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Clearing up confusion: What and whom to charge for medical record copies

If you’re confused about what fees can be charged for copies of medical records and to whom, you’re not alone, in large part because different laws apply depending on the individual requesting copies, the type of record and the purpose of the request.

If a patient—or legal representative such as guardian or health care agent—requests copies of the patient’s records, HIPAA limits the amount that can be charged for those copies to a reasonable, cost-based fee.

If the requestor is someone other than the patient or the patient’s legal representative, health care providers may charge fees up to the maximums allowed under Wisconsin law, indexed annually for inflation.

HIPAA and Patient Requests
Under HIPAA, patients (or their personal representative) may not be charged more than a reasonable, cost-based fee for copies of their medical records. This includes where an individual (such as a patient’s attorney) presents an authorization signed by the patient directing copies be sent to the attorney.

The fee may include only the cost of labor, supplies, postage and preparation of a summary (if requested) and may not include costs associated with verification; documentation, retrieval, storage or other related expenses, even if otherwise permitted under state law. There is no permissible per-page or per-request amount allowed under HIPAA.

Providers have three options in calculating allowable fees under HIPAA:

  • actual costs—actual allowable costs of labor, materials and postage
  • average costs—providers may develop a schedule of average labor costs to fulfill standard requests (provided there is adequate documentation to back up the basis for those fees)
  • flat-rate—$6.50 for electronic copies stored electronically (note this is a permissible alternative calculation, not a maximum)

 
Copies must be provided in the form requested by the patient if readily produceable in that format. For example, if a patient requests that copies of records be produced in PDF and provided to their attorney on a USB drive, the health care provider is required to do so unless it would require them to purchase specialized equipment. Scanning paper copies and converting to PDFs is not considered an undue burden. If a provider is unable to meet the specifics of a request, they must communicate with the requestor to find a mutually agreeable alternative.

For more information on when, whether and in what amount fees can be charged for copies of medical records under HIPAA, see this guide by the Department of Health and Human Services. HHS encourages providers to utilize patient portals and other technology to minimize costs to patients for accessing their health information.

State Law and Requests by Someone Other Than Patient or Patient’s Representative
When a request is from someone other than the patient or the patient’s representative, providers may charge fees as allowed by state law. Wis. Stat. § 146.83(3f) specifies the maximum amounts health care providers may charge for copies of records. These amounts are adjusted annually for inflation. Rates effective July 1, 2018 through June 30, 2019 are listed below and can be found here.

Paper Copies (per page) (Wisconsin law does not separately address electronic copies)

  • First 25 pages: 1.12 per page
  • Pages 26-50: 84 cents per page
  • Pages 51-100: 55 cents per page
  • Pages 101+: 33 cents per page

 
Microfiche or Microfilm: $1.65 per page
Print of X-ray: $11.07 per image
Certification of copies: $8.87*
Retrieval fee: $21.73*

*Certification and retrieval fees may not be charged to “a person authorized by the patient.” Pursuant to Moya vs. Healthport Technologies, Inc., “person authorized by the patient” includes attorneys presenting a valid authorization from their client.

Certain exceptions apply under Wisconsin law, including:

  • Worker’s Compensation:
    • if in paper form: the greater of $.045/page or $7.50, plus actual costs of postage
    • if in electronic form: $26 per request
  • Medical Assistance: Health care providers may not charge a patient, or person authorized by the patient, more than 25 percent of the applicable fee for providing one copy of a patient’s records if the patient is eligible for medical assistance (including Badgercare)
  • Social Security: Health care providers may not charge more than the Social Security Administration reimburses the Wisconsin Department of Health Services for copies of patient health care records if (1) DHS requests the records for use in determining eligibility for social security income or (2) the records requested by a patient or person authorized by the patient are for use in appealing a denial of social security disability insurance or supplemental income.

 
For more information, see “Charging for Copies and Summaries of Protected Health Information” by the HIPAA Collaborative of Wisconsin (HIPAA COW), available here.

Back to October 4, 2018 Medigram