02 May Efficient Medical Record Management for Law Firms and Insurance Carriers
Whether to prove a legal argument or resolve an insurance claim, obtaining and managing medical records quickly and correctly is vital for both law firms and insurance companies. More so than any expert witness, medical records are tasked with acting as the primary authority on an individual’s record of injury, health, and treatment.
Simple errors or inefficiencies in medical record management can lead to delays and poor outcomes, while negligent handling can lead to penalties that reach into the millions and even jail time.
Efficient medical record retrieval and management backed by dedicated experts and internal practices is a must in the legal and insurance industries.
The Legal and Insurance Need for Medical Record Organization
What makes medical record management critical for law firms and insurance companies? Both industries need fast access to accurate, well-organized health information records to perform their roles.
The Impact of Organized Medical Records
Having an effective process for retrieving and using medical records can lead to successful outcomes for your clients, including:
- Claims resolution – Medical record retrieval for insurance companies is necessary to correctly resolve claims and distribute funds or initiate claim denials or negotiations for health care, automotive, homeowners, liability, disability, long-term care, umbrella, or other policies. Some claims require timely resolution, such as those related to covering urgent health care needs.
- Courtroom success – Winning a legal case at trial often involves the strategic use of record data to prove facts, establish timelines, and illustrate pain and suffering. Medical record retrieval for lawyers taking cases to court requires timeliness related to strict scheduling needs, plus careful handling of files to meet Federal Rules of Evidence legal admissibility standards covering chain of custody, authenticity, provider certification, and more.
- Legal case preparation – The use of medical records in court proceedings doesn’t begin at the courtroom door, but much earlier in the litigation process. Record retrieval and analysis are critical to discovery when legal teams uncover facts, determine cause-and-effect connections, identify witnesses, and plan a case theory and strategy. With 95% of civil lawsuits ending in pre-trial settlements, this means that the strongest impact of medical records is usually in the early stages of a legal case.
The Costs of Medical Record Disarray
Conversely, the lack of efficiency in medical record management has significant potential to undermine both specific case or client issues and the company at large.
Missing, delayed, or incomplete documentation can lead to:
- Delays in claim payouts or medical treatment
- Missed court deadlines and rescheduled trial or motion dates
- Loss of clients and damage to reputation
Of particular note, medical record misuse or erroneous management contrary to HIPAA regulations can invoke both civil and criminal violations up to a felony level with penalties including:
- Up to $2.1 million in civil damages imposed by the HHS Office for Civil Rights (OCR)
- Additional penalties invoked by State Attorneys General
- Federal Trade Commission (FTC) actions if data breaches are involved
- Individual criminal fines of $50,000 – $250,000 plus restitution to victims
- Jail terms up to 10 years, including up to a year for violations resulting from negligence
- Separate damages awarded to individuals or entities who bring successful lawsuits
- Referral to a professional licensing authority
Core Challenges in Legal Medical Record Handling
Managing medical records is a unique process that goes beyond the need for client confidentiality. Challenges begin before the records are in your hands, starting with the oft-delayed process of retrieval.
Provider Responsiveness
While some institutions’ records divisions are models of efficiency, or even provide avenues for rush turnaround (typically invoking fees), this is not the case universally.
Providers often require requests to be submitted using their unique set of forms and procedures vs. responding to templated records requests, and they may prioritize requests for legal medical records documents by lawyers and insurers well below those of health care providers and patients.
Missing or Inconsistent Records
After waiting for a record order to be fulfilled, receiving an incomplete file may necessitate starting over with a new request after negotiating with the recordkeeper about what information can be released and in what format or level of detail.
The fact is, the sum of records connected to a patient’s name often goes well beyond what is needed or appropriate for legal or insurance needs. According to a comprehensive 2021 study of medical record components at the Medical University of South Carolina, the legal medical record is only a small fragment of the totality of patient information in storage by many large health care institutions.
And medical institutions have reason to be overly cautious about what they release. Multiple state supreme court rulings, including Connecticut’s 2018 Byrne v. Avery Center for Obstetrics & Gynecology have held that patients can sue for damages when providers release medical information beyond the strict limitations established by HIPAA.
HIPAA Compliance
Understanding and adhering to HIPAA guidelines that apply to the management of protected health information (PHI) requires expertise, attention, and care.
Although lawyers not acting on behalf of a covered entity and insurance professionals other than health insurance providers arguably don’t fit the definition of business associates as defined under HIPAA, both practical considerations and professional ethics suggest they follow HIPAA guidelines.
Format Inconsistencies
Medical records often contain inconsistencies and patched-together files obtained from multiple providers, particularly if they include historical, rural, or foreign treatment documentation.
Additional time, attention, and technology may be needed to create a useful set of connected data from:
- A combination of EMR (electronic medical records) and paper files
- Physical media that requires special handling to digitize (slides, x-rays, etc.)
- Poorly scanned copies of paper files
- Low-quality digital images
- Nonstandard document or image electronic file formats
Best Practices for Legal and Claims-Based Record Management
Whether you handle all requests internally or partner with an expert in medical records retrieval solutions, consider these tips to vet or improve your records information management.
Standardize Internal Request Protocols
Medical health records management isn’t a reinvent-the-wheel opportunity. Standardize your protocols with:
- Templates – Rely on templates for medical records requests and use, based on HIPAA standards and language. In addition to creating procedural consistency, these templates can obliquely remind your team of HIPAA requirements and build trust with entities who receive them.
- Tracking tools – Utilize a system that monitors all access and changes to medical record files. Anyone who touches a file should be identifiable at an individual level.
- Staff training – Train staff responsible for retrievals on best request language, escalation procedures, and monitoring protocols. Any staff member who has reason to handle medical records should be trained on adhering to standards and accomplishing HIPAA compliance with strict digital and physical data security protocols.
Work With a HIPAA-Compliant Retrieval Partner
HIPAA compliance requires dedicated expertise—frankly, it’s a full-time job to stay on top of current guidelines. Connecting with a retrieval partner that understands HIPAA inside-out allows your team to delegate:
- Record requests complying with each provider’s forms and processes
- The monitoring of requests and the pursuit of follow-up contact as needed
- Documentation of record handling and storage
Organize Records for Legal Use, Not Clinical Use
Medical record retrieval services for legal and insurance clients understand that records serve different purposes outside of the clinical environment. In addition to securing and maintaining an original file, working files are established in a system that can:
- Convert scanned image-only files to text with optical character recognition (OCR)
- Ensure digital readiness with paginated, searchable, annotatable, exportable files
- Index by incident date, treatment provider, or service type
- Flag anomalies or missing gaps (e.g., missing pages, missing provider notes)
Maintain Chain of Custody and Secure Storage
To be utilized within the legal system, medical records require a clean chain of custody that protects them from alteration. This includes:
- Limited and documented access to files
- Multi-factor authentication (MFA)
- Audit logs of all points of access
- File encryption
- Vetted systems with disaster recovery and cybersecurity protocols
Selecting a Record Retrieval Partner Built for Legal Needs
The legal use of medical records requires understanding multiple sets of guidelines and protocols, and retrieval can be a lengthy process without experienced oversight. To ensure your team gets their hands on the right records when they’re needed, look for a partner with:
- Legal specialization
- A national provider network and experience with diverse application processes
- User-friendly and up-to-date compliance and tracking tools
- A secure digital infrastructure that meets current cybersecurity standards
Streamline Your Legal Workflow Through Smarter Record Management
For insurance and legal professionals, having the right medical records at the right time is critical to moving forward with claims and cases. Delays and disorganization can hurt your bottom line, costing both time and money.
When you engage retrieval experts, you can turn your team’s attention to strategic legal or insurance work with the assurance that medical records will be delivered with timeliness and careful attention to detail.
Leverage the expertise of American Retrieval to streamline your workflow with secure, efficient, and compliant medical record retrieval solutions.
Sources:
The Law Dictionary. What Percentage of Lawsuits Settle Before Trial? What Are Some Statistics on Personal Injury Settlements?
HIPAA Journal. What Happens if You Break HIPAA Rules? https://www.hipaajournal.com/what-happens-if-you-break-hipaa-rules/
United States Courts. Federal Rules of Evidence. https://www.uscourts.gov/forms-rules/current-rules-practice-procedure/federal-rules-evidence
National Library of Medicine PubMed Central. Defining The Medical Record: Relationships Of The Legal Medical Record, The Designated Record Set, And The Electronic Health Record. https://pmc.ncbi.nlm.nih.gov/articles/PMC8649704/
Relias Media. Legal Case Shows Risk of Improper Patient Info Disclosure. https://www.reliasmedia.com/articles/142669-legal-case-shows-risk-of-improper-patient-info-disclosure
HIPAA Journal. What is Considered PHI Under HIPAA? https://www.hipaajournal.com/considered-phi-hipaa/