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Humana requesting patient records for Medicare Advantage chart reviews
The ISMA has received several calls from physician offices that received requests from Humana for multiple patient medical records dating from Jan. 1, 2006, to present, related to Humana’s Medicare Advantage program.
The primary questions practices ask are whether they must comply and if they can be reimbursed for copying costs. The ISMA staff has been receiving conflicting – and sometimes inaccurate – information on this issue, but now has answers.
Physicians not contracted with a Medicare Advantage plan sponsor are “deemed” to be participating
in the network on a case-by-case basis for Medicare Advantage fee-for-service patients. Physicians
seeing patients insured in a private fee-for-service product who are not contracted with Humana or
other plan sponsors are not required to comply with these requests for chart audits.
If physicians choose to send records, they may charge the amounts permitted by Indiana law for photocopying parts of the medical record. Additionally, HIPAA privacy requirements limiting disclosure
to these requesting plans apply. Make sure to disclose only the minimum necessary to comply with the request; do not send copies of the whole chart.
Any physicians contracted with Humana or other Medicare Advantage plans should review their contracts as they likely must comply as part of their contractual terms.
The ISMA will provide additional information as it becomes available. Please call ISMA’s practice management staff if you have questions.
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