Measure Twice, Cut Once

The minimum necessary standard is pretty simple. It basically says when sending medical records, you need to determine who is getting the records, what they need the records for, and what they require to fulfill that need. Once you've done that, you know what and how much to pull.

Imagine that the patient's medical records are a piece of wood. Not a twig or a mighty redwood in the forest, but a piece of lumber. I'm not talking a piece of pine either. I'm talking about the expensive stuff like one of those exotic woods that certain guitar companies get in trouble for using, or the stuff on "Ax Men" where those logs have been submerged underwater in swamps since the1800s.

Now we have this piece of medical lumber sitting in front of us, and someone requests that we cut it. When we get this request, it's our job to figure out how much to cut off. Cut off too much, then the person isn't going to have enough build whatever they are building. Don't cut off enough and the person is going to have all this extra lumber that doesn't need. In both of these scenarios, we end up wasting time, money, and labor, but that's not even the biggest issue about this. It's a big deal for the patient. If we are sending out to little, it could cause issues with them getting benefits or even the proper care they need for an illness. If we are sending out too much, then it becomes a compliance issue, because the recipient wasn't authorized to get all that extra information.

So, how do we determine how much to cut off? The trick is to look at the request for who needs what and what they are doing with what they get. If it's a kid making a birdhouse for a school project, he's not going to need nearly as much as a commercial builder making houses. The same goes for medical records. If it's an orthopaedist is looking to compare a new MRI to one the patient had years back, the doctor isn't going to need gynecology visits or copies of telephone encounters. However, if it's a subpoena, the court may want to see every piece of information in the patient's chart. Also, remember that "all records" for a doctor isn't the same as "all records" for an attorney. Where a doctor typically only needs to see the progress notes, labs, imaging, etc., an attorney may also need all the correspondence for whatever reason. Making sure that we are reading the request completely and looking for keywords like date ranges, purposes of request, specialist types, and specific record types are vital for complying with the minimum necessary standard.

There's an old saying that says, "measure twice, cut once". Whether you are cutting crown moldings or pulling records, the saying holds true. Keep a mindset that you have one chance to get it right. Taking a little extra time to look over the request and verifying what you pull can prevent compliance issues, double work, and customer complaints. It can also save the company loads of money by reducing the time it takes to print extra pages, reducing the number of faxed pages, reducing mailouts, and reducing the risk of compliance issues.

- Stuart Mobley, Director of Quality + Compliance 

For any questions concerning compliance or HIPAA guidelines, you may contact Stuart at any time.