(1) Flat fees (as listed in this notice) apply to amounts that may be charged by a health care facility or health care provider when copying medical charges or records either: (a) for the purpose of supporting any claim or appeal under the Social Security Act or any Federal or State financial needs based program; or (b) for a district attorney.
(2) An insurer shall not be required to pay for copies of medical records required to validate medical services for which reimbursement is sought under an insurance contract, except as provided in: (a) the Worker’s Compensation Act (77 P. S. §§ 1—1041.1 and 2501—2506) and the regulations promulgated thereunder; (b) 75 Pa.C.S. Chapter 17 (relating to motor vehicle financial responsibility law) and the regulations promulgated thereunder; or (c) a contract between an insurer and any other party.
The charges listed in this notice do not apply to an X-ray film or any other portion of a medical record which is not susceptible to photostatic reproduction.
Under 42 Pa.C.S. § 6152.1 (relating to limit on charges), the Secretary is directed to make a similar adjustment to the flat fee which may be charged by a health care facility or health care provider for the expense of reproducing medical charts or records where the request is: (1) for the purpose of supporting a claim or appeal under the Social Security Act or any Federal or State financial needs based benefit program; or (2) made by a district attorney.
The Secretary is directed to base these adjustments on the most recent changes in the Consumer Price Index reported annually by the Bureau of Labor Statistics of the United States Department of Labor. For the annual period of October 31, 2009, through October 31, 2010, the Consumer Price Index was 1.2%.
Accordingly, the Secretary provides notice that, effective January 1, 2011, the following fees may be charged by a health care facility or health care provider for production of records in response to subpoena or request:
The Department of Health and Human Services has stated that, under HIPAA, medical record copying fees for patients may not include costs associated with searching for and retrieving the medical record. For a subpoena, attorney, or insurance company requests, you may charge the fees, including the search and retrieval fee. To determine your cost for copying and mailing medical records for a patient request under HIPAA, you should consider the following:
- Salary and benefits of the person who does the copying. Include all steps of the process, i.e., verifying validity of authorization, pulling the chart, reviewing the record, removing the records, copying, preparation for mailing, re-assembling the chart, and re-filing the chart.
- Cost of the supplies, i.e., paper, toner, envelopes, etc.
- Cost of equipment, i.e., prorated lease or depreciation expense.
|Pages 1-20||$1.34/page||Cost of copying & mailing|
|Pages 21-60||$.99/page||Cost of copying & mailing|
|Pages 61+||$.33/page||Cost of copying & mailing|
|Microfilm Copies||$1.97/page||Cost of copying & mailing|
If a district attorney requests a medical record for an action or proceeding, a flat fee of $19.92 may be charged. No independent or executive agency of the Commonwealth is required to pay any costs associated to medical charts or records unless required by law. At this time, Workers’ Compensation (utilization review) and Auto (peer review) pay $.12 per page, plus actual mailing costs (scope of release is limited to the treatment of the work related or auto injury). Attorney requests for Workers’ Compensation and Auto treatment records are not subject to the $.12 limitation.
If the medical record is requested for the purpose of supporting a claim or appeal under the Social Security Act, a flat fee of $25.24 plus postage may be charged (the attorney should be able to supply a copy of the Appointment of Representative from the Social Security Administration).
Note: Some health insurance contracts may require the physician to forward patient records to another physician within a network at no charge.