Home Forums Discussions General Discussion Want to earn extra cash working at your computer?

Nope, this isn't spam; we really did get extra money, thanks to some people on this board who have helped me out. Like everyone else, I periodically get requests for medical records from insurance companies. Most often they come from the Medicare Advantage plans. Lately it isn't even the insurance company, it is some third-party they have farmed the work out to. In the past I used to grumble and send the records. After reading about how people here handle it (it might have been Leslie who first suggested this) I started telling them that there was a fee for the records and they would get the charts as soon as I got the fee. While I virtually never charge patients for their records, I generally do charge these companies.
About six months ago we got a record request from one of these plans. They very matter-of-factly requested charts on 18 patients dating back for some years. I don't see a large number of their patients; 18 represents a significant percentage of the total. I told my secretary to send back our stock response which is that we will be happy to provide these records after receiving our fee of $25 per chart. Over the following months a period of negotiation followed. Perhaps negotiation is the wrong word since we just kept telling them our terms and they kept telling us "I need to speak to a supervisor; I'll get back to you about that". Periodically there were vague threats on their part. We got an offer for $10 per chart. Then $20. Then "you send the charts and then we will send the money". Last week I noticed a $450 credit card deposit into our account. We never get credit card payments that are that large so I asked my staff where it came from, they said "they decided to pay for those charts".
At this point, if they want to pay me $25 for every one of my charts, I will be happy to provide them copies.

I thought this was going to be ban-hammer material when I saw the title.

When we were sitting around in Tahoe last year, there were a lot of good ideas about how Doctors can innovate leveraging the technology and change the model.

I'd count that a massive victory on principle. Hopefully more to come.

In Illinois there is a maximum fee for charts, I think set by the legislature. Basic charge $25.00 plus, I think, 15 cents per page. Of course if they ask for billing records, as a lot of attorneys do, that is a separate $25.00 charge, as they are different from medical records and must be "researched" separately.

We have always charged a flat $75 fee. They always pay it, sooner or later. Even the companies that claim it's the patient's cost. We never budge. They always cave in.

I have the same experience as John. But, we charge $10.00 first page, then 35 cents, thereafter.

Jon,
Do you provide a paper chart for each 25$ charge, and what do you print up?
I just recently got a request with about 20 charts to review, from medicare advantage.

That actually presents an interesting question - do you print them for that fee, or print them into a PDF, and send them the PDF?

We print more and more to CD and actually imprint with LightScribe. Very professional. Nowadays, no one even balks at it. We mail them to everyone including referrals. We NEVER print paper. If they want paper, they can print it themselves. For a specialist, it looks much better popping in a CD, and perusing it in front of a patient, then shuffling through papers. One looks OK, the other looks as though you never looked at it, which you never did.

With Adobe, if you wanted, for a tough patient, you can make a book, etc. and the consultant can move through the different areas. Very cool.

One thing. When we charge for records when patients transfer (self pay or private pay -- illegal to charge 10 cents for Medicaid, God forbid), even though $10 plus 35 cents a page (which I must admit I have done away with the $10) not only covers the time for getting the records together, it also covers the time your staff put into the original demographics, insurance, etc.

I have had patients sue me. What is it about the state statute you don't understand.

Now, don't get me wrong. And, I am serious about this although it wouldn't happen. As a patient, I will give you your records everyday for a year for free. You're are patient. Transfer and put up or shut up. Now there are some that may say I am being passive-aggressive. And, those some are right. Bear in mind, I don't charge for leaving due to age or moving, etc.

jimmie,

Print your records to pdf. Then burn EVERY pdf to one CD. Make sure you keep keep a copy. Once the CD is ready, send them an invoice.

In response to the questions by Jimmie and Indy... The format of a chart copy varies based on the requester, just as the content might. So for example, if I am referring the patient to a colleague and want to be sure that the appropriate information is readily accessible, I will take some time to select the right documents and organize them. That might be all the notes (or maybe not) and all of the appropriate outside data (e.g. labs, radiology, pathology). On the other hand, a record request from an insurance company usually leads me to send all of my notes and let them sort it out. By the same token, I get to choose the format for these Medicare Advantage requests. What is easiest for me is to simply print the charts to Updox and fax them to them. This is the quickest and cheapest way to generate the chart and is also HIPPA compliant. No paper, no CD's, and not much time thinking; just send my notes for the time period they are requesting.

Jon,

Thanks, Medicare Advantage is the one entity that requests the most charts, so I think I will do the Updox route for Medicare Advantage, and the 25$ fee should compensate for all the time and effort.

But, isn't UpDox sending via fax?

My guess is that JBS is sending via a Updox message - which they have to pickup via secure login.

I would do that in that fashion as you get a read receipt (proof of delivery), secure delivery, and it doesn't count against fax usage.

Good Job, Jon!

I went around on this subject with Anthem Medicare last spring, never did give them their charts. I told them it was their problem if they had to prove to Medicare that they were providing good service to their subscribers. They always want to quote their HIPPA rights. I tell them I am not concerned about HIPPA but rather the time and expense for which they do not compensate.

Last week, regular Anthem sent a fax wanting complete records on 20 patients. I quoted them the Indiana copying charge legislation. They said that my contract states I am to give them access to records at no charge. I told them that contract was written over 10 years ago before electronic health records. In those days, we would pull 20 charts for them with little difficulty, sit one of their reviewers in the kitchen with her little portable copy machine and she could copy and review to her hearts content. But now, I do not have the staff nor the resources to put 20 charts together for them free of charge. And, I do not have the staff to sit there with them at one of my computers while they review patient records and, no way in HELL will I allow them to sit at a computer unsupervised while they muddle through AC. I told them if they wish to have me sign an updated contract I may consider it, may not. They have never been willing to negotiate rates with me and they currently pay less than Medicare. So, if they drop me, good.

Now, as long as we are on the subject of records, I am sure many of you have begun getting requests from pharmacies and DME's (Such as one who has the name of a famous statue) saying, because of Medicare regulations, they need 6 months of notes on a patient in order for the patient to get their diabetic testing supplies or minineb meds. BS!

I refuse to give this information to them. I reply I will be more than happy to complete a standard form stating why the patient needs to test more than once a day but they will not be getting any info which does not directly pertain to their testing requirements. They also will not receive the patient's latest HgBA1C. It is none of their business.

No patient has yet to NOT receive their supplies.

We do not print ANY records. Most of them go out via fax. Let their fax machine print 100 pages or whatever, unless they are like me and receive them thru paperport or such.

I charge a records research fee and a per-page fee. Alaska does not have a maximum charge as far as I can tell, so I use national standards. It isn't cheap, but I get compensated for paying my staff to do this work.

I generally do not charge a patient for their records. However, one patient recently wanted everything printed as well as the CD! So she got a records charge that was around 45 dollars. Every company seems reasonably happy to pay. More doctors should require compensation for this valuable staff and physician time.

I also give an option of an 8GB USB key with the records on it for a higher fee.