Navigating Record Release Requests: A Guide for Outpatient Therapy Practices
For managers and owners of outpatient therapy practices, managing mail is often a low priority due to the demands of patient care and other matters; however, great care should be taken to review all correspondence for potential time-sensitive requests and their purpose. Requests for additional medical documentation from payers, attorneys, or other entities can result in significant repercussions if not addressed promptly and correctly. Recent trends observed among our clients at BCMS indicate a notable uptick in such requests, particularly from legal representatives and insurance payers
While requests for records most often relate to payer audits, which do not require a patient’s authorization, there are other reasons for record requests. Each time a records request is received, the recipient should determine the requester’s authority and the information permissible for disclosure. What data is restricted? Am I obligated to comply with these demands? This series of blog posts, titled “Release of Records,” aims to address nuanced scenarios that outpatient therapy providers may encounter.
Attorney-Initiated Record Requests: Key Considerations
In this installment, we focus on requests from attorneys, a scenario governed by federal and state regulations, including the Health Insurance Portability and Accountability Act (HIPAA) and state healthcare privacy laws. Under HIPAA (45 CFR § 164.508), healthcare providers are required to release patient records to attorneys under specific conditions. The most straightforward circumstance involves a patient-signed, HIPAA-compliant authorization form that ensures all regulatory requirements, such as purpose specification and revocation rights, are met.
Subpoenas and Court Orders
A more complex situation arises with subpoenas. Providers must comply when presented with a valid court order or subpoena. However, absent a court order, HIPAA requires the requester to notify the patient or seek a protective order to limit disclosure (45 CFR § 164.512(e)). The custodian of the records is obligated to ensure that the above has been carried out before releasing a patient’s records. Similarly, in legal proceedings where medical records are relevant, such as personal injury or malpractice cases, release may occur with the patient’s consent, a court order, or a subpoena.
Additional Scenarios Requiring Release
Two further scenarios merit attention:
- Public Health or Legal Mandates: Records may be disclosed without patient consent to comply with public health reporting (e.g., communicable diseases), mandatory reporting laws (e.g., child or elder abuse), or law enforcement investigations, as required by applicable statutes.
- Discovery in Litigation: In civil or criminal cases, attorneys may request records through discovery. Providers must ensure that HIPAA requirements, such as patient notification or a qualified protective order, as well as other legal standards, including valid subpoenas or court directives, are in place.
Broader Compliance Considerations
While these scenarios provide a foundational understanding, they are not exhaustive. Providers must also account for overall HIPAA compliance, state-specific regulations, mandated response timelines, and associated fees for record preparation and copying. These factors necessitate a comprehensive approach to record management.
BCMS Compliance Program: Your Partner in Compliance
At BCMS, we empower outpatient therapy practices with our robust Compliance Program, which features tailored policies and procedures aligned with HIPAA Privacy laws and other federal regulations. Let us assist you with the complexities of record release requests and other HIPAA issues to ensure your practice remains compliant and secure. Schedule time to discover how we can assist you in your compliance journey by clicking here.
About BCMS
BCMS is a trusted leader in healthcare compliance, delivering enrollment, credentialing, audit, and appeals services, as well as other regulatory solutions, for outpatient therapy providers. BCMS specializes in empowering healthcare providers through our comprehensive Compliance Program, which includes tailored policies and procedures and integrates Federal guidance with robust annual training. Stay informed with our latest insights at bcmscomp.com/blog.
Disclaimer: This blog is for informational purposes only and does not constitute legal advice. Consult an attorney for legal matters or a compliance professional for specific guidance.