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Don’t Overpay for Electronic Records

E. Courtney Gruber

On 3/21/2019, the Commission announced that it had approved changes to the Medical Service Provider Manual.  All of the changes can be accessed on the Commission website and most of them involved changes to billing codes, which are not particularly relevant from a legal standpoint; however, there was a change to the guidelines for costs of production of medical records that was relevant to those of us who routinely request medical records.  Supporting documentation must be produced when providers are submitting claims or when required by the carrier, self-insured, employer, or Commission to submit such documentation and may not charge for those required reports.  A cap of $150.00 plus a $15.00 clerical fee for records electronically produced for other purposes.  Records produced in printed form are subject to a $200.00 cap plus a handling fee of $15.00.

I have provided the actual language below:

Copies of Reports and Records

Providers are required to include supporting documentation when submitting claims, or when required by an insurance carrier, self‐insured employer, or the Commission to submit substantiating documentation, and may not charge for these required reports. (See Regulation 67‐1302 B(2).) However, when the records or reports are not for the purposes listed above, providers may charge for copying costs. Copying charges are sixty‐five cents per page for the first thirty pages provided in an electronic format, and fifty cents per page thereafter provided in an electronic format, which may not exceed one hundred fifty dollars per request, plus a clerical and handling fee of $15.00 plus tax and actual postage costs. Providers must respond to a request for copies within fourteen days of receipt or face a penalty of up to $200.00. Section 42‐ 15‐95 of the S.C. Code, which governs charges for copies, can be found in Appendix A. Providers are entitled to charge for the cost of copying records and reports except when such documents are requested by the Commission or for the purpose of substantiating a charge and /or medical necessity.

Providers are required to include supporting documentation when submitting claims, or when required by an insurance carrier, self‐insured employer, or the Commission to submit substantiating documentation, and may not charge for these required reports. (See Regulation 67‐1302 B(2).) However, when the records or reports are not for the purposes listed above, providers may charge for copying costs. Copying charges are sixty‐five cents per page for the first thirty printed pages, and fifty cents per printed page thereafter, which may not exceed two hundred dollars per request, plus a clerical and handling fee of $15.00 plus tax and actual postage costs. Providers must respond to a request for copies within fourteen days of receipt or face a penalty of up to $200.00. Section 42‐15‐95 of the S.C. Code, which governs charges for copies, can be found in Appendix A. Providers are entitled to charge for the cost of copying records and reports except when such documents are requested by the Commission or for the purpose of substantiating a charge and /or medical necessity.

Providers who use a medical records company to make and provide copies of medical records must ensure that neither the Commission nor the reviewer is billed for the cost of copies when the purpose of the copies is to substantiate a charge and/or medical necessity.

NOTE: Providers do not need to obtain authorization from the injured worker to release medical records relating to a workers’ compensation claim. An employee who seeks treatment under the provisions of the Workers’ compensation Act is considered to have given consent for the release of medical records relating to the examination or treatment.