When it comes to retaining medical billing records, current guidelines require that records be retained for a period of four years—the “lookback” period during which the Centers for Medicare and Medicaid Services (CMS) has the right to amend payments made to physicians for whatever reason is deemed appropriate. However, CMS has proposed changing the current four year lookback period to a ten year lookback period—and retaining the right to conduct takebacks for that long, as well. The Proposed Rule was posted by CMS in the Federal Register on February 16, 2012. The proposed 10-year lookback period would be consistent with the False Claims Act statute of limitations under a provision of the Affordable Care Act. The effect of this change in the statute of limitations for taking back funds previously paid to providers is also consistent with the aggressive stance the OIG is taking toward healthcare fraud.
What this means to the medical office, big or small, is that all records will need to be stored and accessible for 10 years, instead of four under the previous rule. For the most part nobody has electronic records for 10 years--scanned records just haven’t been around that long--so I’m talking about paper records. That’s a large volume of paper to manage. Some providers use record storage companies likeIronMountain, while others still store old patient records in their basements. Some will store records for the 4 years (current “lookback period”), while others will hold them for 7 years for fear of lawsuits.
It may seem that holding those boxes of records for an additional 6 or 3 years is no big deal, but there may be another whole category of record that needs to be stored in addition to those patient records that you may not have considered. I’m talking about billing and coding manuals. It’s wise to store these in the same place and manner as the patient billing records in case you need to be able to provide an explanation for why something was billed in a certain manner under then-current guidelines. After 10 years, billers come and go, and providers will have to justify the reasoning behind a reimbursement.
Unfortunately, when it comes to creating policy, there’s no difference between fraud and error, and I suspect that is the motivation behind this proposal to change record retention policies. This change needs to go into effect first in order for them to be able to hold a doctor liable for a past payment when that patient’s file was legally destroyed years before. That seems fine, and it’s admirable to fight against fraud and waste. My question, then, is this: Why is it that providers only have 90 days to appeal a claim for payment while the government might be allowed 10 years to appeal that same payment? This proposed ruling is overzealous on the part of CMS. Like I said, by all means go after overpayments--but only where intent to defraud exists.
There is relief available to the average provider, though, when it comes to this type of records storage issue. Billing services can be considered the custodians of billing records. The wise practice administrator outsources the billing function along with the headaches that go with navigating an audit such as the type we’re describing. Medical Billing Resources has been storing billing records electronically for years. They are held on an extensive network, and are available to any client at any time. Adding this longer storage period is just another way the cost of doing business in a medical practice is rising, even while fee schedules are dropping. Outsourcing the billing and storage function is one key way to reduce overhead while ensuring that your practice will be found compliant in the event an auditor decides to stop at your door.
