Changes in Medical Records Laws: An In-Depth Discussion

Video Transcription of Melanie Carpenter and Michael Geoffroy Discussing Changes in Medical Records Laws. Introduced by Arlin Crisco:

" Hi, I am Arlin Crisco. You know, medical records are cornerstone to nearly every personal injury case. Lately, however, there have been quite a few changes surrounding medical records laws and how those records can be acquired. I'm joined today by veteran trial attorney Michael Geoffroy of MG Law, and Melanie Carpenter, special counsel of ChartSquad, and a medical records laws expert.

They're gonna be talking today about those changes and what they mean for trial attorneys going forward. Michael, Melanie,

Thanks for joining me.

Thank you so much for having me, Arlin.

I know you all have a lot to talk about, so I will just hand the floor over to you and, and listen away. Thanks very much.

Thank you, Arlin.

Thank you. Hey, well, I wanted to start, Melanie, by telling you a little bit about, I guess my first encounter with medical records and medical records requests. And that was as a self-taught personal injury attorney, getting his first couple of cases, getting his feet wet in this, , practice of law.

I distinctly recall all those years ago,  getting to the point where I was trying to build a case,  put forth my best foot, my best effort, and make a demand package, and realizing then, wow, this is really difficult to get these medical records here I am, you know, all fired up with all my law school knowledge, knowing that I need to get my evidence, that I need to build my case for my injuries, for my damages.

And, and looking and saying, wait a second, the client brought me this stack of paper with some bills and records. I've tried to reach out to this hospital and this doctor's office. I'm not even sure if I have everything. And then realizing, wow, this is going to be a really big part of my practice. And I think is one of the things that really separates the people who know what they're doing in the personal injury field versus some general practitioners and some other people who try to dabble and really run into a lot of the, you know, walls and complications that come with medical record retrieval.

So, you know, that's really when I first saw it. And, and is that something that you see and, and see similar experiences for attorneys out there?

Yes. Well actually that's, sort of what got me into this field, unexpectedly. You know, this affects small firms, single practitioners, big firms. at the end of the day, if you're practicing any type of injury law, you need medical records.

And the problem we face is spending exorbitant amount of time and money just collecting the evidence, as you said, those records, every day, every week that goes by that you are not able to get your hands on that information, is, you know, money down the drain and you can't sustain a business that way.

And that's sort of how I found, you know, my struggling just to, just to stay afloat. And again, this affects every size law firm because you're either hiring. Several individuals to spend all day, every day on just collecting medical records or you're doing it yourself, and not getting anywhere on your cases.

So, that's, that's where this all came from. I started digging really deep into the details of, of what this industry is and who's running the show here, why, what's the hold up? Why are the costs so high, and what can we do about it? Because none of us are gonna make it if, if we can't balance the, the time and the costs that are involved in building these cases and, and completing the case. So that's that precisely everyone's problem.

No, it absolutely is. And, and, and honestly, to vent a little bit, you know what a tremendous time suck this ends up being for all of us in this field, and that's whether you're doing a higher volume practice or whether you've just got a few cases. You know, we all end up saying, man, I've spent so much time and effort trying to get these medical records.

So let, let's jump ahead a little bit and let me ask you a little bit, you know, I remember, years ago, first hearing about the, the HITECH Act and getting my forms together and starting to make those requests as opposed to just using, you know, what's traditionally been called the HIPAA form and requesting from medical providers using a form signed by my client and all of those things.

And wow, we've got this great new instrument in HITECH and it's gonna help us out. And then all of a sudden, you know, I heard about the Azar case and so I want to ask you a little bit, you know, how did we get here and what does the CIOX Health versus Azar, what does that case mean?  just to your average attorney like me, who's out here doing some car wrecks, doing some slip and falls, you know, how has this case upended every single one of my cases in the medical records and bills that I need to get for 'em?

Well, the HITECH Act itself was, was a great tool for attorneys, and individuals. It incorporated into hipaa. The High-Tech Act allows you to disregard, the HIPAA form as, as you were mentioning, the authorization form that contains all of the certain HIPAA elements, where your requesting records on behalf of your client.

The HITECH Act allows you to send a letter saying this patient wants their own records, they want it sent to their attorney, and under the HITECH Act, they were not allowed to charge one cost of reproducing those records. Those costs cannot include, Searching for the records, actually retrieving the records.

They cannot include shipping or sales tax, and they're not selling records. The, the cost can only include what labor it took to actually get those records to the individual who requested them. Typically the, the OCR the Office for Civil Rights, the body that is responsible for regulating HIPAA and HITECH determined that amount to be $6.50.

So this is a great tool for attorneys. Send in this letter at your costs are gonna stay relatively low. We, we were reading, charged thousands of dollars and now, we're getting direct access within a certain timeframe for $6.50 or somewhere around that amount. That's great. It took probably three or four years for anyone to really understand HITECH and most of the medical providers were not.

We're not following the rules here. They would, you know, I'm sure you've experienced this and most people. Yeah, I was just gonna say, if I could interject real quick, I saw that firsthand too, and I bet a lot of folks out there practicing saw it as well, that they were actually educating, you know, not just small doctor's offices, but even large, medical, you know, groups and hospitals that, hey, this is the law of the land now and here's what you've got to do to comply with us.

And so, you're right, not only was it a long fight to get to there, you know, we had to educate the medical industry about it that, you know, patients have the right to this now. They, it's their, it's their medical history, you know, these are their bills and their records and, and they're entitled to it without exorbitant fees.

And it, and it's a real struggle. You send this letter, it cites the federal statute. Here's the law, look it up yourself and get a response that says, I need a HIPAA compliant authorization. I'm gonna forward it to my vendor, my copy service. They're gonna charge you whatever the heck they find to be appropriate.

Regardless of how much you tried to explain to them, regardless of, of the fact that this is actually a law. So even though high tech is a, is an amazing tool, it, it's still a fight, right? And, and that's sort of where, that was our ChartSquad's daily fight for several years. Just educating these medical providers and dealing with the pushback.

The minute we were seeing some success here, right when you saw responses in a positive way, every invoice was $6.50. They were sending the records in a timely manner. Just, just when we started to see the light at the end of the tunnel. A company named CIOX Sues the Department of Health and Human Services.

Wow. Why did they sue 'em? Well, they did not like that. They could not charge a, make a bunch of money off of people's medical records. They were losing profit here. This profit center is suddenly a service that's not making any money. Okay? They don't like that. And they say, that's not fair. Everyone should pay us all the money.

So they sue the HHS. Now, this lawsuit was a sort of a whirlwind, but at the end of the day, it destroyed HITECH.  completely destroyed it, and how well the ruling states, specifically that HITECH was being enforced without the HHS following the proper steps to getting there. They did not provide a opportunity for notice and comment.

What that means is that the large copy services and profit centers did not get a chance to complain about this before it started being enforced, which is not fair (to them). Now, there's a lot of solutions for these copy services, but they don't wanna restructure their business model. They don't want to have to charge the medical providers for their services.

They just wanna keep making money. And that's how it all came down, that the ruling is you have to provide a, an opportunity for notice and comment. Until then, they, HITECH will not be applied to law firms or attorneys. It will not be applied at all if the request is coming as a third party directive.

And what that means is the patient is asking the records to be sent somewhere else, or someone else is requesting the records on behalf of the patient, then they're not gonna apply HITECH.

Okay. Right. And, and this ruling has been, you know, has had just such a major effect on all of us who are trying to, you know, help these medical patients, help our clients organize their lives, understand what's happened to them.

And it seems so foreign to me, you know, that, that people through their attorney, can't get their own medical records and bills under a clearly stated law, you know, and, and that the court makes this delineation between you and your attorney. You know, to me it raises so many fundamental rights to counsel and so many things that I find objectionable to say, hey, if I can get my medical records and bills, why can't my attorney, why is my attorney, you know, getting charged a fee for this?

I, you know, your attorney is in a, a separate industry, the same way that, let's say a. Third party medical billing company is a separate industry, but that's how they want to, to treat us in this. My one sort of specific question is, this came down from the district court in Washington DC and the ruling came down in January 23rd, 2020, and I recommend everybody to grab a copy of this.

It's, it's public for everyone, but even though this is from the district court there in DC it is controlling over all of us. Is that correct?

Yeah, it's funny. I think that in general people have this misconception that attorneys have all the and that they're capable of just paying for everything.

But at the end of the day, these are costs that the patient themselves pays. So it doesn't make sense to ever charge a patient one thing and then they're representative, their attorney another. But that's how it's sort of seen. And then it's just not just costs. It's the fact that when an, a law firm or an attorney sends in HIPAA compliant authorization for medical records, it's considered a discretionary request.

So it could technically, they can put everything you send in the shredder. But when a patient requests their own records, there's a mandatory response. So it's not just the money, it's the fact that you may never get a response at all. And then that's an even bigger problem. So HITECH was pointing us in the right direction.

And somehow the laws that are good and fair and righteous have been destroyed by this one case that is completely the opposite of what the public policy behind these laws are. But there is light at the end of this tunnel, I must say. It is not over. Okay.  the fight. Yeah, absolutely.

Let's get to that. What's kind of more the current status and where do we see things going from now? So right now we're in this  sort of limbo area. Mm-hmm.  where a good regulation was passed. We all know they're sort of your pot of gold. Not not easy to find, but we get a good regulation that, that empowers patients. That lets, you know, everyday citizens have a right to their medical history without exorbitant fees.

And then you get a court that strikes that down on procedural. If, if I'm sort of interpreting that right, Melanie's, and you are the expert on this, you know, I'm a car wreck guy. But, but you, you are the ones who, who deals with this special area, but they, they strike it down saying procedurally, the federal government didn't go through the right steps to do it, so therefore, it's Invalid. And then that gets struck down. So are we back to where we were before HITECH was ever passed? Is there new regulation and you know, spoiler there is, that's gonna be coming out soon and, and what can we expect from that and when?

Well, we have spent the last year at least dealing with the Office for Civil Rights and the HHS and the OIG in communicating, pushing for change.

Okay. And what, what is it that the High Tech did for human beings? Individuals and how could they make it even better? Because at the end of the day, the high-tech is how, how it was written was, was vague and the copy services and the providers still had arguments against what we believed. To be the accurate interpretation, okay.

So, no matter what we did, even as high-tech was written, there was pushback and, and we were unable to consistently enforce it. So we've

been. Give us an example of some of the pushback. What were some of the arguments that were made or the misinterpretations that, that the industry was making to, to claw on, to hold onto their profit center?

Well, to start the medical providers, copy services vendors, they all argue that high tech, as itri as it is, as it is written to only applies to patients themselves. The patient coming in, the patient calling a patient, sending the letter saying, mail this to me, fax this to me directly. They have always pushed back saying, this is not for attorneys.

This is not for insurance companies. This is not even for your mother or your grandmother or your guardian. This is not for your other doctor. They're only, it is only advised for patients. So before the CIOX case, the OCR actually did release an opinion to attempt to clarify HITECH and explain that it does not matter where the request comes from, as long as the patient is the director of this request.

As long as the patient is the one telling it where to go, who to receive then, then it is a HITECH request. So they, they provided this clarification. Great. Guess what the provider said? That's not what the law says. That's just an opinion. So that's part of the pushback. So I've been dealing with the OCR to clarify that language further.

Well, also, you're, you're saying that that people that may have been, you know, had court appointed guardians unable to take action for themselves. They were actually using the la- maybe lack of clarity or specificity to  root those people out and, and to say that they couldn't act even through their guardian to get records.

Definitely. I have, I've seen medical providers where the patient asks for their records to be sent to an email address ending in edu for example. They're going, they're a student and the medical providers will tell them that the edu email address is owned by the school and therefore this is a third party request.

Patients. Oh, wow. To us with asking for help to get their records, be for those reasons. I mean, it's that ridiculous. If you have a PO box, Nope. Third party request, it, it gets, you want 'em faxed to a FedEx? Nope. That's third party. It, it's really, it's really insane. The level they go through to, to make the money.

I mean, it's all about the money.

Right, right. And, and that's worth pointing out that the majority of the time, this isn't you know, that hospital in your little town, you know where I live, we have Piedmont Newton is our little hospital in Covington, Georgia. Or, or it's not your, your family doctor down the street who is holding onto these.

The vast majority of medical providers, both large and small, use these independent third party companies and really shift all of the responsibility in record keeping and responding to these things, to these other companies that are, you know, for profit entities. Then trying to take a collection of, of individuals records and, and make it into a profit center.

Yeah, exactly. And these companies, first of all, are not involved in patient care. So they're not invested in these people like the hospital or the doctor may be invested in them cause they're not caring for them, they're not, they don't care about their health. That's not their job. And they're shielding the medical providers from even knowing that these problems exist.

You can call your doctor or hospital and you ask for medical records and you're transferred immediately over to these companies, these profit centers.  to deal with it because that's who they've contracted with and they don't have the time and they're focused on patient care. Well that's fine, but they don't know that their vendor is violating federal law.

They don't know what kind of charges their vendor is or what fees the vendor is charging. They just don't know. And it's almost impossible to reach someone to like give them this information. So that's another thing I spend a ridiculous amount of time on, is just getting in touch with the actual administration of a hospital or the, you know, somebody who's gonna take note that you know, your vendor is putting you in a sticky situation.

When a violation occurs, when a HIPAA violation occurs, and that's what.  It's not the copy service that's liable. Okay. It's the doctor, it's the hospital. So they need to know, but they're being shielded from these profit centers who, who have arbitrarily invented their own laws, you know, . So, yeah, like I said, we've been working with the OCR to, to clarify to, you know, bulletproof different parts of HIPAA and HITECH.

And I, the good news is that it's working. There's proposed lawmaking for HITECH. It's been revamped. It is more strict it is more beneficial to the patients.  and it includes a decreased turnaround time, meaning right now they have up to 30 days to produce records that is being reduced to 15 days nationwide, which is great.

The faster you can get these records, the faster you can get that case off your table, right? Absolutely. You can't keep taking in more than you can complete, right? So all this is good news but it's not in effect yet because they're providing this opportunity for noticing comment. And lemme tell you, they're commenting the, these copy services vendors, they're commenting, they're outraged and... you can read, it's all public on the HHS's website. You can go to notice and comment section, there's a tab there and, and see sort of what people are saying. For every comment against this legislation, I made a comment for it. So you know, I think we'll win. I think we're doing pretty good here, 

Well,  and that is great news to hear that things are moving in a positive direction. W what about the idea of, of the, the stick on the other side of this. Does this regulation have teeth?

They have 15 days to comply, what happens to them and what acts could you know, I take or my client take? Who's requesting their own records through me? What actions can they take if they run into non-compliance, which. I don't mean to go out on a limb here, Melanie, but I feel like maybe we won't get a hundred percent compliance after this gets, gets through.

Yeah. I think even after the notice, the comment period is over. It's gonna take quite some time to and, you know, as we were doing in the past, educate these providers. One powerful tool is for the patients to contact their doctor or the hospital themselves. Okay? I know that a lot of patients are incapable of doing that or they don't want to do that.

But it is a powerful tool to call, I'm your patient, I want my records. I don't understand what the problem is. Send them, you know, that's a powerful tool. The other tool that there, there is out there is to report HIPAA and HITECH violations to the office for civil rights. This is not something a lot of attorneys in practice.

Have time to do because it does require follow up and they are going to contact the patient, the doctor, and you for more information. If there is an investigation. However, you know, just ChartSquad itself probably reports about 50 violations every single day. Maybe more sometimes. And the point is to make sure that the medical providers are aware of the fact that they can't just keep breaking the law.

You can't just carry on as if these laws don't exist. They're federal laws, so this is part of educating them. You know, I've had small doctors' offices tell me they have their own hipaa, which is impossible, , right? You can't have your own federal regulation, right? So yeah, education is huge and a lot of times the only way to do that is to file a complaint.

Well, and I think that goes a little bit to the value of the services a group like ChartSquad provide to, you know, just all the attorneys out there like me, big and small again, you know, I, I am, you know, working so hard for the, for the clients trying to do what we can in, in every one of their cases.

We know we're in fighting insurance companies and defense attorneys and claims adjusters and all these different folks, you know, to throw on a additional skirmish with medical records companies sometimes, most times I'm sure for all of us is more than we can handle. You know, we specialize in, in this sort of fight, in this area of the law, and you specialize in that area of the law.

So I think that can be really valuable to think about, and it's important to think about the bigger picture that it is, about the number of complaints that get filed so that there's an accurate. You know, understanding by the general public and by the regulators of the number of violations that are going on out there.

Because if none of us stand up for our, our clients and, and none of these patients stand up for their own records, then then this bullying is just gonna continue to go, and this profit center is gonna continue to, to leach on to everyone who is getting medical treatment.

Yeah, I, I think it's important to point out here that you know, your job representing this client, your job is not just to get through the case and get them money in their pocket.

Your job is to fully in represent their interests, all of their interests that are intertwined in this case, there may be more to it than just their injury and the amount of money they get at the end of the day, the part. Being a, you know, part of your representation, part of really taking on a case would include fighting the system of medical record profit centers that you can't let these profit centers take thousands of dollars outta your client's pockets.

They don't have a right to do that. You can't let them violate your client's civil rights. That's what these are, these are patient civil rights. You're, they can't just violate them. You're not really completing your job in a whole manner if you let this all slide, but I get it. This is not anyone else's specialty.

I don't know anyone other lawyer that does this. Actually. I'm the only crazy person, right. That took interest in such a niche, you know, and I don't know where.

Have your craziness, melody . We're glad you're out there. Crazy for all the. Yes. And there's other crazy people in other like niche practices of personal injury that, that wanna help too.

And we, we are a community, you know but it's okay. There's no charge for this. You know, I'm not trying to take anyone's money either. We wanna provide a service, and if that's service, it ends up including filing these violations and protecting these patients, then we're gonna do that. So, yeah, I think everyone, every attorney needs to know you're really not, you're really doing your client a disservice if you don't engage other members of this community to help out on little parts of the case that maybe aren't your specialty or that you don't have time for.

You know, I am so happy to provide anyone with any information links educational material letters, like what can you say? How can you respond? But at the end of the day, you're really spending every single day, all day on just medical records. If that's what you wanna do, then. , you're higher .

Right, right. No, the, you're right. It, it leaves no time for the rest of the case. Which we all know out here in the real world is, is another huge ball of wax. Yeah. So tell people a little bit, because you are, you know, the area expert on this. How do you file those complaints? Where do you go to do that? What are the things that you need to do to file those complaints on behalf of your clients?

So it's really easy. You just go to the HHS's website. You can actually even Google HIPAA violation complaints. The first thing that'll show up and it, you click a link. It's very easy. Now, there are certain rules to filing these complaints. You need to identify what the HIPAA violation is. All right?

So you need to get the statute out and say, you know, is it, is it a turnaround time violation? Has it been over 30 days? Anything over 30 days, file a complaint. Is it a excessive fee violation? Identify that. Write the words. This provider is charging excessive fees in violation of high tech. This provider has failed to respond to a patient request for records and it's been over 30 days.

Identify the violation. You know, you submit it online so you don't have to mail anything. Please just do it online. Or if you're a ChartSquad client ChartSquad member, we're gonna do it for you. You just have to click a button that says, report this. We're gonna fill it out. We're gonna do all the follow up.

We'll deal with the OCR in their investigation. Nine out of 10 times, that's really all it takes. They get audited from the OCR. There's a full on audit done on their medical records department, HIM, release of information. They educate them and then they keep an eye on 'em for some months to come.

So, There's fines, as there's penalties that maybe excess if they're violating over and over and over again. You know, they usually get a first chance. Or what's the word I'm looking for? So this is strike one.

Have you seen in the past the more extreme measures, I guess them really pushing the enforcement and, and levying funds?

Yeah. You know, we're, we're in this gray area, right? So we kind of lack a sword at the moment.

The OCR doesn't know how to respond, so. We did get several complaints were investigated and be the law was being enforced. And then this new case came out and now I see a lot of letters in response to the violations that say, look, we don't really know what to do here . So the turnaround time violations are very successful.

It doesn't matter who you are. There's a 30 day rule, and again, that's going to turn into 15 days. And we are at the precipice of another new piece of legislation that's really gonna help us a lot. And it's called the 21st Century Cures Act. But in the meantime, yes I am. We're in this gray area.

It's very difficult. So I think it's worth pushing and worth filing the violation, whether or not they're gonna enforce it because the OCR is collecting this information when they're creating the legislation. If all of these patients are aggrieved, they must fix this problem. So I do think it's worth filing the violation.

Okay. Okay, great. So tell us a little bit more about this 21st Century Cures Act. I feel like a kid on Christmas Eve thinking about   what we could actually get out of this. You know, where do we, where do we see this going and where do we hope to be?

So there's a lot involved here. Not trying to bore everyone, and I'll try to make it as simple as possible.

But let's start with, you know, all of these, at least the major hospitals have electronic record systems. Okay? They're not handwriting their notes anymore. We call those an emr. So in this EMR, it's easy to, there's a file you can drag and drop it, or what they're doing now is there's companies like MyChart that are contracting with the hospital themselves to release a very limited part of the medical records online for free for the patient. All right. So depending on where you go to the hospital, there's different systems, but you, it's easier the patient, you log in and they're gonna give you a little snippet of what happened, maybe some lab results.

This is your doctor's name. This is what you were prescribed. What you're not gonna see is operative reports product IDs. You're not gonna see medical history, social history you're not gonna see medication administration. Maybe what was prescribed, but not how much was given and what time it was given and who gave it.

So basically the important parts of your file are gonna be totally missing from that. But the 21st Injury Cures Act allows companies like ChartSquad, which 'cause we are a personal health record company, to go in and access the electronic record system directly. So we don't need to go through those third party copy services in order to gain access to the records the middleman has been removed.

Oh wow. That's very promising. Huge. Right. So and, here's another kicker. If there's an EMR and if you have what's called an API direct access, they can't charge anything at all. Oh, written in the law. This will be free. This

is huge. When are some of these timelines? Because I think I've, I if I'm getting this straight, we kind of have first of all the  amendment that were due after the AZAR case.

To, the HITECH to get it back in place. But then we have a separate second thing that we're waiting on with the 21st Century Cures Act, or is this all the same?

They're two different pieces of legislation. Okay. So what's the timing on both of them? Well, I wish I had a better answer for you. It's been pushed back three or four times now.

The last timeframe was to end June 30th. I have a feeling it will be pushed back again. You know, there's so many excuses right now as to why everything takes so long. So I can only. Estimate. I'm hoping this summer we, we have some resolution here, at least one or the other, you know, and nobody's really arguing against the 21st Century Cures Act.

Cause what are you gonna say? It doesn't cost any money to produce those records. It doesn't cost any money to let anyone access it, and it's very secure. So there's really nothing they can say or do about that. So I see that being affected or that going into effect sooner than HITECH because high tech is such a hot topic, you know.

Oh, wow. Okay. Yeah, I know I had seen the HITECH, there was a February, 2021 date, you know, at one point for implementation after the Azar case, and then that got pushed back. And then, like you said, I think the most recent date is June 30th. But no one realistically sees that as an accurate implementation date as far as the Cures Act.

Legislatively has that. Has that passed? Is, is that something that is just waiting on regulatory fine tuning? Or, or where is that in the process?

So there's a provision in the proposed 21st Century Cares Act that allows medical providers and hospitals to adjust their systems and procedures in order to comply once it is in effect.

So right now they're just allowing some time for that. Like I said, there's kind of boring coding talk. There's something called an API. Everyone has to have the availability to create or connect an API. So I think that's basically what's going on is they're allowing hospitals and providers the time to get all of that in play.

Now we both know that they don't want to do this, so , I'm guessing they're not going to. And then the law will go into effect and they'll all be issued fines and penalties for non-compliance, and then they'll put 'em into play. You see, it's like everyone wants to pretend it's not a thing, you know? Right.

Right. So let's, let's take it back. I think we've done a great job of talking about the legislation, the rule making, all of these things on the, the higher line fight that's going on. You know, let's bring it back down to the everyday lawyer working, you know, with this, I'm pulling my hair out, I'm not getting responses.

You know, what's my next step from there? If I'm reaching out to a third party, if I'm reaching out to ChartSquad, how do I make this happen?

Well, Michael, I can tell you ChartSquad is the only company currently in existence that makes it super easy on you. We are a ne use on demand company. You don't, there's no contracts, there's no requirements. You don't have any numbers or quotas you have to make. With ChartSquad, you can't get your records, you just log in.

You might have to create an account if it's your first time, but you just provide simple information, your name, your telephone number, your bar number and dependent on the case management software you have. You might be able to directly send all of your client information to us. Oh, wow. If not, yeah, just send a ChartSquad, click this button.

We'll have all the information, their name, date of birth, everything we need. We have some proprietary documents on our website that I advise everyone to just stick in their retainer package. Have it signed on hand just in case. A lot of firms like to streamline and do everything the same way every time for consistency.

And so you know what stage your case is in no matter what. Those people do use ChartSquad for every single record request and billing request. So get that document signed. If you're gonna use us on demand or every single time you're gonna want that document signed, right? All you need to do is upload it and hit go.

We've got probably 50,000 medical providers in our database and you can add more anytime. It's very, very easy. Within the same day, you're gonna see that progress has been made on that request and exactly where we stand and what's going on. And like I said, your client's gonna get an email. Welcome.

You've got this account, it's free. Okay. And, and that's it. I mean, we're not charging per page fees, we're not selling medical records. We're just providing a service. What

are some practical tips? You know, that you have, you know, you guys there at ChartSquad are the experts not just in what the rules should be, but how to operate within them.

And I thought what you said about filing the complaints was, was the first great tip for all of the, you know, sort of Joe Schmo attorneys like me out there that I need to be doing for my clients and for my practice. What are some other things that, that you have as a practical everyday tip?

Yeah. I'm glad you asked. I, you know, and at the risk of sounding sort of like I am an elementary school teacher, you've gotta, you've gotta analyze. Where you're spending your time here and how much is it costing you? Okay. By the way, you're not the first person who felt the need to talk to me like an elementary school teacher. I get that all the time. So don't worry about it, 

I mean, that's probably one job I could never have to be honest with you, but , yeah, I, you know, so you can hire someone to spend all day requesting medical records, filing complaints, and fighting with medical providers, okay? Those are all costs that you're gonna pay and you're never gonna get back.

Alright? That's an employee's salary, a workation, worker's comp, insurance, whatever other benefits you offer. Paid time off, you know, just for someone to handle medical records. And guess what? They're probably not gonna be very successful because as we've discussed in this moment in time, we're in a gray area.

And even when these laws are in effect, you're gonna have a huge fight. Okay? These should be. If you, if you're holding onto these cases for forever and ever, because you can't get the records and you're paying someone every single day to spend all your time on this, you're not making any money. That's bad business.

All right? Don't do business that way, okay? You need to engage help here. It's, you can keep your costs down, your upfront costs out of your pocket. Stop subsidizing these costs through your own office. All right? These are case costs. Get help. We have the time, we have the energy, and we have the tools to get you those records faster and for our less money so that you can carry on with your business.

Now, as lawyers, we don't go to business school. , but this is just logic, right? You, you can't spend all the money and not make any, right? You've gotta keep a, a smooth flow. It's gotta be in and out and in and out. And the only way to do that is if you've got these records coming in faster, right? You can't, you can't wait eight months or six months.

Imagine if you had your entire file complete within a week of signing a case, right? That's how you should do your, do business and, and you know, not just a pump chart squad, because there's other services that you may wanna engage too. But the medical records is the major problem here. And billing for, for that matter.

I talk to attorneys all the time that are sort of kicking themselves in the face because they finish a case and then three months, six months later, other bills they didn't even know about start coming in out of nowhere. Or their clients calling and saying, I got sent to collections. Aren't you responsible for these bills?

Absolutely. And that's a nightmare that I think a lot of us. Are concerned, worry about, and, and, and even see, you know, practicing day to day. And I, part of my pitch when I talk to clients and prospective clients is that I tell them, Hey, this is gonna be on me. We're gonna get all your medical records and we're gonna make sure that all of them, everybody who needs to get paid back out of the settlement gets paid back.

We're gonna take care of these subrogation concerns, you know, so that you don't have to worry about it. But that means I'm on the hook, like you said, and if I'm not doing an accurate job of getting all of the medical bills, making sure that, wait a second. This got sent to an independent lab who sent a separate bill.

And you know, if you don't realize that from, from these medical records, you're gonna end up missing out on the full recovery and as much money as you possibly could for your client. And you're also potentially ending your case, leaving a landmine out there. So, you know, that's only gonna end up with an unhappy client, a negative Google review or other things that can hurt you.

Yeah. There's another thing Melanie, that I thought you said that was really, really key for attorneys is, you know, many of the most talented attorneys that I know out there are not great business people. And being one doesn't necessarily mean the other. And it's so hard for us because we spend so much time on CVN watching the great trial attorneys and working on our cross-examination and our deposition skills.

To, to remember to run our business as well as we can, and not just for our own pockets, but also for our clients you know, for, for them to get the po- best possible service. And you mentioned how much getting these records quickly can make a difference. And one thing that I always think about and talk to other attorneys about is think about how difficult it is to get 10 or 20% more out of every case you have, you know, to say, okay, I'm gonna improve my client's outcome and my profitability by getting 10% out of every case I have, or 15% more out of every case.

It's so difficult now to wrestle that out of insurance adjusters and defense attorneys and, and even if you're arguing it at trial out of juries to say, Hey, I'm gonna get 10 to 15% more. That's close to impossible, I think for most of us. But what is possible. Is to look at the bottlenecks in your process and what is slowing up resolution of cases and say, you know, if I got every medical record back 10% faster, or if I shaved 20% off of how long it took me to put together the records and bills to make my demand, you know, there's a profit source for me.

There's room for growth by doing this job better. Not reinventing the wheel, but just getting more efficient in the process. Because I think without question, medical record and bill retrieval is a bottleneck for all of us.

Yeah, I mean, you, you're kind of hitting the nail on the head here. Time on desk is a, a money suck.

Okay? You need to reduce the time on desk. How long is that file in your.  To start, how do you do that? Well, you need to get all of your evidence in quicker. All right? Now a lot of times you need a police report and I can't really help you there, but  that might take forever. Like I know in Los Angeles, it's like, forget about it.

But, you know, if you can reduce your time on desk, you're gonna, everything's going to flow a lot smoother. You're gonna have more money in those trust accounts coming in and out. You're gonna be able to run your practice better. The one way to reduce your time on desk also is to really embrace technology.

You know, you don't need to print everything. You don't need a fax machine, all right? You don't need to go anywhere, right? Look at us right now. So, utilize technology. Don't be that guy wheeling a suitcase into court with a bunch of sticky notes. You know, you need to be able to adapt to the tools that are available here, or you're gonna be left behind, okay?

Making sure your file is complete. , that's a huge deal. Like you said, you're gonna add 15%, 20%, 25% under your case, maybe even more if you know you have everything that, that is applicable here. Unless you're, well, I guess there's two ways to go about doing that. You can hire somebody who has a degree or education in CPT coding and record analysis that's gonna cost a lot of money, pretty much like a paralegal or more to sit there all day and analyze medical records.

Or again, utilize a service like ChartSquad. We've already hired those people and we can assure you that there's a great detail of review going on to make sure that you get every single bill that may possibly exist. And if we can't find it, we'll make sure to get you a letter that says, this bill doesn't exist and it never will.

Just in case, you know, just in case they come back another time. And, and that's a way to increase the value of your case. And let's, let me tell you, we're not gonna take forever. Once those records come in, they're being reviewed immediately. All right? The other tool that you need to utilize here is the people that already work in your office.

You and the people that work for you have far more important things to do than chase medical records all day or analyze medical records all day. There's more to the case than that. You know, there's, there's a non-economic damages you need to evaluate and analyze and include. There's client contact and client communications.

One thing that ChartSquad really prides itself on is empowering the patient, the client themselves. Every time you sign someone up, you give us their email address, they get a notification saying, guess what? You have the best lawyer ever. They have created a ChartSquad account for you. It is free. You can now review your records, request your records, store them, organize them for the rest of your life, or you can say, no thanks.

It's up to them. But that's a point of contact and it gives them control knowledge over what's going on. How many calls do you get a day where someone's just like, what's happening with my case? And what's the next step? Well, how many

Are you even doing anything? Responding? Yeah. How many calls am I responding?

We're still waiting on medical records or Exactly. You know, we've made our third request to, to your er, or whoever else it might be. I really love the idea of empowering, you know, the client and giving them an active role because it is difficult when you take over a case that there are these long stretches of time that you have some great clients who want to genuinely help you pursue their case.

And there isn't as much for them to do because we're not up to deposition yet, or we're, we don't need help with discovery responses yet. But empowering them to help get these, and like you said, the medical providers, they listen to their patients more than they listen to some dumb lawyer on the phone.

I mean, they do not want the lawyer to call, nobody wants to hear from the lawyer. Okay.

Not even my wife. Not even my wife. Right. But absolutely, I love that idea. And I'm gonna go out on a limb here and say that while, while the majority of our clients are great people, every now and then, maybe you get a, a person who's a little bit of a complainer or a problem.

And I think what you're talking about helps with that situation too, that you have updated them. You have, you know given them the opportunity to take further action. If, if they're going to point the finger and say, well, Michael, I hired you to solve this medical record problem, and nothing is happening, and you're saying, well, look, here's my seven times that I made a request and here's my complaint that I filed.

And they say, well, look, that's, that's not good enough for me. You know, you have given them the opportunity to, to intercede as well and to help get it done. And I think that can help with your client satisfaction when you do hit those clients, that that may end up being a

problem. You know, one common scenario here is when your client calls and you say, look, I'm waiting on your records.

I'm waiting on your records. They call their doctor their hospital. They, the hospital says, I don't have a request. Nobody even asks me for the records. Oh, absolutely. That's common. They're just lying. They're lying. So how do you convince your client. You're, you're the lawyer and you're telling the truth, but their doctor is lying.

Like it doesn't, you know, most people are gonna believe their doctor. I'm, I think unless you're like really good at getting people to trust you, you know, at the end of the day they're lying. They're just saying that. Or their HIM department put it in the shredder, right? Because as we discussed, it's discretionary.

How do you explain that? You've done so much work and they're on the phone going, you haven't done anything. All right. Well, if they have a ChartSquad account, everything is transparent. They can see every single phone call that was made, every single time a request was set, it's time stamped, it's dated.

Is it a reminder? Is it a second reminder, a third reminder? You can't look at these logs and these transcripts and think my lawyer is doing nothing, because there's a great deal of work that goes into this. So transparency builds a trusting relationship. You see? And that, that's really key to avoiding those post case client complaints.

I couldn't agree more about let's you, if they trust you, then you're gonna be okay. Your case is gonna be successful and they'll probably refer other people in return. If they don't trust you, then you're not, this is not a good working relationship. So you've gotta have transparency, you've gotta empower them.

They have to be informed, you know, and that's really hard to do on a regular daily basis. So ChartSquad creates those point of contacts, that transparency and gives 'em a little bit of control and power. I think that's really important.

I will say going back to sort of the practical tip element of things.

One thing we do here, on our calendaring system. We, we know as trial attorneys that we are a, you know, deadline driven operation. We have court dates, we have response dates, everything. Especially if you work in federal court. Oh my goodness. You know? Yes. It's, it's a nonstop calendaring of response due here.

Motion due here. Hearing, coming up, we actually put our medical requests as a separate person in our calendar. So it doesn't necessarily go to me even though it's my case or go to my paralegal. And then we keep those because we know it's sort of a, a secondary deadline that we should be hearing back within 30 days for these folks.

But on the 30th day, it's not the same sort of three alarm fire as the 30th day that your response brief is due. Right? Right. So we keep that as a separate person and then when we have the time, we jump back in. And whether that means, having a call with our third party provider like ChartSquad to get an update on everything that's going in, going on with, with our requests, or checking on some requests that we've made ourselves and going back and saying, okay, we have this group that are, past due and we're going to file a complaint or we're going to send another request.

So we do that to separate it because we know there is a hierarchy of deadlines and, and frankly, with medical requests, you know, you would, you'd overdo your calendar. It would just explode if, you know, I average six medical requests per client and then I have this many. If I had all of those deadlines on.

So we treat those as a separate employee in our calendar, which gives us the ability to, say: Hey, we've got a little time here. Why don't you jump in and do this? Or, we're going to bring in an intern and they're gonna check on this and, and help us with it. But that's a little practical tip we use at my firm.

That's great. And I'm assuming most offices are using some sort of case management software at this point. So a lot of that can be automated. If you reach out to your software, whatever software you use, if you reach out to them, they can help sort of build some things to automate different calendaring systems.

And there are a few softwares that integrate with ChartSquad, push this button, message ChartSquad, push this button, request more records, things like that. So again, going back to embrace technology. All right, whatever. You're gonna spend a little bit of time, a little bit of money, Getting new products and new software, but it's totally worth it in the end, you know, if you don't already have something  and don't, no, but I think it comes up and don't be afraid to reach out and ask for something like, can you build this or can you include this?

You know, I'm missing this function I would like, and we are, we are definitely on demand in that way of in-house coders and what you need, I'm gonna make it for you. So I know a lot of other companies that are like that too.

That's great, Melanie. And, and it gets back to the idea of best practices and I think brings us full circle as to why we, we had this in the first place and why this is important.

You know, you, you don't want to be the area expert in this. Melanie already exists, and you don't want to be your own coder and be prepared to, you know, jump in, win the 21st Century Cures Act. You know, comes to be that you're going to be the person going into the electronic records. However, it's important to understand it.

You can't just farm this out and say, well, I, I'm a trial lawyer. I don't need to know about medical records requests. I'm just gonna let somebody else handle it. I, I think you do have a duty to your client and to your practice and everybody that you work with to make sure that you understand it and that your team understand it, and it's gonna work better if you do.

And at the same time, like you said, you, you need to use technology. You know, the days that you could come in with a pen and paper and a typewriter.  and have a functioning practice. I mean, that was 30 years ago. Yeah, we need to be using technology. We all have Zoom meetings, we all have email. We need to all have methods like calendaring and case management software that keep us doing the best so that we can provide the best service for our clients and that the cases can get resolved in the best possible way for as much as we can for our clients as quickly as possible.

So I think that, you know, third party vendors like ChartSquad are an important part of that, but it's also incumbent on you, the attorney, to understand the state of the law, with the AZAR case, with the 21st Century Cures Act coming up and to understand, the technology to some degree and the rights that your clients have to make sure that you're doing everything for 'em.

So I really appreciate you coming on here and talking to us about this. And like you said, you're that mad scientist. Working on  that, that special witches brew to get this to work for all of us out here. And, and really, I really appreciate that there are so many attorneys like me that struggle with this and really count on experts like you to do it.

So thank you for being out there and fighting that fight. And, and I wanted to ask if there was anything that you wanted to close with.

You know, I just wanna say that really appreciate CVN, for creating these webinars and letting us have a moment to share some knowledge and information in our community.

CVN is part of that technology we were just talking about. You know, there was a time where you had to beg and plead to get in to watch a trial. You know, when I was an intern I would follow people around and just, please, can I come in and watch this? And now we can view it all on our laptops at home, laying in bed.

We can. Learn from the best, the absolute best attorneys litigators there are out there. I, I think that's great. And I couldn't agree more about CVN and we talked about technology before and best practices. You know, what a great example of a way to, without having to go, you know, trek all the way down to that seminar to hear from, you know, some, old Windbag about some case they had  a long time ago.

And I will encourage all the attorneys out there, be a leader in your community. Step up and volunteer. Don't just work. Within your practice and for your clients, work for your whole community and try to make sure that everybody, has a better idea of what attorneys are and what we do for justice, for everyone.

So thanks to everybody out there for watching and thanks to CVN.

Thank you so much."