| This page
answers many, but not all questions about medical records in Texas. One
question that comes up is who owns the medical records on a patient. The
healthcare facility which compiles or generates those records owns them,
but the patient about whom they are compiled, has a right to request
COPIES of these records. In general, healthcare records should be
maintained at the generating facility for seven (7) years.
Another question that arises is "What is the right way to correct a medical record?" The accepted method is for the person making the change, to put one horizontal line through the material to be corrected, and then to put a small mark of their initials near the change to identify the person making the change. I always feel that, if space provides for it, the initials should be accompanied by the date the change was made. In general, use of materials such as "whiteout" or other expunging correcting tapes or fluids, should be avoided. Please read on. |
This site has NOT been updated since that time, and the
material presented on this page was correct, as far as
the author could determine, on that date. No implied nor express,
implicit nor explicit representations are herein made
about the validity of the material presented after that
date. Laws can and do change. If question arises, please
check with the Texas statutes online for the latest
changes.
http://tlo2.tlc.state.tx.us/statutes/statutes.html
Texas constitution
http://tlo2.tlc.state.tx.us/txconst/toc.html
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TEXAS MEDICAL RECORDS
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about the laws of Texas and other important information which is useful to the
health care consumer.
NEED TO LOOK UP
INFORMATION ON A DOCTOR?
http://www.docboard.org/tx/df/txsearch.htm
NEWS ITEM ON ENFORCEMENT OF
MEDICAL RECORDS LAWS IN TEXAS
" In the News"
http://www.lubbockonline.com/stories/011108/loc_235668037.shtml
"
Friday,
January 11, 2008
Story last updated at 1/11/2008 - 2:42 am
The Texas attorney general filed a lawsuit Thursday against a Pennsylvania-based company accused of discarding hundreds of intact medical records in a Levelland Dumpster.
Authorities found more than 4,000 pieces of patient information, including names, addresses, treatment details and bank account and Social Security numbers, in a Dumpster behind the national medical company's branch in Levelland. The branch closed in October.
That same month, Levelland police recovered information from more than 1,000 patients of Select Physical Therapy Texas Limited Partnership, also known as Health South Rehabilitation Center. But it's too early to determine if anyone's identity has been stolen as a result, authorities said at a news conference in Lubbock.
"I still don't feel secure and I don't think I ever will. I guess I was one of these folks that sat back and thought this isn't going to happen to me," said Marquita Darland, a 64-year-old whose private records were found inside the Dumpster.
The Levelland resident said she checks her accounts three to four times daily for suspicious activity.
She's part of a growing class of victims: More than 25,000 Texans are impacted annually by identity theft, Attorney General Greg Abbott said.
"We are trying to send the message to businesses across the state of Texas: You have a responsibility to shred or redact information in your records that contain personal identifying information of your customers. If you fail to do so, the Texas Legislature has established very high penalties," Abbott said.
Select Physical Therapy and its parent company, Select Medical Corp., are accused of violating a Texas law passed in 2005 to guard consumers from identity thieves who comb trash for personal records. The law requires businesses to make identifying customer information unreadable prior to disposal.
Businesses who break the 2005 Identity Theft Enforcement and Protection Act can be fined up to $50,000 per violation, a fine that will be sought, along with additional civil penalties, in this lawsuit, which is the seventh filed against businesses accused of violating the act."
MY NEWS PAGE ON HIPAA RELATED MATTERS :
LATEST
NEWS ON HIPAA (CURRENT)
http://www.newsinferno.com/archives/2363
" Two former Amgen employees are
charging that the drug maker engaged in illegal
marketing practices in an attempt to increase sales of
the drug
Enbrel. The former Amgen salespeople claim that
they were encouraged by the company to illegally access
patient records to induce insurance carriers to pay for
Enbrel, an extremely pricey drug.
According to the drug’s website, Enbrel is a type of protein called a tumor necrosis factor (TNF) blocker that blocks the action of a substance made by the body’s immune system called TNF. People with an immune disease, such as rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and psoriasis, have too much TNF in their bodies. The Food & Drug Administration (FDA) first approved Enbrel in 2000 for treating rheumatoid arthritis, and its approved uses where expanded several times to include psoriasis and other conditions.
Elena Ferrante of Montvale, New Jersey, who was terminated by Amgen in 2005, and Mark Engelman of Laguna Niguel, California, who resigned from the company last year, is suing Amgen for lost wages and other compensation after refusing to participate in improper promotion of Enbrel. Enbrel is approved only for treating moderate to severe psoriasis, but the former employees say they were expected to engage in promotion efforts that sometimes included patients with less severe disease.
Ferrante and Niguel claim that Amgen sales reps were instructed to go into dermatologists’ offices and get permission to go through files to identify patients with psoriasis based on the diagnostic coding system insurers use for reimbursement. The representatives were told to then call insurers covering patients with mild psoriasis to seek approval for reimbursement of Enbrel, which costs $20,000 to $50,000 per year, depending on the severity of the sometimes-painful skin condition. When calling the insurance companies, they were instructed not to identify themselves as Amgen sales reps. Rather, they allege that they were told to say that they were “calling on behalf of Dr. So-and-so.”
The representatives also allege that the Amgen sales force was told to write letters on behalf of doctors, seeking advance approval so doctors could write prescriptions for Enbrel. Doctors writing prescriptions would benefit from frequent patient visits to have the drug injected..
If proved, the allegations could cause Amgen serious trouble. The Health Insurance Portability and Accountability Act (HIPAA) contains very tough sanctions for disclosing someone’s health information — up to 10 years in jail and a $250,000 fine if the information was transferred or used for commercial advantage. Physicians who agreed to participate in the alleged Enbrel marketing scheme could also be in trouble.
An attorney for the two former Amgen employees told the Associated Press that the New Jersey attorney general’s office is investigating and has interviewed Ferrante. According to the Associated Press, that office would not confirm or deny any investigation of Amgen or Enbrel. However, last fall, the New Jersey attorney general convened a task force to investigate how the doctor-patient relationship is affected by the widespread practice of drug and medical device makers giving physicians gifts and fees for researching, consulting and speaking about their products. "
http://members.lycos.co.uk/hipaa
SPECIFIC PAGE ON REQUEST FOR CHIROPRACTIC RECORDS (CLICK HERE)
PAGE
LAYOUT :
The First Section is about
the HIPAA release being used to get patient records
from providers.
The
Second
Section is about the Texas Medical Practice Act
which governs
release of records.
The Third Section talks about the fees that hospitals can charge for records.
SECTION ONE
Request of
Medical Records by a lawyer on a patient...
Lots of
attorneys are using a HIPAA section to request medical
records on patients.
They are commonly using 45 CFR
§164.508 (c).
What does this section state ?
For ALL sections (which I believe providers should read)
please see this
pdf.http://www.wedi.org/snip/public/articles/45CFR160&164.pdf
CLICK HERE TO OPEN A NEW WINDOW WITH SALIENT POINTS
THE HIPAA RELEASE FOR HEALTHCARE PROVIDERS
-------SNIP-------
The attorneys do not usually give you all the
citations, nor do they let you know that
a healthcare providing entity, may opt NOT to provide
the requested "all records" which
are frequently sought. The provider may opt to do a
summary instead. Also, there are fees which the provider
may charge for copying, labor, postage, etc. Also, the
provider has 30 days to respond, and also, there is a
provision for getting a 30 day extension if warranted.
Please see farther down for this information.
""(b)
Implementation specifications: requests for access and
timely action.
(1) Individual’s request for access. The covered entity must permit an individual to request access to
inspect or to obtain a copy of the protected health information about the individual that is maintained in a designated
record set. The covered entity may require individuals to make requests for access in writing, provided that it
informs individuals of such a requirement.
(2) Timely action by the covered entity.
(i) Except as provided in paragraph (b)(2)(ii) of this section, the covered entity must act on a
request for access no later than 30 days after receipt of the request as follows.
(A) If the covered entity grants the request, in whole or in part, it must inform the
individual of the acceptance of the request and provide the access requested, in accordance with
paragraph (c) of this section.
(B) If the covered entity denies the request, in whole or in part, it must provide the
individual with a written denial, in accordance with paragraph (d) of this section.
(ii) If the request for access is for protected health information that is not maintained or accessible
to the covered entity on-site, the covered entity must take an action required by paragraph (b)(2)(i) of this
section by no later than 60 days from the receipt of such a request.
(iii) If the covered entity is unable to take an action required by paragraph (b)(2)(i)(A) or (B) of
this section within the time required by paragraph (b)(2)(i) or (ii) of this section, as applicable, the covered
entity may extend the time for such actions by no more than 30 days, provided that:
(A) The covered entity, within the time limit set by paragraph (b)(2)(i) or (ii) of this
section, as applicable, provides the individual with a written statement of the reasons for the delay
and the date by which the covered entity will complete its action on the request; and
(B) The covered entity may have only one such extension of time for action on a request
for access.
(c) Implementation specifications: provision of access. If the covered entity provides an individual with access, in
whole or in part, to protected health information, the covered entity must comply with the following requirements.
(1) Providing the access requested. The covered entity must provide the access requested by individuals,
including inspection or obtaining a copy, or both, of the protected health information about them in designated
record sets. If the same protected health information that is the subject of a request for access is maintained in more
than one designated record set or at more than one location, the covered entity need only produce the protected
health information once in response to a request for access.
(2) Form of access requested.
(i) The covered entity must provide the individual with access to the protected health information
in the form or format requested by the individual, if it is readily producible in such form or format; or, if
not, in a readable hard copy form or such other form or format as agreed to by the covered entity and the
individual.
(ii) The covered entity may provide the individual with a summary of the protected health
information requested, in lieu of providing access to the protected health information or may provide an
explanation of the protected health information to which access has been provided, if:
(A) The individual agrees in advance to such a summary or explanation; and
(B) The individual agrees in advance to the fees imposed, if any, by the covered entity for
such summary or explanation.
(3) Time and manner of access. The covered entity must provide the access as requested by the individual
in a timely manner as required by paragraph (b)(2) of this section, including arranging with the individual for a
convenient time and place to inspect or obtain a copy of the protected health information, or mailing the copy of the
protected health information at the individual’s request. The covered entity may discuss the scope, format, and other
aspects of the request for access with the individual as necessary to facilitate the timely provision of access.
(4) Fees. If the individual requests a copy of the protected health information or agrees to a summary or
explanation of such information, the covered entity may impose a reasonable, cost-based fee, provided that the fee
includes only the cost of:
(i) Copying, including the cost of supplies for and labor of copying, the protected health
information requested by the individual;
(ii) Postage, when the individual has requested the copy, or the summary or explanation, be
mailed; and
(iii) Preparing an explanation or summary of the protected health information, if agreed to by the
individual as
required by paragraph (c)(2)(ii) of this section."
===SNIP=======
What is "reasonable"
and "cost based"?
See the following: (Used pursuant to FAIR USE doctrine)
http://www.hipaadvisory.com/action/legalqa/law/Legal47.htm
"
Whether and how much to charge patients, attorneys, and healthcare providers for copies of patient medical records while complying with HIPAA and state laws has become a hot topic. Copies of medical records are routinely requested by patients changing providers, by providers in connection with providing treatment to patients, and by attorneys as part of legal disputes. The HIPAA Privacy Rule (the "Privacy Rule") requires covered entities (i.e., health plans, clearinghouses, and providers who transmit health information in electronic form in connection with a HIPAA covered transaction) to inform individuals of their right of access to inspect and obtain a copy of their protected health information ("PHI") in the individual's designated record set maintained by or for a covered entity. Generally, a designated record set consists of those records that contain health information, including billing information, about the individual.
The Privacy Rule permits covered entities to charge "reasonable, cost-based fees" for providing copies of PHI to individuals or their personal representatives. According to the Privacy Rule, fees for copies of medical records can only include the costs for: (1) copying, including the cost for supplies for and labor of copying; (2) postage if the individual has requested that the information be mailed; and (3) preparing an explanation or summary of the PHI, only if agreed to by the individual as required if the individual requested a summary or explanation instead of records. 45 CFR § 164.524(c)(4).
In the Preamble to the Privacy Rule issued on December 28, 2000 (the "Preamble"), the U.S. Department of Health and Human Services ("HHS") clarified that copying fees are to be reasonable and based upon the costs of making the copies, including but not limited to labor and supply costs (examples included in the Preamble are costs of paper for hard copies and the cost of a disk for electronic copies supplied on a computer disk). Furthermore, covered entities may not charge any fees for retrieving or handling the information, or for processing the request for copies. The Privacy Rule does not provide a maximum fee, including a per-page or per-record maximum, so depending upon the length of the record, the total fees could be quite high.
In the Preamble HHS also wrote that fees for copying and postage costs provided under state law are presumed to be "reasonable", however per-page costs that include costs excluded under the Privacy Rule (e.g., processing, retrieving and handling) are not acceptable. As a result, state-mandated fees for copying charges may be preempted by HIPAA and the Privacy Rule. Many state-mandated copying fees are higher than the costs involved in copying the information and therefore these fees may be preempted by the lower "reasonable" cost standard. In connection with providing copies to individuals or their personal representatives, covered entities will need to carefully review the state-mandated fees and determine whether they meet the Privacy Rule reasonableness standard.
The aspect of the Privacy Rule requirements for medical record copying fees that is currently drawing attention is the scope of the fee limitations. The Privacy Rule copying fee requirements seem to only apply to requests made by individuals or their personal representatives and not to other requests or permissible disclosures under HIPAA. Within the context of the access rule itself (45 CFR § 164.524), only individuals are addressed and by another provision (45 CFR § 164.502(g)), references to individuals include their personal representatives. In general, the authority of a personal representative under the Privacy Rule to act on behalf of an individual stems from the representative's authority to make healthcare decisions for that individual. Furthermore, the Preamble clarified that the intent of HHS was to enable individuals' access to their PHI: "We do not intend to affect the fees that covered entities charge for providing protected health information to anyone other than the individual." 65 Fed. Reg 82462, 82557 (Dec. 28, 2000), see also 67 Fed. Reg. 53182, 53254 (Aug. 14, 2002). As a result, requests in the form of subpoenas or from third parties and their attorneys appear to fall outside of the HIPAA-imposed fee limitations and remain subject to applicable state laws.
The Privacy
Rule standard has added another (federal) standard to
the patchwork of medical records copying fees
regulations that exist under various state laws
governing requests by patients, subpoenas, workers
compensation, insurance and medical claims, and other
agency requests. However, the Privacy Rule fee
restrictions only overlap with certain requests for
copies -- namely those by an individual or the
individual's personal representative, for the
individual's PHI. Fees for other copy requests do not
appear to be affected by the Privacy Rule. This is an
area of the Privacy Rule that has generated confusion
and has been gaining attention and may well become the
subject of litigation."
===SNIP===
Also on this topic, see this :
HIPAA copy charges for medical records
"
When patients request a copy of their medical record, how much do you charge? And how do you itemize that expense? Do you have clear-cut policies about how to charge? An often overlooked element in the HIPAA Standards for Privacy of Individually Identifiable Health Information concerns how much an entity may charge patients or their designated representative for a copy of their medical record.
The HIPAA privacy standards section 164.524 (c)(4) states the following about charging patients for copies of their medical records:
Fees: If the individual requests a copy of the protected health information or agrees to a summary or explanation of such information, the covered entity may impose a reasonable, cost-based fee provided that fee includes only the cost of:
(i) Copying, including the cost of supplies for and labor of copying, the protected health information requested by the individual;
(ii) Postage, when the individual has requested the copy, of the summary or explanation, he mailed; and
(iii) Preparing an explanation or summary....
The preamble to HIPAA privacy standards section 164.524 (c)--Provision of Access further states:
We clarify this provision in the final rule. If the individual requests a copy protected health information, a covered entity may charge a reasonable, cost-based lee for the copying, including the labor and supply costs of copying. If hard copies are made, this would include the cost of paper. If electronic copies are made to a computer disk, this would include the cost of the computer disk. Covered entities may not charge any fees for retrieving or handling the information or for processing the request. If the individual requests the information to be mailed, the fee may include the cost of postage. Fees for copying and postage provided under state law, but not for other costs excluded under this rule, are presumed reasonable. If such per page costs include the cost of retrieving of handling the information, such costs are not acceptable under this rule (emphasis added).
Providers should familiarize themselves with the HIPAA mandate and establish a clear-cut policy for medical-record copy charges.
What Can and Cannot Be Charged?
In addition to paying for copies of the medical record, patients who request a summary of their record must agree in advance to pay the cost of such a summary. Therefore, many of the activities listed in the sidebar above will occur, and providers should determine which activities can be charged and which cannot. Also, a qualified individual needs to review and summarize the record.
Alternatively, the organization could consider these options:
* Establish an appointment schedule to have a health information professional, the attending physicians, and/or another healthcare professional review and explain the contents of the record to the patient
* Define the "summary" as including certain designated documents such as transcribed or typed documents in the patient record
An hourly rate could be established for the first option, shared with the patient or patient's representative, and accepted by the patient before any effort begins. For the second option, the health information management (HIM) department could determine an average charge for these types of reports in a medical record of different stay increments, such as 1-5 days, 6-10 days, 11-20 days, 21-40 days, and more than 40 days. The charge would vary by length of stay. These are just two options; the healthcare organization's privacy committee may have considered others.
HIPAA Preempts Many State Laws
Although the preamble to the HIPAA privacy standards indicates that the per-page copy fees established by the states will be "presumed" reasonable, some experts believe that this will be a point of contention with plaintiff attorneys nationwide. Many state-mandated copy fees are higher than the costs involved in the single activity of copying and, therefore, could be preempted by the HIPAA regulations. Preemption is intended to protect patients' right to privacy and to allow patients greater access to their protected health information.
Given these criteria, the state-mandated fees could be more costly than the labor needed to make copies, possibly making patients' access to their protected health information cost-prohibitive. As a result, HIPAA may open a quagmire whereby state fees are preempted by the lower "reasonable" cost to make the copies. Note that this mandate applies only to copies requested by individuals or their designated representatives. Other requesters, such as insurers and attorneys, can continue to be charged the state-mandated fee.
Some state-mandated fees consist of a relatively substantial retrieval or handling charge ($10-$20) plus a per-page copy fee ($0.25-$1.00). Every state varies. Clearly, the HIPAA privacy standards preamble bars any covered entity from charging individuals the "retrieval or handling lee." "
FOR THOSE JUST
WANTING THE MOST RECENT INFO ON COST OF GETTING MEDICAL
RECORDS,
PROCESS, AND OTHER SIMPLE INFORMATION, I HAVE INCLUDED
THAT AT THE TOP OF THE PAGE AS
AN UPDATE.
|
Per
http://www.tsbme.state.tx.us/rules/rules/165.htm 165.1.Medical Records.
165.2. Medical Record Release and Charges.
165.3. Patient Access to Diagnostic Imaging Studies in Physician's Office.
165.4. Appointment of Record Custodian of a Physician's Records.
165.5. Transfer and Disposal of Medical Records.
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