The understatement of the decade may be that the medical record portion of the healthcare industry has changed. Over the past few years, ScanSTAT has been tracking these changes and educating medical practices on hot topics accordingly. Today, we’d like to discuss the subject of fee pre-approvals when it comes to copying medical records for release.
There is a historic practice of legal entities, record retrieval services, and other requestors for copies of medical 
records to demand a preauthorization for fee approval before the requestor agrees to pay for records. In the good ole days of a paper medical record chart, a simple count of the pages of the chart to oblige this request may have seemed reasonable. However, the onset of an electronic medical record has made this almost impossible to accomplish.
Furthermore, states regulate the fees associated with receiving a copy of a medical record. In almost every state this fee is tied to the number of pages that are a part of the designated record set that match the associated request for records.
By the time enough information has been gathered to be able to accurately provide the page count to determine if the fee will be within the scope of the pre-approval tolerance provided by the requester, at least 85% of the work has been completed. Upon notice of the fee being above the random threshold, the requestor then feels justified in denying the order for records and refuses to pay.
Let’s compare this to a similar, yet unrelated, example. You wouldn’t expect to be able to walk into a neighborhood family-friendly restaurant, similar to Applebee’sTM, and randomly order multiple items off the menu simply just to smell, taste and review to your satisfaction with the intention of only paying for one meal (and tip the server on only one bill). Now, there is no rule posted that says you can’t do this, however, the restaurant manager reserves the right to refuse service, and ask you to leave if this type of activity persisted. Now, you can certainly send back a dish that is unsatisfactory and request a new dish. But who would do this type of unethical act just for the option to taste and try both dishes? If they did, this person most likely would dine alone, because most people would not want to be associated with such an unethical person.
The above restaurant scenario is an attempt to deceive. We recognize that the requestors of medical records are certainly not intending to deceive, but rather simply operating under some old protocols because they can. There is nothing in most state or federal regulations that say a requestor CAN’T request this type of Pre-authorization, however, on the contrary there is nothing that says you as a provider have to oblige it either. The few states that do have this provision available to requestors have not analyzed the impossible task of providing this information in advance of purchasing the record since the transition to an electronic medical record.
Historically, providers have attempted to accommodate this type of request to the best of their ability; however, as this article started out stating, the change to an electronic medical record has now deemed this practice no longer viable. It’s not simply that we are not willing to accommodate the request; we simply CANNOT accommodate the request. It is physically impossible to do.
At ScanSTAT, we totally understand why the fee approval is being requested. There are legal, insurance, and other business situations where a requestor of information is attempting to analyze the financial burden requesting the record will be to their case and then will determine if indeed they really need this information in order to proceed with their business with the patient. Is this analysis the financial burden of the medical practice? Emphatically, NO, we don’t believe that this is the financial burden of the practice.
A request for medical records needs to be treated like an order. You place an order and you are delivered a service. If a requestor walks through all of the effort to secure the proper authorization, submit the request to the provider to get the records, then you need to ensure prior to these actions that this patient is a properly qualified potential candidate for your business. In 90% of the fee approval requests we receive, the actual record page count and associated fee are within 10-20% of the fee limit. It is only the rare occasion that the actual fee is drastically above the fee approval limit. However, simply because a requestor states a fee limit, does not entitle them to negate the legal allowable state fee schedule for a copy of a medical record. This would imply that the requestor sets the fee for medical records and not the state…really? We don’t think anyone thinks this is the intention.
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