Yes, lawyers can hold a client’s files until their bill is paid, such as the power of the attorney’s lobby, but refusing to provide medical records on behalf of a patient that owes you money is not a proper collection tactic.
From the standpoint of public policy, the belief is that medical care, and the information that is needed to provide that care trumps getting your outstanding bill paid. Simple as that.
In fact, Federal regulations 45 CFR 164.524(c)(4) is very specific as to your right to charge an individual for a copay of their electronic health records, however, you cannot withhold or deny a patient a copy of access to that record on the grounds that they owe you money. And in NY physicians are limited to a per page charge of $0.75 to make copies of that record.
Now the regulations that set the per-page price do not contemplate passing on the medical record in an electronic manner so the guidance would be to charge the cost of the media material and a nominal fee. However, the regulations speak to providing the patient with a copay of the records, there is no provision that mandates that you pay for the cost of mailing or otherwise sending the records.
Therefore, you may want to set up a policy that you will provide the records, but that they must be picked up by the patient or an authorized representative at your office, or that the patient provides you with a paid Federal Express or another secure delivery service. You can invite the patient to either pick up the records, send the pre-paid delivery envelope, or pay the cost of such. All should be received by your office prior providing. Collecting the records by billing is unlikely.
Now if the patient says they cannot afford to pay for the records, you are entitled to ask for documentation of their financial hardship to then waive the cost. In such incidences, keep your cost exposure to paper copies, no mailing, require pick up.
Similarly, physicians have crossed a red line when they have not reported medical testing results to patients with outstanding balances. There is an obligation of the physician, often delegated to staff to report test results. Not only can test results not be held up due to outstanding balances, it is the practices obligation to contact the patient with the results, it cannot and should not pass that responsibility to the patient. Yes, you can tell them when the results are in if they choose to call, but you have to reach out and present the results if they don’t. And do so reasonably soon after receiving the results. This is not only good for patient satisfaction but also good for patient care, especially if those results result in the recommendation for further care or testing.
The unfortunate reality is that once medical services are provided there may be reduced interest by the patient in paying for them. You are most at risk for non-payment on your commercial patients, where coverage and auditions, as well as nuances of approval and networks, is often confused. Here you might want to consider contingent credit card authorizations to give you some cushion if the information you rely on from the payer as to coverage, deductible levels, and copays is less then accurate.