Insurers have successfully pushed toward requiring “objective” measures and “evidence-based” medicine before authorizing treatment for patients and injured workers. It means doctors must document their physical exam findings and accurately record the patient’s history to justify treatment recommendations.
Combine the pressure to see more patients and spend less time with them — especially providers at 24-hour care facilities — and well, you can imagine what happens in documenting the physical exam — mistakes are made from selecting the improper “drop-down” choice to failing to select a choice to indicating the wrong body part, left or right side. Doctors also use voice recognition software to dictate their notes — a technology still has recognition and accuracy limits.
Most injured workers in Tucson are treated first in urgent care facilities such as Concentra, NextCare, FastMed or Banner Urgent Care. Mistakes in medical records can sometimes result in valid workers’ compensation claims being denied by the insurance carrier, or more typically, delayed authorization for treatment of the injury.
That’s why it is important to know your rights regarding your medical records. Federal law guarantees that you have a right to see and get a copy of your medical records. Under the Health Insurance Portability and Accountability Act (HIPPA) of 1996, patients can get some or all of their medical records. Hospitals, medical clinics, doctors, pharmacies, and insurance companies are required to make the records available at a reasonable cost. New guidelines issued in 2016 allow for a maximum cost of $6.50 for electronic records, which can be sent to an attorney advocating on behalf of the patient.
Here’s a “health checkup” you can try: Request your medical records from every health care provider you’ve seen for the last two years. See how long it takes to receive the records. See how much they charge you for copies. Review the medical notes for errors and inaccuracies. [Note: Electronic patient portals typically include only limited information without the doctor’s notes taken during the visit].