March 5, 2001

Medi-931-01

TO: ALL MEDICARE PROVIDERS

SUBJECT: MEDICAL RECORDS RELATED INVOICES

PRIMARY INTERESTS: ADMINISTRATORS, BUSINESS OFFICE MANAGERS, MEDICAL RECORDS DIRECTORS

Riverbend GBA has on occasion received invoices from providers or their subcontractors requesting payment for photocopying or shipping expenses associated with RGBA's request for medical records. RGBA is not obligated to reimburse providers for these expenses via individual invoices when the request falls under the guidelines outlined below. The following is taken from section 2140 of the Medicare Intermediary Manual.

"It is often necessary for an intermediary to secure copies of medical records in the claims process—e.g., in order to verify the services for which the program is billed. Policy and procedures on payment to providers for furnishing copies of medical records depend on whether or not the amount of reimbursement due the provider is directly affected by the intermediary's determination.

2140.A. Amount of Reimbursement Due Provider Is Directly Affected-

A participating provider is required under section [1815] 1815 of the Act and section 405.485 of the regulations to furnish information the program needs to determine the amounts due the provider. Consequently, in situations where the amount of reimbursement due a provider is directly affected, the program will not recognize a specific charge by the provider for furnishing a copy of a medical record. Any costs incurred by the provider in making this information available to an intermediary would be recognized as an allowable provider administrative cost and the program would reimburse its proportionate share of this cost.

Examples of situations where the amount of reimbursement due the provider is directly affected are where the contents of the medical record are needed by the intermediary:

1. For the purpose of determining the level of care required by an inpatient;

2. For the purpose of determining the amount of Part B payments due for the services of supervising physicians in a teaching setting when the physicians have assigned their rights to the hospitals, or;

3. For the purpose of determining the amount of Part B payments due hospital-based physicians for professional services furnished program beneficiaries. "

THIS BULLETIN SHOULD BE SHARED WITH ALL HEALTH CARE PRACTITIONERS AND MANAGERIAL MEMBERS OF THE PROVIDER STAFF. NO COST COPIES ARE ALSO AVAILABLE FROM OUR WEB SITE AT riverbendgba.com

Please refer any questions to our office toll free at 877-296-6189.