How Long Does a Medical Facility Have To Keep Billing Records?

Medical billing records are critical because they are used for insurance claims, whether you have a private provider or use government-supported Medicare or Medicaid. 

But it’s more than that, too. The billing records also provide the complete medical history of a patient, which is crucial for future treatment considerations. 

What are Medical Billing Records?

A medical billing record is documentation of the charges a patient racks up in healthcare services and procedures. It is used to generate their complete billing information.

It contains the following vital information:

Individual Payment

A patient can keep track of their billing information throughout the years. While some may consider these details mundane, they may be an important matter for others, especially those with chronic illnesses. 

For example, the billing charges are necessary information for insurance claims. In some cases, the record may be a vital part of an ongoing legal case. There could be various reasons why a person would need this information, including medical billing issues or disputes.

Procedure Coding

Medical billing uses codes to indicate a patient’s diagnosis and the corresponding medical care and procedure provided. Codes are also used to identify what equipment was used to care for the patient and the medications given. Coding simplifies these reports for insurance companies. 

The medical billing record contains these codes, which carry information about the medical procedures, medical equipment, and pharmaceutical items you received over the years. The report will give attending physicians your complete medical history so they will know the appropriate treatment to provide. 

Codes are also necessary when a person makes an insurance claim. They will help insurance providers analyze the diagnoses and corresponding care given and determine if there is a legal, financial claim. 

Patient Chart Notes

Not everything can be coded, so critical medical remarks are also noted on medical billing records. This would give attending healthcare providers a complete picture of a patient’s medical history. They don’t just get the clinical information but also the expert opinion of previous medical practitioners. 

How Long Must Medical Billing Records be Kept?

A medical record retention policy determines how long a medical facility must keep medical records. 

The policy was created because there was a time when the only records available were those put on paper and kept in steel cabinets. These documents are a fire hazard and need to be disposed of. However, they could still be required for billing claims and other healthcare-related issues. They are also necessary for coding and billing compliance.

So, these documents are saved in medical facilities for years. How long should medical records be kept?

Federal Law on Medical Billing Records

The Centers for Medicare and Medicaid Services (CMS) determine the medical record retention policy at the federal level. It requires medical facilities to maintain medical records for seven years from the date of service. 

The facility doesn’t have to do the record-keeping as it can be done by a third party. However, the facility will be accountable for those records. Whenever there is a request for medical records, they must satisfy it even if another party handles record-keeping. Requests are usually made by CMS or Medicare contractors. 

What are the documents covered under the medical record retention policy?

• Medical orders

• Medical certifications

• Medical referrals

• Prescriptions

• Requests for payments - services, drugs, and other items

Non-compliance with these regulations may result in the revocation of a medical facility’s Medicare enrollment. 

CMS states: “If we revoke your enrollment, we bar you from participating in the Medicare Program from the effective date of the revocation until the end of the re-enrollment bar. We may consider each instance of noncompliance in determining the length of the re-enrollment bar.”

State Law on Medical Billing Records

States have different statutes on how long a medical facility should maintain records. Every state is independent in its own way, which explains the varied medical record retention policy. It usually ranges from five to ten years, although a few go beyond. 

Here are some of the medical retention policies by state:

• California - 10 years

• Florida - 5 years

• Georgia - at least ten years

• Illinois - 10 years

• Massachusetts - 30 years

• New Jersey - 10 years

• New York - 6 years for adults; 6 years for minors or a year after they become an adult

• Ohio - 5 years for the healthcare service provider; 6 years for the healthcare facility

• Texas - at least seven years

HIPAA Law

Because every state has its own medical record retention policy, the Health Insurance Portability and Accountability Act of 1996 no longer imposes its own. 

However, in contracts with Medicare Advantage (MA) organizations, there is an agreement to maintain “books, records, documents, and other evidence of accounting procedures and practices” for 10 years. 

The purpose of keeping records for this long is to accommodate periodic auditing of financial records, to allow CMS to evaluate the quality and timeliness of services, and to enable CMS to inspect the MA organization’s books to determine financial losses, if applicable. 

The Role of Medical Billing Service Software in Medical Record Retention Policy

Keeping physical records is vital because some agencies require them to be saved for years. However, using software will make things easier when it comes time to access these records. It could help reduce medical billing errors too. 

Why use medical billing software?

Convenient and Fast

It would take hours for staff to sort through documents from around ten years ago. But when the medical facility uses software, any record can be located within minutes. 

Even when paperwork is in a storage facility, it would be easier to pinpoint the exact location with digitization. Additionally, we see more and more situation when automatically submitted claims are reimbursed faster than manual ones. 

More Reliable

The software reduces or eliminates the risk of mistakes. And if there are errors, they are easily corrected. This is why electronic claims using software are often considered more reliable. 

Higher Chance of Claim Acceptance

Electronic claim submissions have a 30% more chance of claim acceptance. Plus, payment time is reduced by as much as 50%. This process saves you time, money, and energy. 

Automatic Data Imports

If you need to consolidate data and records with documentation from years ago, the software will make it much easier. No matter how far back they go, claim information will be easily downloaded. 

How Long Should You Keep Medical Bills and Records?

As always, it depends on local government laws. States have different statutes on medical record retention policy. Some states only require that you keep them for at least five years, while many require between six and seven years in accordance with the CMS guidelines. A few states require keeping records for as long as 30 years. 

Whatever your local government requires, reliable medical billing software will make record-keeping convenient for you. It also eliminates errors, and if there are any, it would be easy for you to correct them. 

BillPro will satisfy your Medicaid billing software needs in New York.