When a person is injured in an accident, because of the negligent actions of another it may take the injured party weeks or months to recover. After going to the emergency room for initial treatment, the injured person or persons could be faced with a number of additional visits to physicians including:
- Orthopedic surgeons to treat any broken bones or fractures sustained in the accident
- Plastic surgeons for skin grafting if the injuries are from a dog bite
- Therapists to assist with general rehabilitation
Obtaining Medical Records is Crucial to Any Personal Injury Case
If the injured party retains an attorney, the attorney will be responsible for ordering and receiving detailed medical and billing records for their clients. This can be an arduous task depending on the hospital, facility or medical provider where the client treated.
Medical and billing records are crucial because they form the basis of the case an attorney builds for their clients. When an attorney, with the approval of their client presents a settlement demand to the insurance company, that demand must be supported with records that demonstrate the extent of the injury and the costs of treatment. A full recovery for the person who was injured is the primary goal.
Most medical providers, through their Release of Information (ROI) department, have similar processes in place. Generally speaking, it follows these steps in order:
- A records request is made by the attorney, which includes a HIPAA form (Health Insurance Portability and Accountability Act) signed by the client
- The request is received by the ROI department and entered into an electronic system or a hardcopy is placed in a manual filing system
- The request is validated making sure that the patient information is correct and that the patient in fact treated at the facility
- An invoice for records retrieval is created and sent to the attorney’s office
- The attorney pays for the request with either a credit card or by mailing a check
- Once payment is received by the provider, the records are released and sent to the attorney
The process sounds pretty straight forward but in big cities like Houston, with large hospitals and a medical center, there are literally thousands of requests made every day.
Technology and the Medical Records Process
Needless to say, the most efficient process makes use of a web-based system that is accessible by the attorney, patient and the hospital’s release of information department. Memorial Hermann in Houston was one of the first hospital networks in Texas to implement such a system.
An attorney begins by making the request online, uploading their documents and HIPAA. This step alone cuts out so much inefficiency. Requests sent by mail or by fax can be lost, leaving the requestor with no idea if the request was received. Even if the fax was transmitted successfully there is no guarantee that it was picked up and put in the right place, either on a computer network or on someone’s desk.
An efficient web-based system will notify the requestor in 2 to 3 days that the request was received and validated. If the request failed the validation protocol the requestor is notified as to why giving them a chance to resubmit the request without having to wait weeks to find out that it failed, or having to make time consuming phone calls to follow up on the status of the request.
An invoice is generated by the hospital and the requestor is notified who submits payment. Records are then released; the requestor is again notified who can download the records or receive a hardcopy in the mail.
Third Party Records Services for Hospitals
Some hospitals will use a third-party records service to handle the duties associated with release of information. Although this process is not as efficient as a web-based system, if the lines of communication between the requestor and the records service are open it can be acceptable. Instead of sending the request to the hospital, an attorney would send it directly to the records service for processing.
Third Party Records Services for Attorneys
In recent years companies have been offering attorneys the option to offload the burden of the medical records request process. Companies like Allegiant Resource Group in Houston will do all the groundwork and follow-up so the attorneys can spend more time working up their cases for trial or settling them with the insurance companies. Many of these companies offer access to a web-based system so that paralegals can keep up to date on requests that are in progress.
In-House Manual Records Services
Many smaller hospitals, doctor’s offices, MRI and imaging facilities and clinics use some form of hybrid computerized-manual system to fulfill records requests. This begins with the attorney sending a fax of the request to the facility. It is highly recommended that, in these situations a representative at the attorney’s office follows up closely on these requests. This could be a paralegal or an administrative assistant.
In some cases, the attorney’s office builds a rapport with the facility, with open lines of communication which reduces the amount of follow-up required. In other cases, the paralegal or administrative assistant will have to be very diligent in following up on any outstanding requests. It is not uncommon to find out that a request that was successfully faxed over has gone missing or was never received. This can be frustrating especially if this request is the last set of medical records for a client’s case. An attorney must receive ALL records before they can make a demand of the insurance company and begin settlement negotiations.
Texas State Law
In Texas it is required that any medical provider who receives a valid request for medical records, from a patient or from an attorney representing a patient, has 15 business days to fulfill the request. A valid HIPAA signed by the patient must be included as part of the request. Even with this regulation in place the most efficient release of information department has a very hard time meeting this requirement.
Depending on the level of efficiency of medical provider and the processes they have in place, it may take 6 weeks or more to obtain medical records. If you are an attorney or a paralegal working for an attorney you need to be meticulous and thorough with your management and follow-up of medical records requests. If you are aggressive in managing this process, it will reduce the amount of time it takes to get cases settled for your clients. And in the end that is the most important thing.