What Can A Practice Charge a Patient for Medical Records?

Date of Publication February 14, 2018

Entities covered by the Health Insurance Portability and Accountability Act (HIPPA) are required to provide patients, upon request, with access to their protected health information (PHI). However, the entity may charge the individual a fee for that record, and HIPAA limits the amount that may be charged.

Only three costs may be charged to the patient: the reasonable cost of labor for creating and delivering the record in the form and format requested; the costs of supplies for creating the paper copy (such as paper or toner) or for creating the electronic copy (such as a USB drive); and the actual cost of postage, if the patient has requested the file be mailed. It is important to note that costs associated with reviewing the request, searching for or retrieving records, or preparing the record for copying may not be charged.

If the patient requests an explanation or summary of the medical record, the cost for the preparation of that explanation or summary may be charged to the patient as long as he agrees to the charge in advance.

Entities can calculate their actual labor costs for each request, or they can develop a schedule. However, they cannot charge an average labor cost as a per-page fee unless the medical record is maintained in paper form and the individual requests a paper copy. As a result, under HIPAA, a per-page fee is not permitted for electronically maintained medical records.

Even if an entity's fee takes into account only permissible costs, that fee must also be reasonable. Additionally, entities should give copies without charge to individuals who cannot afford the fee. Fees cannot be charged for a patient accessing their individual PHI through the entity's EHR system, nor can fees be charged if a patient inspects their PHI at the entity's office.

An entity may, instead of calculating actual costs or developing a schedule, simply charge a flat fee of up to $6.50. That $6.50 amount includes labor, supplies, and any applicable postage, for requests for electronic copies of medical records maintained electronically. The $6.50 is not a maximum, but is an alternative if the entity elects not to go through he process of calculating actual or average allowable costs for request for electronic copies.

In addition to the rules imposed by HIPAA, Iowa Code Section 622.10(6) requires that a provider must provide copies of requested records to the requestor within 30 days from receiving the written request.

More information about the requirements under HIPAA is available here. For further inquires about the fees that may be charged to a patient for copies of a medical record, please contact Kate Strickler.

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