Monthly Archives: August 2015

August 21, 2015

Medical Record Retention

by Kim C. Stanger, Holland & Hart LLP

I am often asked how long a practice must maintain medical records. The answer depends on the type of provider you are and your risk tolerance. Providers should generally consider the following in establishing their record retention policies:

1. Patient care. The primary consideration should be patient care. Some practices (e.g., oncology) may want to retain medical records longer than the relevant regulatory requirement or statute of limitations period because the records may be important to future patient care. If your electronic records program allows, you may want to retain the records permanently.

2. Statutory or Regulatory Requirements. State and federal regulations require hospitals and certain other institutional providers to maintain medical records for specified periods, but those laws usually do not apply directly to physicians or physician groups. There are numerous guides online. For example, HealthIT.gov published a 50-state survey of record retention requirements at http://www.healthit.gov/sites/default/files/appa7-1.pdf. The Idaho Department of Health and Welfare published a helpful but incomplete summary of federal record retention regulations, which may be accessed at http://healthandwelfare.idaho.gov/Portals/0/Medical/LicensingCertification/RecordRetentionReqs.pdf. CMS published a MedLearn article on record retention at https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1022.pdf. AHIMA is usually a good source for online guidance about record retention laws and regulations. Continue reading →

August 6, 2015

US District Court Decision Provides Cautionary Tale on False Claim Act Requirement to Return Identified Overpayments from Medicare or Medicaid

by Pia Dean, Holland & Hart LLP

A recent ruling from the United States District Court for the Southern District of New York is the first decision regarding the requirement of the Affordable Care Act (ACA) to return identified overpayments from Medicare and Medicaid within 60 days and provides a cautionary tale about the failure to do so. The Court’s opinion offers clarification about when the 60-day “report and repay” provision of the ACA starts and underscores the importance of identifying and acting on a notice of improper payments in a timely manner.

Background

The action stems from a computer glitch on the part of Healthfirst, Inc. (Healthfirst), a private, non-profit insurance program. The glitch caused three New York City hospitals to submit improper claims to Medicaid for services rendered to beneficiaries of a managed care program administered by Healthfirst. All three hospitals belong to a network of non-profit hospitals operated and coordinated by Continuum Health Partners, Inc. (Continuum). Continue reading →