Patient Billing Records – the thorn in your side…

Common reaction to chasing billing records

Are Missing Patient Billing Records Ruining Your Day?

Stress no more.  MEDRECS will take care of it for you:

MEDRECS Inc. has a handle on the dizzying vicissitudes of the patient billing record industry.  We call this an “industry” because the recent proliferation of outsourced billing companies has snowballed into BIG business, on a national scale.  There is now a nationwide labyrinth of billing services, hospitals, ER departments, and parent medical systems, with requirements so complicated it will make your head spin.  The most immediate and perplexing consequence of this is that clinics and hospitals are less and less likely to maintain their own patient billing records, and often times they do not have correct information regarding how to retrieve the billing records.  Below we provide some very valuable information to help illuminate some of these recent changes for you:

EPBS Intermedix is an emergency physician billing service in Oklahoma which maintains patient billing records for no less than 6 Washington State providers.  As of recently, EPBS now requires the “emergency/medical group” name on the patient authorization –  i.e. they will no longer accept just the Hospital name on the authorization.  Below are the Hospital names with the corresponding group names that must be on the authorization. 

Capital Medical Center – Thurston Emergency Group 

Valley General – Northsound Emergency Medicine 

Swedish Medical First Hill – Seattle Emergency Physicians 

Auburn Regional – Cascade Emergency Physicians 

Holy Family – Emergency Physicians Services

Similar requirements are now in place for our local facilities in Washington: 

Association of University Physicians now requires the authorization to list not only the Hospital but the exact medical group, clinic, or emergency physicians for which you desire billing records.  

Similarly, Swedish Cancer Institute requires us to request patient billing records from 3 separate contact fax/phone numbers depending on which services were provided.

It is critical to be aware of these requirements in advance so you can plan accordingly and prepare the necessary request information.   MEDRECS is here to help you and your law firm navigate the challenging world of medical and billing record retrieval.  Please leave a comment or let us know if you have any questions.  We are always happy to help!

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HIPAA tightens its grip…

In the ever-stricter world of protected health information (PHI) and HIPAA compliance, nothing can be left to chance.  Healthcare facilities are no longer interested in inferring anything from the authorizing documents.  All requests must be explicit and direct.   Interpretation is out of the question: if there is even the slightest ambiguity on the stipulation, authorization, or subpoena nowadays, the request will likely result in a rejection.  This level of scrutiny is vastly more stringent than it was even one or two years ago.  Here are a couple important tips to remember:

If you require billing records from a particular organization, you must (1) determine where the billing is done and (2) include the specific billing department’s name and location on the stipulation/authorization.  Many hospital billing departments are now off-site and/or outsourced.  This is true for hospitals such as University of Washington and Harborview Medical Center.  In the past, it was sufficient to state on the stipulation that you require medical records and billing records from University of Washington Medical Center, or Harborview Medical Center.  Now, if you require billings in addition to the medical records, you must list the billing departments separately from the medical records departments.  So for Harborview, you must indicate “Association of University Physicians” billings (and include the address), as well as “Hospital Collections” billings.  Furthermore, you must indicate whether you seek billings generated by a UWMC Doctor or department, or a Harborview Doctor.  Yes, this is much more detailed than it was a year ago.  But it is useful to be aware of these nuances in advance as requests will be processed more quickly and achieve a higher level of success if copious information is provided at the outset.  If you have any questions about this, please contact MEDRECS.  If you are unsure of the exact wording or address for a billing facility, please contact MEDRECS.  Note – citing incorrect address, name, or facility information on a stipulation may result in a rejection from the facility.  Therefore, it is advisable to cross-check all information with MEDRECS before proceeding.

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MEDRECS L&I Update

Hello MEDRECS friends!  Springtime litigation is heating up and there is a regular need for record retrieval from the Washington State Department of Labor & Industries.  Please take notice: Washington State L&I has been cracking down lately on their acceptance of patient signed authorizations to comply with the State RCW 51.28.070.  In order to authorize the release of L&I records, the Stipulation or authorization form must specifically indicate it intends “to release Labor and Industries records” or “to release workers’ compensation records.” The Department of L&I has informed us that wording such as “any and all medical records” will compel the release of “medical records” from L&I, but not the entire L&I file.

Electronic Health Records at the “click-of-a-button”? Not so fast…

Electronic health records (EHR) have been hailed as a huge technological breakthrough in Health Information Management sciences.  And while EHR brings many benefits, there is still a long way to go before electronic records are available to us at the “push of a button”.  In fact, the idea that EHR has solved everything for us, and that medical records are now easily available from the Provider, is a common misconception.  Healthcare providers have a lot of work to do before we will begin to see seamless and efficient methods for EHR storage and delivery.

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Last week I met with Erin Ussery, a leader in the Health Information Management industry, to try to get to the bottom of what is going on with electronic health records.  In particular, if electronic records are supposed to be such a huge breakthrough in efficiency and cost-savings, then why is it still so difficult to pry records out of hospitals and why are records still so expensive?  What I learned was quite revealing, and a couple of brief examples illustrate the challenges that healthcare facilities continue to face while they try to “go electronic.”

In the early-to-mid 2000’s the electronic health record industry was “hot”, resulting in a blitz to develop and sell EHR systems as quickly as possible.  The healthcare industry became saturated with EHR possibilities which resulted in different EHR systems being installed within one single hospital.  This inevitably led to incompatibility issues. Take the Swedish Edmonds Campus, for example.  Swedish Medical Center is an advanced healthcare facility but their electronic medical record system will make your head spin.  According to Erin, “the records custodian at Swedish Edmonds has more than 5 different EHR systems to search through in order to find records pursuant to a request.  In addition, the custodian must search the hard copy storage of records maintained off-site by Iron Mountain, as well as entertain the possibility of older records stored on an ancient microfilm system.  Billing records are also stored in two different locations depending upon their history:  billing records created more than 4 years ago will be maintained off-site in paper storage.”  Needless to say, tracking down patient records at this facility is not a quick and easy task.

There is also a recent pattern of conglomeration taking place in the healthcare industry: large hospital systems acquire smaller clinics and bring them under their umbrella.  Take for example, a large healthcare system in Yakima with numerous affiliated clinics: pain clinic, cancer center, rehab center, 2 radiology departments, etc..  Nearly each clinic has a different EHR system and several still have records stored on microfilm.  Moreover, in order for the hospital to produce billing statements, the custodian must navigate through 2 separate systems: the first system reveals the account number associated with the particular date of service (DOS) and the second system is where you must enter the account number to find the bill associated with the DOS.  Sound cumbersome enough?  Well, it gets better:  this same process must be performed for each DOS.  So if the custodian must produce billing statements for 15 dates of service, this same process must be repeated 15 times since there is a different tracking number associated with each DOS visit.  The billing statements must then be converted to PDF (15 PDFs) and the multiple PDFs must be merged and excess/blank pages that result from the conversion must be deleted.

Then there is the common concern of excess pages and/or nearly blank pages found in abundance in many sets of electronic medical records.  This occurrence may turn what would normally be a 50 page chart into a 200 page chart, which not only increases the work involved to produce the chart, but also increases the cost.  Why is this so?  Erin states, “One of the most popular and widely used EHR systems is programmed such that each entry made creates a separate document within the electronic record.  So there may be 100 pages of records with each page containing nothing more than one or two lines of content at the top of the page.  When the record custodian goes to produce this record to the requesting party, each page must be selected, QA’d (“Quality Assured”), and then downloaded separately.  It is not uncommon for a 200 page chart to take one whole day for a person to download and QA.”

Speaking of QA (which is really the most important part of this whole process) we haven’t even mentioned the HIPAA disclosure requirements.  There are 14 requirements for an authorization form to be HIPAA compliant.  Furthermore, the records custodian at the healthcare facility must QA every single page of the electronic record prior to release to ensure cogency between the authorization and the information being released.

What we have found is that the process for releasing electronic records is far more involved than just a “click of a button”.  In fact, who would actually want their healthcare information sent around if the only thing the custodian had to do was “click a button.”  These HIPAA protections and strict QA and review of records are important safeguards for patient privacy.

Despite these bumps in the road and the current labyrinthine nature of EHR systems, EHR is the wave of the future and holds great promise as the industry moves forward and irons out the kinks in the current systems.  According to Erin, electronic records currently take longer to find, prepare, review/QA, and release than paper records.  However, we are already seeing many benefits of the electronic health record revolution:  “E-records are more secure than paper records, and are redundantly backed up on proxy servers at secondary locations in the event of disaster.  E-records can also be securely transferred online much more quickly than snail mail.  And new compatibility systems are being developed that allow for the ease of sharing and access among doctors at various clinics/hospitals.”  And of course, e-records are phasing out the need for paper and are thereby saving trees.  Still, for many people electronic records are difficult to read, navigate, search through, annotate, and so on.  Fortunately, MEDRECS is actively creating solutions for these issues such as OCR/keyword searchable PDFs, organized and hyperlinked index within the records, chronologically sorted records and medical record summaries.  While the advent of EHR has yet to speed up the release of information process on the provider side, there is huge upside potential and room for innovation in the EHR world while we work to make EHR more accessible and actionable for all parties involved.

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MEDRECS Tips for Record Retrieval – VA Hospital / Madigan Army Hospital

The Department of Veteran Affairs and Madigan Army Hospital receive a huge volume of requests for medical records.  Naturally, processing time may be delayed in some cases, and for this reason it is critical to provide as much information as possible at the outset of the request.  Today’s “MEDRECS tip” concerns spouses of servicemen/servicewomen:

If the spouse of a serviceman or servicewoman gets injured, they may be treated at the VA or Madigan Hospital under their spouse’s military insurance. i.e., the husband is in the military, his wife gets injured and taken to Madigan.  When medical records are requested from Madigan under these circumstances, it is important to have the “sponsor”, or servicemember’s social security number in order to obtain the records.  If the records are requested using only the wife’s SSN, for example, Madigan may state that there are no records for this patient, when in fact they do have the records, but the records are filed under the husband’s SSN.

As a service to the legal community, MEDRECS provides periodic medical record retrieval tips and pointers that we believe will help to make everyone’s lives easier.  We understand the pressures of litigation, and that’s why we do everything we can to provide knowledge and expertise that helps law firms streamline the record retrieval process.  To download VA and Madigan authorization forms, please visit our Resources page.

Veterans Affairs medallion - Dakota Sisterhood...

Veterans Affairs medallion

MEDRECS – Group Health Authorization Form

In the interest of thoroughness and stringent commitment to the confidentiality of patient health information, Group Health all but requires the use of their own particular authorization form in order to release protected health information (PHI).  If you attempt to request records from Group Health with something other than the Group Health Legal Release Form, your chances of gaining compliance to your request are rare indeed.  For this reason, it is highly recommended that you utilize the Group Health Legal Release Form for any medical records requests made to Group Health.  The Group Health form is updated periodically and MEDRECS keeps a keen eye out for any updates to the form to ensure that the forms we provide access to contain all the most recent verbiage.  The most recent Group Health form includes authorization language for sensitive information.  This form, and dozens of other facility-specific authorization forms, can be found in a reliable and up-to-date format on MEDRECS website.

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MEDRECS Record Retrieval Tips to Remember – Download

Happy 2013 to all of our family and friends!  We are looking forward to another successful year of service and dedication to the legal community.

We would like to start the year off with our first installment of the MEDRECS Tips to Remember series for medical records retrieval.  Click here for our free white paper which contains helpful reminders for requesting medical records for auto-accident injury cases and on-the-job injury cases:

We periodically post white paper downloads through this blog so stay tuned for more helpful tips from your friends at MEDRECS!

MEDRECS is a trusted leader in the records retrieval industry and this download offering is just one way of showing our appreciation and support for our customers and the legal community as a whole.

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