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HIPAA’s “Patient Rate” Does Not Apply to All Requests

Recently, a Federal Court ruled that the HIPAA “Patient Rate” only applies when the patient – or the patient’s personal representative – requests records for use by the patient. 

Wait, What’s The HIPAA Patient Rate?

The “Patient Rate” is what you can charge a patient (or the patient’s representative) for a copy of their medical records.  Under HIPAA, you can charge a reasonable, cost-based fee that only includes:  

  • Labor for copying and preparing the requested record, whether in paper or electronic form;
  • Supplies for creating the paper copy or electronic media (e.g., CD or USB drive) if the individual requests that the electronic copy be provided on portable media; and
  • Postage, when the individual requests that the copy be mailed.

You can’t charge for costs associated with: verification; documentation; searching for and retrieving the record; maintaining systems; recouping capital for data access, storage, or infrastructure; or other costs not listed above – even if such costs are authorized by State law.

What The Court Ruling Makes Clear

The Court says you are only limited to the Patient Rate when the patient (or the patient’s authorized personal representative) is making the requests for their own use.  Other types of requests for patient records – like where a third party is making the request, or the patient is asking records to be sent to a third party – are NOT subject to the HIPAA Patient Rate.  Those requests are just subject to any limits imposed by state medical records laws. 

Here's 3 Examples:

  1. When the patient (or personal representative) requests records and says “please send them to me,” the HIPAA Patient Rate applies.  You may only charge a reasonable cost-based fee for copying, etc., regardless of whether state law would permit you to charge more.
  2. When a the patient (or personal representative) requests a copy of their records and send “please send this to a third party (such as my lawyer),” the Patient Rate does not apply and you may charge whatever state law permits.
  3. When a third party (such as the patient’s lawyer) makes a request for records and attaches the signed patient authorization, the Patient Rate does not apply and you may charge whatever state law permits.   

Questions?

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