBS assigns its own physician IDs to all physicians during credentialing process. It is usually a 4-digit number. You would have to call BCBS to find out what your BCBS ID# is.

In NYC, Empire BCBS uses a 6-digit number as far as I know. But I would think that now your NPI would work also. But maybe not.

Well, apricot and Wayne, I think the better part of valor would simply not be to charge. If I look at myself carefully, I would probably do it more as a passive-aggressive thing than to recoup the costs of the money.

Boy, I read a NY Times Union Blog followed by comments of patients, lawyers and other doctors that made my blood boil. I should share it on the forum. Opinions are great, but there is nothing worse than opinions which come from groups of people such as attorneys that really don't understand the complexities of the physician-patient relationship. I wanted to comment, but it was closed after hundreds of comments.

I think you're right. We don'tcharge for it. But we do charge any lawyer or other business entity that requests it. They often need it to come directly from the physician's office to insure it hasnt been 'doctored" so they can't circumvent the fee by havingthe patient request it.

Yeah, you should share that blog.

So what good is it to have an NPI if the insurance compnies still force you to use their own "unique" ID number?!!!

Personally, I'm getting more than just a little fed up with the insurance industry setting their own standards and not being required to abide the same rules. What other industry/market/prefession/whatever can the user determine the what they will pay the provider.

Try this the next time you go to the gas station. Fill your tank with gas for $4 per gallon, tell the station owner that you will only approve $2.50 per gallon, and that your gasoline "insurance plan" will send them 80% in 30 (or 60 or 90) days, but only if the sttation "participates" in the plan otherwise you will receive the check and reimburse the gas station after they bill you. After all, we all know the price of gas is too high and the oil industry executives make too much money.

Oh BTW "I forgot my checkbook and so can't pay my co-pay today. Just send me a statement." How fast would you end up in jail for a drive off?

Great analogy. Well said. Once again, I think much of this stems from the fact that most people including Congress has no idea how the system works.

But, don't worry, if we get into trouble we can rest easy knowing that the government will save us out with a $700,000,000,000 bail out. Did I get enough zeroes?

DISCLAIMER: I don't know anything about macroeconomics especially at that level, so maybe I am speaking out of ignorance. Wouldn't be the first time.

My wife/office manager recommends you check your state statutes as in Arizona the rules/responsibilities are spelled out in the statutes. I also thought HIPAA stated the first copy to a patient is free, yet I could be wrong on that.

Wouldn't it be nice if there was one "cheat" card that would spell out all the main regulations re: records and practice requirements for each state? (Sort of like the one page cram sheet that some professors would allow on tests. Hmm, wonder if we could get our state medical associations to compile these, as this would certainly be a worthy service, and not something to profit off of.)

Thanks Scott,

It's pretty clear here in Maine that it is legal to charge for records. Ironically, it is the statute that was written more to keep anyone from overcharging. The attorney for the Maine Medical Association interprets the phrase "patient's authorized representative" to include a new physician's office.

I don't think there is anything in HIPAA which would preclude someone from charging for records.

As usual in these situations, much of this is dictated by the way it has always been. I think a lot of patients are under the impression that the first copy is free when in reality it has always been a courtesy. So, if you do charge (which just makes sense if you really think about it), it seems to everyone that it is outrageous.

Of course, I could ask my actual practice attorney. Then, after he found the correct statutes he could copy it and fax it to me and charge me for both the copying and faxing. As you probably know, it is itemized right there on the bill even if it is just one fax page. But, as physicians, we are expected to bear the brunt of all the charges.

I have basically come to the reality that it probably isn't worth it. I have to put the record together, do that math, send ot a letter which I normally wouldn't informing the patient the records will be sent when the payment is received covering the copying, etc. Then, I have to have my staff receive an angry phone call and possibly a letter from an attorney who may not know the law. Then you get calls from the other office wondering why the records haven't been forwarded. All for about $30 to $40 and possibly a little satisfaction if one is willing to admit to it.

http://janus.state.me.us/legis/statutes/22/title22sec1711-A.html

Bert,

Pooh on the angry patient calls....they are leaving you anyway. In Indiana we have strict laws which cover our abilities to charge for copies and I do charge. We count the numbers of pages, call the patient and tell them what it will cost us to copy and then do not copy until we are paid. Many times patients will then tell us to only copy the last 1-2 years. It is a tremendous consumption of staff time. If they say, "Can't you just fax it over there?" we tell them "No". It is virtually just as time consuming to fax from the EMR as it is to copy from paper so I still expect to be compensated. As far as attorney letters, check the state statue number and give it to them if they complain. My bet is, they are well-aware of the law but hope you are not. I have had lawyers from a neighboring state whose statute says the first copy is free tell me they expect a free copy of the records. I tell them I do not practice in their state and if they want the records, they will pay for the copy.

Leslie

I forgot to add this but, we also tell the patients if they want to reduce their charge for copying records, they can call the hospital or the lab where they have had tests done and ask them for copies....they generally do not charge. If I have to copy that report for them, I will charge.

Leslie

You are awesome. I totally agree. Where I have gotten nervous is that Medicaid won't all you to charge. So that got me to looking into the private carriers since I was told that the participation agreement overrides the statute, because you agreed to not charge the patient for records. This is where this thread started -- so far not a lot of direct feedback on that.

I guess I should check the contract. Maybe it says that if they leave I must purchase them a BMW.

Bert, I asked my contracts person at my billing service to look at my blue cross contract and see if charging is allowed. I'll get back with you in a few days on it.

That would be great. Appreciate it. I keep waiting for Paul to weigh in on this. It seems like he would be all over it.

OK Bert, here I am coming out of my Hidy Hole. If I understand the Medicaid rules correctly, and I could be wrong here, is that you can charge them, but if they don't cough up you must supply them anyway, you can not hold the records hostage so to say, and you can't force them to pay if they stiff you. But if you bill, invoice them for it and they are willing to pay, under the laws of your state (NYS is $0.75 per page) more power to ya... There you happy now??? Miss you too...

Paul

Wow, 75 cents per page. I think I would encourage transfers at that rate. Probably not worth is with Medicaid then. So, how about the big-time insurers? Do I have a different participation agreement with BC/BS of Connecticut than I do with Texas or Maine?

I think for regular process the claims requests you must just cough 'em up free of charge. We don't charge for those but I do fight them tooth and nail because I have been taught by a great NYS Medical Society lawyer that all such chart requests are really chart reviews that the carriers use to gather info on your charting verses you coding and billing... If they claim they are spying on the patient they are also spying on you and visa versa too.

Now when lawyers or these companies that get paid to middleman chart requests for life insurance claims and to process peoples health status for life insurance and the like we have found that they never pay up if you simply send the records with an invoice. They will stiff you every time, so the only way to get paid is to do a page count, send them an invoice, wait for their check to arrive and then and only then send them the records they have requested. That works almost every time.

And I call the patient every time I get a request from a lawyer or the like to confirm that they actually did sign the form and want us to send out the info. Honestly, how do you know that the awful looking faxed or multi-generation copied signature is really that of you patient even if you can compare it to something on file? Call the patient. They love knowing that I am watching out for their privacy by doing such things. It's a not so sutle way to convey that us IMP's and other small solos are different then the factory practices. "Gee Paul, that was so nice of you to call and confirm that... Thanks for looking out and being protective of us like that..."

Just my two cents on the matter... I'm real tired, time to crawl upstairs to bed with my own head cold... Night y'all....

Paul

Bert,

Here is what my billing/contract service told me in response to your question:

"Providers can bill for the copying of medical records…physicians usually do not charge other physicians as a courtesy (if you think about it what if they need records do they want to be charged). In short there is nothing that says physicians can not bill other physicians…if they want they can…I don’t think they should."

You can bill for copying, yet I think my practice people felt that since the request was being originated from another physician's office (and not from the patient) this would constitute billing the requestor (the physician) and not the patient. I'm not sure that is completely accurate, yet the bottom line seems to be you can bill based on the contracts.

In my practice, we give the first copy free and then charge for subsequent copies from patients. With regards to other physician requests, we do not charge, although we do call someone when they leave me and then see 2 subsequent primary cares before settling again. I do wish to charge for those, since I am no longer the PCP of record. My wife/HIPAA expert/office manager tells me charging is not wise, yet she won't continually copy records either. What a pain! Hope this helps.

Scott,

Yes, that does help. But, I do a few things differently or at least look at them differently. I have always sent ALL records for free unless an attorney requests them. They generally offer anyway. I never charge for records sent to a consultant. The key here is when I say charge for records, I am talking about charging the patient. Again, I wouldn't for sending records to a consultant -- that would be fairly ludicrous and counterproductive.

This may seem like an exaggeration and something others would disagree with, but I would have no problem copying records to a CD for one of MY patients ten times in a row. Couldn't care less. That is extreme but just making a point.

Now, I have only recently considered charging for the transfer of medical records to other offices. In my view it is actually the patient asking for the records to be transferred. I do have to admit that I am being a bit passive-aggressive. Guilty as charged.

As to sending records multiple times, we send the entire record (as allowed by law in Maine) to the new provider and, therefore, don't send them again. If the patient needed them again, we would charge. The irony is that it is also legal to only send notes produced by my office, but I do think that is not helpful for the patient.

Thanks for the information. It is very helpful.

My feeling is that if a patient is leaving, the few dollars that are collected are simply NOT WORTH IT. The current patients are held waiting for help at the counter (or wherever) while they perceive that you are making it hard for someone to get the records. (For what? $5.00?) The staff that are put in the position of holding the patients records hostage for the $5.00 are sometimes put in a bad mood by the stressful encounter and carry this to the next phone call or patient, with predictable results.
I even believe your last shot at free advertising is when the doctor shopping patient is hassling the NEXT office, and makes the comment, (in a big huff) "Well! I never had a problem like this at Dr. Sechrist's office."
No, I don't want the doctor shopper back, but there is always a chance that other patients who have been waiting an hour in the new doctors waiting room are thinking of making a change....

Martin,

Good thoughts. However, rarely does a patient come to our office and get the records standing in line. Even if they did, they certainly would not be allowed to hold up patient check ins. I would estimate that > 90% of all transfers are in the form of receiving a records release by fax from the new office.

Plus, the charge for a records transfer in Maine is $10.00 page one, and 35 cents for each page thereafter. This is $45.00 for a 100-page record. I, too, have come to the conclusion that the entire process is probably not worth it (although I evaluate it all the time). But, once again, the expectation that each doctor will send records as a courtesy for a patient who may have just been discourteous is there because we are just used to it and do it. Try calling an attorney who has accumulated 200 sheets of documents on you and asking them to be transferred to your new attorney. It won't be free.

Bert, PAINFULLY true, painfully true.