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August 29, 2007

Electronic Medical Record Copying Fees

NEW LEGISLATION. On August 27, 2007, Governor Blagojevich signed into law Public Acts 95-478 and 95-480, which govern requests for electronic copies of patient medical records. Both Acts take effect on January 1, 2008.

Although P.A. 95-478 limits hospital reimbursement for providing medical information in an electronic format to 75 cents per disc, P.A. 95-480 was signed later and therefore supersedes that provision, and replaces it with the more reasonable rate of 50% of the paper rate for the number of pages on the disc.

These Acts establish obligations for hospitals that maintain patient medical record information electronically and are able to provide such information in an electronic format to anyone with a valid authorization seeking such records. This memorandum describes these changes.

Requirements under P.A. 95-478 and P.A. 95-480 (Effective January 1, 2008)

Under P.A. 95-478 and P.A. 95-480, a hospital may only charge someone seeking medical records for the following:

1. A $22.84 handling fee,
2. Actual postage and shipping,
3. Applicable paper copying charges (current rates are 86 cents per page for the first 25 pages; 57 cents per page for the next 25 pages; and 29 cents per page thereafter)
4. $1.43 per page for copies made from microfiche or microfilm;
5. 50% of the paper rate for each page on each computer disc generated to provide electronic versions of electronically maintained medical record information;
6. An additional fee for the reasonable cost of duplicating information that cannot routinely be copied or duplicated on a standard commercial photocopy machine (e.g. x-ray films or pictures).

The rates under items 1, 3, 4, and 5 are automatically adjusted annually on January 20^th for inflation. See http://www.ioc.state.il.us/office/fees.cfm for the most current maximum amounts. HIPAA permits such fees as long as they are "reasonable" and "cost-based" to include the cost of supplies and copying labor. However, HIPAA prohibits charging a handling fee to patients and those involved in making their health care decisions. This prohibition, however, does not apply to other requestors of patient records, such as the patient’s attorney. P.A. 95-478 also specifies that copies of records retrieved from "scanning, digital imaging, electronic information or other digital format" may not be charged at the microfiche rate. Instead, the paper rate would apply.

But the major purpose of these Acts is to set the terms for producing medical record copies maintained by hospitals in an electronic format. P.A. 95-478 states that if records are "already maintained in an electronic or digital format" they must be provided in such electronic format when so requested. However, if the hospital’s "record system does not allow for the creation or transmission of an electronic or digital record," then the hospital must inform the requestor in writing why the records could not be provided electronically. The hospital may include this written explanation as part of the package of paper copies that are being provided to the requestor.

Thus under these Acts, a hospital must provide medical record information in electronic format to a requestor with a valid authorization for such records, if the following conditions are met:

1. The requestor asks for the records in an electronic or digital format;
2. The hospital already maintains such records in an electronic or digital format; and
3. The hospital’s record system actually allows the hospital to put such information on a CD Rom, DVD, or other electronic storage media.

If all of the conditions for the provision of electronic record information are satisfied, the hospital must provide the information to the requestor in an electronic format at the statutory rate of 50% of the paper rate for the number of pages on the disc.

Nothing under these Acts requires hospitals to adopt electronic medical record systems and they do not require hospitals to develop systems that will accommodate the provision of medical records to outsiders on CD ROMs’, DVDs or other electronic media. But if a hospital does not maintain medical information electronically or its system does not allow for such production, these Acts requires the hospital to provide the requestor with a written explanation as to why the request could not be satisfied.

Implications
In today’s complex medical record world, a patient’s record may take many forms and exist in many places (e.g., billing, imaging, radiology, outpatient department). Some may be kept in hard copy (e.g., the traditional bedside handwritten chart). Some may be kept on film or microfiche. Eventually, as technology improves, all of the patient’s information from all sources may be available through a single computer inquiry. We are aware of no hospital that has this capability today. Consequently, no patient can expect to get their entire medical record from a hospital on a computer disc. That system has yet to be invented.

Under this hybrid system, hospitals may be asked to provide medical record information in a variety of formats (e.g., paper, film, microfiche, and computer disc). In combination, P.A. 95-478 and P.A. 95-480 only change the way hospitals may bill patients and their representatives for such records that are maintained electronically and are capable of being provided on disc. Until medical record technology allows for a single record search inquiry to download all of the medical record information in the hospital’s possession for a specific patient onto a disc, medical record production will remain a difficult and painstaking process. Nothing in these Acts alters the task of gathering such information from within the hospital. However, they do change the way hospitals may be paid for providing such information to requestors based upon the format of the information (e.g., paper, film, or disc).

P.A. 95-478, can be accessed at: http://www.ilga.gov/legislation/publicacts/fulltext.asp?Name=095-0478&GA=095.

P.A. 95-480, can be accessed at: http://www.ilga.gov/legislation/publicacts/fulltext.asp?Name=095-0480&GA=095.

If you have any questions regarding P.A. 95-378 or P.A. 95-480, please contact Ted Nodzenski at tnodzenski@ihastaff.org or 630.276.5472.