It is not uncommon for lawsuits to arise from wound care treatment. You can provide care to the best of your ability, and sometimes poor outcomes still happen. A poor outcome does not necessarily mean medical negligence; however, when a poor outcome happens, patients can perceive that the standard of care was not provided, become unhappy, and file a lawsuit. Common allegations include delay in diagnosis, failure to properly treat, failure to timely refer, and failure to obtain informed consent. Therefore, it is of utmost importance to take measures to protect yourself and your patients during the wound care process.
All healthcare professionals like to receive positive online reviews. It’s a great way to let people know about you and the exceptional care you provide. Which, in turn, can help send new patients your way.
To have a thriving practice, you must have patients. While it is great to get new patients, it is important to focus on retaining established patients, too. If you create loyal patients, they not only return to your office for appointments, but they promote your practice to their friends and family which is great for business.
As a doctor, you use your knowledge, experience, and medical judgment to determine the best course of treatment for your patient. However, adult patients with decision-making capacity have the right to choose or refuse to follow your treatment plan.
A doctor’s obligations regarding how to respond to medical records requests from Medicare, Medicare Advantage, and insurance companies can easily cause confusion. Receiving medical records requests is a frequent and common occurrence and it’s important to note that responding to these records requests does not require the doctor to acquire a medical records release form from the patient first.
HIPAA Rules for Releasing Medical Records
In fact, HIPAA allows medical records to be released without a patient release form in many different settings, including for patient treatment, billing, etc. Because HIPAA allows information sharing for billing purposes, any language on a CMS 1500 form is superseded by HIPAA guidelines – the CMS 1500 form does not prevent a release of records that is otherwise allowed by HIPAA.
Regarding record requests from Medicare, Medicare Advantage, or commercial insurance plans, HIPAA also allows the doctor to provide medical records without a patient release form. HIPAA allows sharing of patient records for purposes of “health care operations,” which includes quality control, audits, licensure matters, etc. Additionally, most (if not all) provider agreements contractually require doctors to provide records to the insurer or to Medicare upon request and doing so does not require a patient release form.
Patient Medical Records Release Forms vs. Informed Consent Forms
Also keep in mind that a patient medical records release form is different from an informed consent form. A medical records release form pertains to the sharing of health information, while an informed consent form relates to the authorization of medical procedures or treatments after understanding the associated risks.
Comply with Medical Records Requests to Avoid Issues
A simple and reliable recommendation is that doctors comply with record requests from Medicare, Medicare Advantage, and commercial insurers, and remember that patient medical releases are not required to do so. Furthermore, refusing to comply with record requests is playing with fire – Medicare can revoke a doctor’s billing privileges for refusing to comply, and insurers can terminate the doctor’s provider agreement for failure to comply. It is never advisable for a provider to withhold or refuse to provide records in response to a request from a payer, whether governmental or private.
The Need for Fairness in Healthcare
In a perfect world, healthcare access and provision would be fair for all people, regardless of ethnicity, race, religion, gender, socioeconomic status, geographic location, language, age, disability, and other variables. Unfortunately, this is not always the case. To help address disparities in healthcare and improve patient outcomes, here is some guidance for practicing patient-centered and culturally competent healthcare.
Imagine this scenario. You perform surgery on a patient and the patient does not heal as expected or has a complication. You perform another surgery to correct the problem, but the patient eventually needs further corrective surgery. Your relationship with the patient has deteriorated, and the patient decides to seek treatment from another physician. In the meantime, the patient’s bills are piling up and the patient is having a tough time paying the bills. To make matters worse, the new physician criticizes your surgeries. The patient decides to sue you.
UPDATE 2/10/25: The Feb. 12, 2025 date referenced in this article has been delayed to April 13, 2025 by all seven Part B Medicare Administrative Contractors (MACs).
The Centers for Medicare & Medicaid Services (CMS) recently finalized Local Coverage Determinations (LCDs) for skin substitute grafts and Cellular and Tissue-Based Products (CTPs). Released by all seven Part B Medicare Administrative Contractors (MACs) on November 14, 2024, these policies will govern the use of skin substitute grafts for Medicare Part B beneficiaries for services rendered on or after February 12, 2025. The new policies set forth coverage requirements and limitations, including a list of covered and non-covered skin graft products, for the treatment of diabetic foot ulcers (DFUs) and venous leg ulcers (VLUs).
You might be wondering what a dental practice has to do with podiatric medicine. Well, unfortunately, your podiatric medical practice could be just as vulnerable to a HIPAA violation as any other healthcare practice. This recent case illustrates the devastating repercussions of failing to comply with the HIPAA Right of Access Rules. Read below to find out how this happened.