While most healthcare providers are compassionate and want to provide optimal care to their patients, implicit biases exist. Healthcare providers may not be aware of implicit biases, which may be subtle and unintentional, that can influence clinical interactions, lead to a lack of trust between the patient and the healthcare provider, and result in healthcare disparities.
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.
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 Because HIPAA allows information sharing for billing purposes, any language on a CMS 1500 form is superseded by HIPAA guidelines – the CMS 1500 form does not prevent a release of records that is otherwise allowed by HIPAA.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.
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.
If you prescribe opioids in your practice, it is important to be familiar with current clinical practice guidelines for prescribing opioids, DEA requirements, and federal and state laws and regulations to reduce your professional and administrative liability risk. In this article we will discuss some of the guidelines, requirements, and regulations relating to prescribing opioids.
The Medication Access and Training Expansion (MATE) Act was passed by Congress as part of the Omnibus Bill of 2022. The MATE Act mandates a new one-time, eight-hour training requirement on the treatment and management of patients with opioid or other substance use disorders for all Drug Enforcement Administration (DEA)-registered practitioners (other than practitioners who are solely veterinarians) who prescribe schedule II, III, IV, or V drugs.
We continue to receive questions from podiatry practices regarding the use of and billing for amniotic fluid injections for musculoskeletal purposes. We recently published an article, “Caveat Emptor Vendor: Skin Substitutes & Injectable Amniotic Fluid” that details some real-life examples of the risk providers incur if they fail to do proper due diligence in these situations. In the article below, we continue the conversation around amniotic fluid injections by answering three of the most asked questions so you can make informed decisions at your practice.
In the past year, we have seen a dramatic uptick in audits and overpayment claw backs involving two high-dollar products: skin substitutes for wound care and injectable amniotic fluid used for musculoskeletal conditions. While there is no question that these products work, practitioners are often guilty of listening uncritically to sales pitches by vendors who promise high reimbursement and certain payer coverage. Failure to conduct due diligence on these products puts providers at high financial risk because of the substantial cash outlay required to purchase the products, typically upfront.