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OkHIMA August 2017 Newsletter

Please check out this month's newsletter!

Inside this Issue:

HIPAA Access and Fee Guidance

The Office for Civil Rights (OCR) recently issued guidance regarding the individual’s right of access to his or her protected health information (PHI). This article clarifies how a covered entity may determine the fees it charges for copies of PHI to ensure that they are consistent with the requirements of the Privacy Rule. Providing individuals with easy access to their PHI empowers them to be more in control of decisions regarding their health and well-being and is a necessary component of delivering and paying for health care.

Right of Access

The Privacy Rule requires covered entities to provide individuals, upon request, with access to PHI about them in one or more “designated record sets” maintained by or for the covered entity. This includes the right to inspect or obtain a copy, or both of the PHI, as well as to direct the covered entity to transmit a copy to a designated person or entity of the individual’s choice. Individuals have a right to access this PHI for as long as the information is maintained by a covered entity, or by a business associate on behalf of a covered entity, regardless of the date the information was created, whether the information is maintained in paper or electronic systems onsite, remotely, or is archived, or where the PHI originated. See 45 C.F.R. § 164.524(a)(1).

Fees For Copies

Under the Privacy Rule covered entities are permitted to impose a reasonable, cost-based fee if the individual requests a copy of the PHI or agrees to a summary or explanation of the information. However, the fee may include only the cost of (1) labor for copying the PHI, whether in paper or electronic form; (2) supplies for creating the paper copy (paper, toner) or electronic media (CD or USB drive), if the individual requests that the electronic copy be provided on portable media; (3) postage when the individual requests that the copy or the summary or explanation be mailed; and (4) preparation of an explanation or summary of the PHI, if agreed to by the individual. See 45 C.F.R. § 164.524(c)(4). A covered entity may not require an individual to purchase portable media, and individuals have the right to have their PHI e-mailed or mailed to them upon request. The labor for copying PHI may include only the time that a workforce member requires to create and deliver the electronic or paper copy in the form and format requested. Labor associated with photocopying paper PHI, scanning paper PHI into an electronic format, converting electronic information in one format to the format requested by the individual, and transferring (uploading, downloading, attaching, burning) electronic PHI from a covered entity’s system to a web-based portal (where the PHI is not already maintained in or accessible through the portal) portable media, email, app, personal health record, or other manner of delivery of the PHI are permitted in determining a reasonable and cost-based copy fee. However, labor for copying PHI does not include reviewing the request for access, searching for and retrieving the PHI, which includes locating and reviewing the PHI in the medical or other record, and segregating or otherwise preparing the PHI that is responsive to the request for copying. In addition, costs associated with updates to maintain systems, data storage, labor associated with ensuring compliance with HIPAA, and other costs not included above, even if authorized by State law are not permitted in calculating the fees that can be charged to individuals.

Options for Calculating a Reasonable Cost-based Fee

If a covered entity intends to charge a fee to copy PHI, it must inform the individual in advance of the approximate fee. A reasonable, cost-based fee can be calculated using any of the three following methods:
  • Actual cost: A covered entity may calculate actual labor cost, as long as the labor includes only labor for copying and delivering PHI in the form, format, and manner requested. A covered entity may add the cost of supplies, (e.g., paper, ink, USB, CD), postage (if mailed), and/or creating and explanation or summary. Actual labor cost would be based on the actual time it takes to make and send the copy of the specific PHI requested, multiplied by the hourly wage of the responsible workforce member.
  • Average cost: A covered entity can develop a fee schedule based on average labor costs to fulfill “standard” types of requests. For example, a covered entity may calculate average labor costs for emailing records maintained electronically, downloading records maintained electronically to portable media, printing paper copies of records maintained electronically, and scanning paper records to a patient portal. Actual costs for supplies and postage may be added. Please note that a per page labor charge is not permitted when the requested records are maintained electronically.
  • Flat fee: A covered entity can charge a flat fee of $6.50 for records maintained electronically and which are requested in electronic format. Any supplies and postage are included in the $6.50. This option is available for covered entities that do not want to go through the process of calculating the actual or average allowable cost for requests for electronic copies of PHI maintained electronically.

While the Privacy Rule permits covered entities to charge a reasonable costbased fee, covered entities should consider providing individuals who request access to their PHI free of charge. This is particularly vital in cases where the financial situation of an individual requesting access would make it difficult or impossible for the individual to afford the fee.

For more information visit

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Health Care Fraud Takedown: Charges Against Individuals Responsible for $1.3 Billion in Fraud

On July 13, the Department of Justice and the Department of Health and Human Services (DHHS) announced the largest ever health care fraud enforcement action by the Medicare Fraud Strike Force, involving 412 charged defendants across 41 federal districts, including 115 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $1.3 billion in false billings. Of those charged, over 120 defendants, including doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics.

“The United States is home to the world’s best medical professionals, but their ability to provide affordable, high-quality care to their patients is jeopardized every time a criminal commits healthcare fraud.” said DHHS Secretary Tom Price, M.D.

See the full text of this excerpted press release (issued July 13)

AHIMA Takes on Streamlining ROI

AHIMA has developed a model Patient Request for Health Information form, officially released on July 14, to help streamline the release of information (ROI) process for Health Insurance Portability and Accountability Act (HIPAA)-covered entities. In addition, AHIMA is hosting a summer series of webinars on the topic of HIPAA and ROI. The first webinar, "HIPAA Individual Right of Access, or Why Your ROI Process May Not Be Compliant with HIPAA,"  is now available on demand.

 With these resources, AHIMA aims to help clear up confusion about ROI and improve the process for providers and patients—which often includes a fair amount of confusion regarding compliance and fees, as patients' ROI requests are often not accompanied by a simple form that makes it clear who is submitting the request.

Read More

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