What Records Should You Send When Requested?

Continuing our discussions on medical records requests, this week we’ll focus on determining which records to send upon request. Watch the video for more information.


We’ve had some great conversations with doctors across Illinois surrounding medical records requests. And really as a result of a lot of our conversations that we’ve had with the patient’s right of access along with the more recent risk adjustment audit requests that have been coming into a lot of our doctor’s offices. And so some of the questions that we’re getting surround okay, what exactly do I send in so I, the baseline is really this. And this is really important to remember, with the way that HIPAA is structured, you want to make sure that you send the minimum necessary to be able to fulfill the request. When it comes to standard request, I’m not talking about right of access, but standard across the minimum necessary. In other words, if the patient is authorized in one particular request, you to send an attorney for example, the medical records, and they give very specific timeframes for authorization, you don’t provide information outside of those timeframes. Also, if the request narrows it even further, you want to make sure that you adhere to that request specifically.


Now additionally, on these risk adjustment audits, when they request for the medical records, they’re giving you a specific timeframe for a specific plan. And it’s important to remember that you’re also adhering to that as well. In other words, you only give them the specific dates of service that they’re requesting. If they say all of a particular calendar year then January 1 of that year to the end of the year. That’s all you sent. Now, here’s the question that’s come up. What happens if the patient in the middle of the year through a shifting policy or shifting contracts with a prior employer or whatever the case might be in the middle of the year they switch from one Medicare Advantage plan to another Medicare Advantage plan or if they end up switching off of standard Medicare to a Medicare Advantage plan or vice versa? Well, in those particular cases, you have to pay attention to the entity that’s making the request, they’re not entitled to see the other portions of the patient’s medical record. In other words, if they switch so if they switch from insurance company A to Insurance Company B in the middle of the year, and an entity on behalf of insurance company A or insurance company A themselves make that medical record request, you only send Insurance Company A records. In other words, those specific records that have been directed or that have been billed to insurance company A, if they’re the ones making the request, they have to be just to that entity. And just within that timeframe, it’s a really important distinction.

Also, remember that a patient and this is an incredibly rare circumstance. But a patient can actually direct you not to share medical records with an insurance carrier, we’ve got a full article that covers all that. But just be cognizant, if you do have a patient or two that has given you specific instructions on not to share medical records with an insurer then in those cases, you cannot share those records. And you have to make sure that you split apart those records and don’t send in the ones that they’ve told you not to share with the insurance company.

But again, the biggest thing is this, follow the instructions and the request to a tee, and make sure that it is only for the entity that’s making the request. And when in doubt, always verify to make sure to check with the entity making the request or check with the insurer to find out exactly what they’re requesting. And if you don’t get something clarified, ask them to give you something more clear inside of the request. In other words, send a new request that is more clearly defined exactly what they want. Otherwise, at the end of the day, always give the minimally minimal necessary information to be able to fulfill that request.

And by the way, on a side note, if you weren’t if you didn’t know, although the patient right of access is a must you must share those records under a patient right of access. HIPAA and all of the others even under a standard authorization is still a may share. And so if you do make mistakes, the only mistakes and the only challenge that could come back is more related to more related specifically to your contract with the insurer that you’re that is requesting those medical records and whether or not you get paid or whether or not you’re fulfilling your contract and not necessarily a violation of HIPAA. So remember standard HIPAA requests and authorizations are may share. Although we strongly recommend that you do share those cases, right of access when a patient’s making the request either for themselves or for you to send it to another entity under a right of access. And that will be typically clearly notated on those requests. That’s a must. So you always have to but on all of them. Make sure you narrow it down to the minimum necessary to be able to fulfill the request as it’s on the paper. We hope this information helps you out and we’ll catch you next week.

About Author

Marc Abla, CAE

Marc Abla began working at the Illinois Chiropractic Society in 2002 and became the Executive Director in 2008. He brings his extensive financial, administrative and association experience to the ICS. He is a Certified Association Executive and a graduate of the Certified Leadership Series through the Illinois Society of Association Executives. Additionally, he is a member of the Illinois Society of Association Executives, the American Society of Association Executives, Association Forum, Congress of Chiropractic State Associations, and the American Chiropractic Association.

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