Colorado used to have a nice simple formula for the maximum (reasonable) charge for medical records. $14 for the first 10 pages, $0.50 for pages 11 through 40 and $0.33 for every page after that. It was a bit more for patient representatives, but on the whole you knew what you could expect. It kept the lid on offices that wanted to charge you an exorbitant fee for a “records review” before releasing records. Or copiers that wanted to change $1 a page just to copy records. Well, now that’s all gone.
Things are not simplified. That formula? Too complicated! We got a fix for you. See if you can spot it:
Colorado – Medical records law was recently redesigned for HIPAA compliance. See Colorado Statute § 25-1-801 (1)(b)(I)(a) for records in a medical facility and §25-1-802 (1)(b)(I)(a) for records in custody of individual health care providers allow a patient or the patient’s personal representative (as defined in 45 CFR 164.502) to obtain records at a “reasonable cost.”
In the past, the “reasonable cost” if a patient or personal representative (as defined under HIPAA § 164.502(g)) requested records was $14.00 for the first 10 or fewer pages, 50¢ for pages 11-40 and 33¢ per page for every additional page. Actual postage and applicable sales tax may also be charged. The per page fee for records copied from microfilm shall be $1.50 per page. A “reasonable cost” for requests made by other designated representatives was defined as $16.50 for the first 10 or fewer pages, 75¢ per page for pages 11- 40, and 50¢ per page for every additional page. 6 Code of Colorado Regulations 1011-1, Chapter 2, Part 220.127.116.11. However, this section is now “reserved” and does not include any text. 6 Code of Colorado Regulations 1011-1, Chapter 2, Part 18.104.22.168 does state that discharged inpatients or their representatives “shall not be charged for inspection of patient records.” Code of Colorado Regulations.
So, what was previously regulated to keep doctors’ offices from gouging patients is now limited to “reasonable.” Who get’s to decide what’s reasonable? The doctor’s office (or their copier).
What do doctors think about having to copy records?
They hate it.
It is small potatoes to them. It gets in the way of doing their “real” jobs and making the real money.
So, in many instances, they outsource the job to a copier service. What do copier services think of making records available? Well, under the old system, the first 40 pages cost about $40. Do you think you could copy 40 pages in an hour? How about half an hour? Sure, why not. And I think I am being conservative when I say you could easily copy 80 pages in an hour. So copiers were at least charging an estimated $40 to $80 an hour.
Nowadays when most records are electronic to begin with, it is more a matter of dragging a folder to a printer icon or running a “search and print” routine. 80 pages in an hour? I suspect it is closer to 80 pages in 5 minutes (or less).
And now with the fee schedule eliminated, the prices can just go higher and higher. Remember the fee schedule didn’t prevent doctors from charging less. They only kept them from charging more.
Now that the limit is gone, what do you think is going to happen?
Reference: State Medical Record Payment Rates.
Image provided by Provincial Archives of Alberta.