TMA Experts Dispel Myths of Medical Records
By Alisa Pierce

Confused about whether your practice can charge fees when fulfilling a request for a copy of medical record?   

That was the main focus of the Texas Medical Association’s Nov. 16 edition of its “Ask the Expert” virtual series, created to give members direct access to professional experts who can answer questions on legal, practice management, advocacy, and regulatory topics.  

The TMA expert panel shared insights on regulations concerning permissible fees for copies of medical records and how to properly dispose of those records, among other helpful tips.  

The Texas Medical Board (TMB) generally allows physicians to charge a “reasonable, cost-based fee” for the release of medical records, with rulemaking setting maximum costs for both paper and electronic copies. Federal law can also impact what copy fees for medical records are permissible.  

Under TMB rules, for medical records provided in a paper format, physicians can charge no more than $25 for the first 20 pages and 50 cents for each page thereafter; for medical records provided in an electronic format, physicians can charge no more than $25 for 500 pages or fewer and $50 for more than 500 pages.  

However, charging the maximum amount may not be sufficient to meet TMB requirements, says Kelly Flanagan, TMA’s associate general counsel. Charges must be “reasonable” and “cost-based” to meet regulations.  

“If a lesser [fee] amount would … meet that standard, that would be the amount that would be appropriate,” she said during the event.  

TMB regulations state that copy fees charged for medical records provided in a hybrid format must also be reasonable and cost-based, and can be a combination of fees allowed for providing records in a paper format and in an electronic format.  

A reasonable copy fee may only include:  

• The costs associated with copying and labor, including compiling, extracting, scanning, burning onto media, and distributing media; 
• The cost of supplies for creating the paper copy or electronic media if the individual requests portable media;  
• The cost of postage, if the individual has requested the copy or summary be mailed; and  
• The costs associated with preparing a summary of the records.  

The fee may not include costs associated with searching for and retrieving the requested information. And, due to the 21st Century Cures Act’s information blocking requirements, a fee may not be based in any part on the electronic access of a patient’s electronic health information by the patient or their representative.  

For instance, fees may not be permitted where patients access their health information through a patient portal, Ms. Flanagan said.  

There are exceptions to charging fees as well, she noted. A physician may not charge fees for medical records for certain workers’ compensation purposes, or for medical records related to benefits or assistance claims based on a patient’s disability.  

As for how to properly protect paper charts, while some physicians still like to leave patient charts outside an exam room, doing so is only permissible if the clinic takes reasonable and appropriate measures to protect the patient’s privacy, says TMA practice management associate Beverly Chilton.   

For example, Ms. Chilton recommends that patient charts face towards the wall and emphasizes they should not include patient information on the outside of the folder. 

“There are still paper charts out there, and you want to make sure that when you need to dispose of them, you do so properly,” she said. “They can be shredded, burned, or pulverized. But the main thing you want to watch is that the records are rendered essentially unreadable and cannot be reconstructed.” 

Ms. Chilton adds that the same concept applies to electronic records, which may be stored in software that includes programs that can overwrite a patient’s protected health information (PHI), when it is time to dispose of the patient’s medical record. PHI includes any identifier that connects a patient to his or her health information, including the patient’s street address, phone number, or automobile license number.  

For past and upcoming topics and events, visit TMA’s Ask the Expert webpage.   

For more information on medical records, including fees for copies, check out TMA’s white papers on medical records (member log in required). For guidance from the U.S. Department of Health and Human Services (HHS) regarding methods to deidentify PHI in accordance with the HIPAA Privacy Rule, visit HHS’ webpage.