When it comes to records requests, practices know it’s no fun chasing down payment from patients. Yet often practices don’t realize this task isn’t really their responsibility, especially when the requestor is an insurance company claiming the patient is responsible for payment. Let us walk you through an example.
Steve Smith is looking to get health insurance coverage through BIG TIME Insurance Co for an upcoming surgery. So, per company protocol for determining coverage, BIG TIME requests patient records from ACME Orthopedics, who uses DataFile for release of information workflows. DataFile processes the request on behalf of ACME Orthopedics and sends the requestor the invoice before we release the record. One day later, BIG TIME Insurance Co calls ACME Orthopedics disputing the DataFile invoice for release of information services stating they should receive records at no charge as it is the patient’s responsibility to pay for the request.
Pop Quiz: Whose responsibility is it to chase down payment from Mr. Smith? ACME Orthopedics’ (the provider), DataFile’s (the service provider) or BIG TIME’s (the requestor)?
The answer: it is the requestor’s (BIG TIME Insurance Co) responsibility. When it comes to records requests, it is the responsibility of the requestor to get payment from the patient. In this case, since BIG TIME is requesting the records it is their responsibility to seek reimbursement from their potential client, Mr. Smith, or defer the invoice to the patient for payment. It is not ACME Orthopedics’ responsibility to chase down payment from their patient in order to fulfill the insurance request simply because the requestor states that the patient is responsible for payment. This actually puts an unnecessary bad taste in the mouth of the patient that the provider office is “making” them pay for these records, when in fact it is the insurance company “making” the patient pay for records.
To give further clarity to the answer above, DataFile does not contact or bill the patient on the requestor’s behalf, as it is not our responsibility to determine when the patient is responsible for payment or not…that is the responsibility of the requestor. You would think in normal business operations that the insurance companies would be scrambling to acquire the records in order to earn the premiums and the ongoing business of the patient.
So what should your practice do if you are put in this situation?
DataFile does not release records until payment has been made in these cases. Thus, your practice should invite the requestor to simply pass on the invoice to their potential client, or direct them to the DataFile website for payment. Once payment is received, DataFile will gladly forward a copy of the record.
To discuss this situation or any other question you may have about releasing records or payment responsibilities, please contact one of our records experts. We are always happy to help, give advice, and determine the right action for your practice to take.