Jay Rath
In North Dakota, it’s illegal to serve pretzels with beer. In Hartford, Conn., it’s against the law to “educate dogs.” When parking your elephant next to a meter in Orlando, you must deposit the same amount of change as if your jumbo SUV were just a Jumbo.
We’ve all laughed at lists of absurd laws still on the books. Perhaps sensible long ago or in certain places, these out-of-context statutes and ordinances are amusing. But what to make of today’s bewildering variety of ROI charges? Patients, payers and others across the country face different state fees for copying.
It should be pretty straightforward. HIPAA says that a “reasonable, cost-based fee” may be charged to provide PHI to an individual, personal representative or designated third party. “The fee may include only the cost of certain labor, supplies, and postage.”
But “reasonable” has many definitions, and “certain” leaves a lot of wiggle room. Even the U.S. Department of Health and Services admits that, “our experience in administering and enforcing the HIPAA Privacy Rule has shown there is confusion about what constitutes a prohibited search and retrieval cost.”
The American Health Information Management Association has argued that hospitals, physician practices and other facilities should charge no more than the actual supply and labor cost for providing paper copies of medical records. “If it costs only a dollar, that reasonable cost-based fee can’t be more than that,” noted Katherine Downing, AHIMA director of HIM Practice Excellence.
States’ Release Rates Vary
But just look at the map. According to one roundup of search fees alone, Alabama charges $5, Arkansas charges $15, and to-the-penny Colorado charges $18.53.
Arizona, Hawaii and Iowa specify only “a reasonable fee” for searches. West Virginia charges $25 per hour. Georgia has no search fee. Instead it has a $25.88 “administrative fee.” Florida charges only $1 per year per search request.
And recall the old Lone Star boast that “everything is bigger” in Texas? A search of electronic platforms there will cost you $82.87.
In 2015 AHIMA surveyed more than 300 of its members. More than half of those surveyed said they charge for electronic copies, and 64.7 percent reported they charge patients for paper copies. When charges are made, roughly 65 percent of respondents said, the cost is less than $1 per page.
Most states have sliding scales, where the more pages you receive, the less each page costs. Starting costs range roughly between 50 cents and $2 per page for the first 10 pages. Maximum costs are often capped, but limits vary widely.
Not All States Let You Slide By
Some states, however, have no sliding scale. Montana, Oklahoma and Nebraska charge 50 cents per page. New York charges 75 cents per page, but it has no search fee, and the other three states do ($15, $10 and $20, respectively). The bargain is Rhode Island, at 10 cents per page for copies made from electronic records, capped at $25.
Special fees are often charged for X-rays and other media copies, and for fast turnaround. Some states make distinctions whether copies are for patients, attorneys or other parties. Various states also have minimum charges, charges for workman’s compensation claims — and Pennsylvania even has a special fee for district attorneys ($21.69, flat).
No doubt all the states have good reasons for their varied approaches, no matter how baffling the rules may initially appear. And on reflection, even strangest healthcare-related statute may very good sense, indeed.
For example, in Illinois it’s illegal to give a lighted cigar to your pet.
The U.S. Department of Health and Human Services offers a FAQ on HIPAA access rights and fees.