07/26/2024
If we are required by federal mandate, are we allowed to charge per chart?
If we are required by Federal Mandate/law to provide medical records to third party companies that audit on behalf of commercial insurance medicare advantage plans (i.e. aetna medicare advantage is outsourcing medical record requests to Episource). If we are required by federal mandate, are we allowed to charge per chart? Are we allowed to put the burden on them to retrieve HIPPA consent forms from the patient allowing us to send to said third party?
Whether you are allowed to charge for these things or not is determined by your provider agreement with the payer. The provider agreement that you signed typically addresses this exact thing….what they can request, how many they can request, how frequently they can request, whether you can charge or not, etc.. These terms can differ from payer to payer based on the agreements you signed. Some inappropriately say, “Just make them pay!” and that blanket statement is dangerous because whether we can charge these payers or not depends on the provider agreement with the payer. The only way to answer your questions is to review your agreement with the payer(s) in question. If you have administrative defense coverage (ADC), this review may be something your ADC carrier is willing to help with.
APMA members can read more about this here:
Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC, CPMA
Lehrman Consulting LLC