The below excerpt is copied from: Drew Voytal, Associate Director MGMA Goverment Affairs, GovChat

Following a federal court ruling, the Office for Civil Rights (OCR), the federal agency tasked with enforcing the HIPAA privacy and security rules, issued a notice modifying the agency’s policy regarding the fees practices and others are permitted to charge when a patient requests that their medical record be sent to a third party (such as a law firm). The court vacated the “third-party directive” within the individual right of access “insofar as it expands the HITECH Act’s third-party directive beyond requests for a copy of an electronic health record with respect to [protected health information] of an individual . . . in an electronic format.”

In light of this ruling and policy change, practices are no longer prohibited from setting their own fee for sending a patient’s medical record to a third party. Despite this change in policy, practices are still limited in what they can charge patients when they request a copy of their medical record for themselves and OCR has emphasized that they plan to “vigorously enforce” the patient right to access their information. To better understand practice rights and responsibilities in this area, GovChat participants are encouraged to download the updated MGMA member-benefit resource: The Patient Right to their Medical Record: Format, Fees and other Requirements.

Please feel free to reach out with any questions or comments.

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Drew Voytal
Associate Director
MGMA Government Affairs
Washington, DC
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The following is an excerpt from The Patient Right to their Medical Record: Format, Fees and other Requirements.

Charging patients fees for copies of PHI

Practices are permitted to impose a “reasonable, cost-based fee” for the PHI, including:

1.         Labor for the actual copying of the PHI, whether in paper or electronic form (i.e., labor to scan records, prepare an e-mail, transferring PHI from one format to another, and other activities).

2.         Labor to prepare an explanation or summary of the PHI, if the patient in advance both chooses to receive an explanation or summary and agrees to the fee that may be charged.

3.         Supplies for creating the paper copy (e.g., paper, toner) or electronic media (e.g., CD or USB drive) if the patient requests that the electronic copy be provided on portable media

4.         Postage, when the patient requests that the copy, or the summary or explanation, be mailed.

The practice must inform the patient in advance of the approximate fee that may be charged for the copy.

NOTE:  Labor for copying cannot include costs associated with reviewing the request for access or searching for and retrieving the PHI.

There are three ways a practice can calculate this reasonable, cost-based fee for the PHI maintained electronically:

•           Actual costs;

•           Average costs; or

•           Flat fee

NOTE:  Flat fees cannot exceed $6.50, inclusive of all labor, supplies, and any applicable postage.

A practice may not:

•           Withhold a patient’s PHI (even if the patient has an outstanding account balance);

•           Withhold the PHI and apply the fee charged to the outstanding account balance;

•           Charge patients a fee to view or inspect their PHI; or

•           Charge a patient who takes notes or pictures to capture PHI.

TIP: While the Privacy Rule does permit practices to charge patients a cost-based fee for a copy of their medical record, practices should consider implementing a policy of providing a no-cost option for the first request

Sending PHI to third parties:

•           A practice must transmit the PHI directly to another person or entity designated by the patient.

•           The request from the patient must be in writing, signed by the patient, and clearly identify the designated person/entity and where to send the PHI. Practices must take action within 30 days.

•           Practices may rely on the information provided in writing by the patient about the identity of the designated person and where to send the PHI for purposes of verification of the designated third party as an authorized recipient. However, practices must implement “reasonable safeguards” to carry out the request, such as taking reasonable steps to verify the identity of the patient making the access request and to enter the correct information into the practice’s system.

•           Practices must safeguard the PHI in transit and may be liable for impermissible disclosures that occur in transit. The only exception, as noted above, arises when a patient has requested that the PHI be sent to the third party in an unsecure manner. If the patient was warned of and accepted the security risks, the practice is not responsible or liable for disclosures that occur in transit.

UPDATE AS OF JAN. 2020:  Following a court ruling, the Office for Civil Rights has revised its policy regarding the fees practices can charge for patient records that are sent to third-parties. There is no longer a prohibition on practices setting their own fees for transmitting patient data to a third party. However, the fee limitations outlined in this document still apply when patients request their data for their own use.

Intersection of HIPAA with State Law

• Practices must comply with any additional requirements under state laws or regulations if they are more stringent than those outlined under the federal standards.
• For example, practices must comply with state law should it require that the patient is to be provided one free copy of their PHI. HIPAA does not override those State laws that provide individuals with greater rights of access to their PHI.

NOTE:  Search and retrieval costs or other costs not permitted by the Privacy Rule may not be charged to patients, even if authorized by state law. Example: If state law limits costs to 25 cents a page and the actual cost is only four cents per page, then the practice may charge only four cents. If the cost is 30 cents per page and state law allows for 25 cents, then the practice may charge no more than 25 cents.

Humana has the “POET red line” of the agreement. They received it in October 2019. Unfortunately, Humana’s new review system for contracts appears to have issues causing a delay. POET ‘s contact at Humana has been working to obtain the current status.

Stay tuned in….

BCBSTX notified POET in November of a fee schedule update to be effective as of March 1, 2020. They have indicated the fee schedule is not ready for distribution at this time. We have been assured POET will receive the new schedule when ready. We will quickly prepare your hot codes and get them to you.

We will keep you posted.

Texas Insurance Commissioner Kent Sullivan is reminding insurers of their obligations under the state’s new baseball-style arbitration law to resolve disputes on many out-of-network medical bills.

In a letter Tuesday addressed to “the health plans of Texas,” Mr. Sullivan said the Texas Department of Insurance (TDI) will monitor how health plans implement Senate Bill 1264, passed during last year’s session of the Texas Legislature and now in effect.

“We expect you to be proactive to meet both the letter and spirit of SB 1264,” Mr. Sullivan said. “Review your policies and procedures and address potential issues quickly.”

The letter highlighted several of the plans’ responsibilities in relation to the law. The commissioner’s letter noted that:

• State law requires plans to cover medical screenings necessary to rule out the presence of an emergency condition;
• For emergency care, claim denials based on failure to meet the prudent-layperson standard must be based on the patient’s presenting symptoms, not on the later diagnosis code;
• Plans must meet required deadlines to promptly adjudicate clean claims; and
• Plans must be ready to provide accurate information about the new law, including required notices about mediation and arbitration, on explanations of benefits. The plans must be able to quickly respond to questions from policyholders and practitioners.

Mr. Sullivan’s letter noted that TDI has set up an SB 1264 page on its website, which includes a link to the state’s new portal for mediation and arbitration requests.

The Texas Medical Association has published a brief overview of the new law for physicians.

Last Updated On

January 09, 2020

Joey Berlin

Quoting Texas Medicine December 2, 2019

“An April 2019 study by Massachusetts General Hospital and two universities examined physicians’ knowledge of legal obligations when caring for patients with disabilities.”

“The study said most physicians interviewed “exhibited a superficial or incorrect understanding of their legal responsibilities to patients with a disability.”

The ADA defines a person with a disability as someone with “a physical or mental impairment that substantially limits one or more life activities”; someone with a record of such an impairment; or someone who is “regarded as having such an impairment.”

Among the ADA standards required for accessible exam rooms, according to the guidance:

•  The entry door to the exam room should be a minimum width of 32 inches when the door is opened at a 90-degree angle;

• There should be a minimum of 30 by 48 inches of clear floor space next to the exam table; and

• An accessible exam table should be able to be lowered to the height of the patient’s wheelchair seat, 17 to 19 inches from the floor .

Federal guidance also includes requirements on removing architectural barriers, accessible parking, and entrance and maneuvering spaces – which apply to both for-profit and nonprofit organizations. Among them:

• Designated accessible parking spaces must be included among any parking the business provides for the public “if doing so is readily achievable.” Those parking spaces should be the closest to the accessible entrance, on level ground. The spaces should be at least eight feet wide, with an access aisle on either side.

• For accessible spaces for cars, the adjacent access aisle must be at least five feet wide; for van spaces, eight feet wide.

• If achievable, an accessible service counter must have a maximum height of 36 inches, with a clear floor space of 30 by 48 inches to permit the use of a wheelchair.

• Hearing-impaired patients present their own considerations for delivering adequate care. TMA’s white paper, Americans with Disabilities Act and the Hearing Impaired, contains a summary of physicians’ requirements for those patients under the ADA and guidance from the Department of Justice (DOJ) on how they may be able to meet those requirements.

• In 2014, DOJ substantially increased ADA penalties for small businesses. The maximum fines are now $75,000 for a first-time violation – $20,000 higher than the previous maximum – and $150,000 for any subsequent violations.

To read the entire article, please click below.

Tex Med. 2019;115(12):40-41
December 2019 Texas MedicineContents
Texas MedicineMain Page 

Click here to read Mailing from BCBS.

Please welcome Brigitte Monrose, M.D., Family Practice. She will be joining Dr. Charles Evans.

Click here to view the Updated Directory.

Are you looking for a tool for conducting performance conversations with your employees?

Click “Differentiating Staff Worksheet” to review this sample worksheet from “Results that Last”.

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