[Date]
e
l
p
Re: [Name of Client]
Dear [Name of Doctor]:
Dear Sir/Madam
ng a HIPAA-compliant med
me
We represent [Name of Client]. We are enclosing
medical
FIED medical records and all rrecor
in the CERTIFIED
authorization allowing us to obtain
records
pertaining to her file.
m
a
ocopy of the CERT
CERTIFIED
IFIED complete
complet medical rec
Please provide us with a photocopy
record/chart of
in
amed patient and all
all materials or information incl
uding, but not limited to, all
the above-named
including,
physician
sur
al records, hospital records, physicians
medical
physicians’’ records, surgeons
surgeons’ records, consultation
cords, operative reports, physical therapy and other therapy
her
records,
ther
records; x-ray, CT scan,
othe diagnostic
MRI, PET scan and reports or other
diagnostic studies;
s
laboratory reports; patient
questionn
nformation and history questionnaire;
phys
i
information
physicals
and history; discharge summary;
ogress notes; prescriptions and
a medication
rogress
medicati records; nurses’ notes; psychotherapy notes,
progress
spondence; consent for treatment;
respondence;
treatme CERTIFIED statements for services rendered; (all
correspondence;
ot
ng) or any other
material (whether written or stored, created or maintained in any
billing)
materials
other form) relating or pertaining to this patient, including documents and records
d from or th
received
that were created by another provider.
S
HIPAA permits you, as a “covered entity,” to impose reasonable, cost-based fees for
op
providing the requested medical records. The fee may include only the cost of copying
(including supplies and labor) and postage, if the patient requests that the copy be
1
th
mailed. The fee may not include costs associated with searching for and retrieving the
2
ed States Departmen
Department
requested information. As part of the Medicare program, the United
of Health & Human Services has established a rule for determining
terminingg cost-based fees for
photocopying medical records. Pursuant to that “Photocopyy Reimbursement
ts per page as the appropriate
blished 7 cents
Methodology”, Health & Human Services established
3
rvices proposed a rule to increase
rate in 1992. In November, 2002, Healthh & Human Services
rds from 7 cents per page to 12 cents per
cost-based fees for photocopying medical records
compo
page, to reflect inflationary changes in the labor and supply
the
supply cost components
of th
4
believ that it accurately
acc
formula. Although thee new rule hass not yet been adopted, we believe
anges
reflects those inflationary
ationary changes.
S
e
l
p
m
a
As you
State law permitted
ou are aware, before the effective date off HIPAA, New York
Y
you to
providing photocopies of medical
o charge a fee of up to 75 cents per page for prov
records.
1
45 C.F.R. § 164.524(c)(4).
164.524(c)(4).
2
See 45 C.F.R. § 164.524.
164.524
3
57 Fed. Reg. 47,779.
4
67 Fed. Reg. 70,358.
Our research has revealed no provisions of HIPAA that prevent us from offering to pay
you a fee greater than 12 cents per page, if we request special “expedited service.”
e
l
p
ncluding postage),
po
Accordingly, we are offering to pay you a fee of 75 cents per page (including
if
y of the date
you send us all of the records that we are requesting within 100 days
dat of this
esting within 10 days
day of the
letter. If you do not send us all of the records that we are requesting
se forth
e, plus the cost of postage, as set
date of this letter, we will pay you 12 cents per page,
in HIPAA and the proposed federal rule.
m
a
his matter.
Thank you for your courtesy and cooperation
ooperation in this
Very truly yours,
[Name of Law
aw Firm]
S
y: _________________________
By:
nclosure: HIPAA-compliant medical
medica authorizat
Enclosure:
authorization
S
m
a
e
l
p