Obtaining Medical Records for Medical Record Review Purposes

The Privacy Rule and its Bearing on Medical Records

Medical records, being legal documents, have to be obtained for medical record review purposes in personal injury and medical negligence litigation. In the United States, the Privacy Rule allows, with a few exceptions, individuals the right to inspect, review and receive a copy of their medical records and billing records retained by healthcare providers and health plans that are covered by the Privacy Rule. The individual concerned, or his/her personal representative are the only people who have the right to access the records. State laws may affect how this representative can be chosen. A health plan/healthcare provider can send copies of the medical records to another provider/health plan only when they are needed for treatment or payment or with the patient’s permission. The Privacy Rule does not require the provider or health plan to share information with other plans or providers.

The only medical documents to which individuals don’t have access are a provider’s psychotherapy notes. These notes that are taken when a mental health professional converses with a patient are kept separate from a patient’s medical and billing records. HIPAA does not allow the provider to reveal most of the content in these records without the authorization of the patient.

Why Obtaining Medical Records Can be Difficult

• Obtaining medical records one is legally entitled to can sometimes prove difficult.
• Some experts point out that practices sometimes do not release medical records in order to prevent a patient from leaving the practice and going to another provider.
• Now, with the electronic health records that are often incompatible with other records systems, it has become more difficult to share information with other providers.

Medical Records – Vital in Malpractice Litigation

Medical record review for attorneys becomes most significant in a medical malpractice case, wherein obtaining the medical records in a timely manner is very critical. Malpractice victims require accurate evidence of their medical history. Often, in medical negligence cases, providers may destroy or hide incriminating medical records. Plaintiffs have won many malpractice cases in which attorneys were able to prove that a healthcare provider involved, tampered with or falsified the victim’s healthcare records to distort the data and hide errors or evidence of negligent care. Proficient attorneys with the support of reliable medical record review services have often been able to identify variations in handwriting, spot incongruencies and missing records, all of which have helped in establishing malpractice and winning the case for their clients.

The 30-Day Rule and Other Patient Rights

• HIPAA rules that providers must respond to a patient’s request for access to his/her medical records within 30 days. This 30-day rule also covers a representative who is legally authorized to act on behalf of the patient.
• Healthcare providers cannot deny a patient a copy of his/her medical records because the patient has not paid for the services received.
• The provider is allowed to charge for the reasonable costs of copying and mailing the records, though the patient cannot be charged for searching for/retrieving the records.
• HIPAA also gives a patient the right to request a change or amendment in the medical record if they find that some information in the medical or billing record is wrong. The provider/health plan is required to respond to this request and if it is responsible for creating the information, must immediately correct such incorrect/incomplete information. In case the provider or plan refuses to comply with the patient’s request, he/she has the right to submit a statement of disagreement that the plan/provider must add to your record.