Medical Records Retrieval for Law Firms

• MODERN MEDICAL RECORDS RETRIEVAL SERVICE – AUTOMATION, COMPLIANCE, SAVINGS

The modern Medical Records Retrieval (MRR) service is a combination of modern web-based technology and a rules-compliant outsource solution. Historically lawyers and their staff would have to set aside a portion of their time, often a lot of time, to capture necessary information for cases that involved medical records. It’s not that the process is complex. Quite the contrary, every attorney, paralegal, and litigation-support person knows exactly what needs to be done.

It may appear simple, but it is a very manually intensive process. Someone at the firm must acknowledge the need for the records. Necessary forms must be completed to ensure compliance with a myriad of laws (including HIPAA), which the firm and often the patient (who may or may not be the firm’s client) would need to initiate a request. Then, the firm must track the progress of the request, and eventually receive, review, and organize the results, or note that there were no medical records available related to the matter.

To support the business of running a law practice, sophisticated and affordable software tools include new client/business intake, workflow automation, and conflicts management. Vendors who provide early case assessment tools and e-discovery-based technology-assisted review have begun to offer solutions for small firm and solo practitioners. In this article, we will show you how you can improve productivity, lower costs, and better manage billing for MRR expenses.

How Medical Records Retrieval Services Work

Here’s how a typical MRR service works for a small firm/solo practice. One of the firm’s employees logs into a secure, encrypted website. He or she then submits an order outlining the patient’s information, the records being requested, and any other data necessary to complete the request. What happens next is truly a game-changing activity. Instead of the firm’s billable resources chasing record requests from hospitals, doctors, and other healthcare providers, they go back to doing other, productive work, while the MRR process self-executes, and eventually provides you with the requested information and documents or informs you that there were no responsive documents.

Questions Regarding MRR Services

The availability of MRR services presents all attorneys, but especially solo and small firms, with the following important questions:

• How do you start with an MRR service?

• How are the record requests processed?

• Is this process HIPAA-compliant?

• When and how am I alerted to the status of my requests?

• How do I distribute the costs/fees associated with outsourcing medical records retrieval?

Choosing Your MRR Provider

To reduce the risk of choosing the wrong MRR service, consider the following best practices:

1) Ensure that the MRR service can prove secure access to its website (and your records) via a login and password.

2) Understand the MRR service’s processes to ensure protection of privacy.

3) Understand its service level agreements, which explain their process and anticipated turnaround time.

4) Verify that the MRR service has experience with expediting record requests by requesting a list of reference clients.

5) Review the process by which you and/or your staff are notified of updates, including record availability or notice of “no record found.”

6) Ask for the MRR service’s price schedule, preferably in a format that will permit you to do an apples-to-apples comparison of the fees of other MRR services.

When possible, a dedicated MRR service is a better choice than a firm that offers a multitude of legal practice services of which records retrieval is only a small subset of their overall business.

Getting Started with the MRR Provider

Upon choosing your MRR provider, the steps to starting to work with the provider are straightforward and similar to those when signing up with any on-line type of service:

• The firm identifies the approved personnel who are authorized to access the secure system.

• A unique user ID is created for the firm at this time, with a strong password required for all future access.

• Often, this is also the time that billing information is provided, and thus a financial account with the firm and MRR is created for future invoicing.

• Each authorized person completes a new user profile and sign-on request. The user must provide email and phone contact information.

• It is the responsibility of the law firm to notify the MRR as soon as possible in the event that an existing authorized user should be removed from the access control. The MRR should remedy and respond as soon as the user access has been removed.

• While the use of the MRR site should be quite easy for most users with minimal training, additional site support generally is available from the MRR’s services personnel via phone or email request.

Safeguarding Privacy

No matter how beneficial the technology, the firm must ensure compliance of federal and state HIPAA guidelines and any ethical rules about maintaining client confidences. Therefore, they must ensure that the MRR service collects, hosts, and provides access to client(s) records while maintaining compliance with privacy guidelines. Note: This should be part of your due diligence when selecting a provider.

The MRR Service should comply with Federal and state privacy laws. MRR services should keep up to date with changing rules of privacy such as the HITECH Act.

MRR agreements should expressly state that no personally identifiable health information (PHI) can ever be used for non-business related activities such as marketing and/or sales lead generation.

Record Processing

Once you have chosen an MRR service and set up your account, obtaining medical records is relatively straight-forward:

• After you enter a request into the system, the MRR service creates an MRR record request connected to the unique ID of the requester (the specific user at your firm), and confirms receipt of the request via an email.

• A reviewer is assigned to assess the necessary actions to fulfill the request, and will notify the user of any questions regarding the record request. In some states, including California, an electronic request can be executed from the MRR service to the healthcare provider, eliminating the need for paper-based transaction.

• The provider then tracks the request, and conducts any follow-up communication by any means available, including email, telephone or in-person visits if necessary, to acquire clear copies of records requested.

• If the record is available and legible, it is scanned into the secure web-based system for access by the user. Otherwise, a “no record found” is annotated to the request, and communicated back to the user.

Communication Is Key

Nothing can be more frustrating to case management than waiting for needed information from a third party. The MRR service must not only forward the record request to the healthcare provider, but also must provide the firm an ongoing and timely response regarding status. Each record must be tracked in real-time with detailed notes from the MRR agents. The MRR service should send alerts if additional information is required, provide replies via email, and deliver the link to download and/or view completed requests as soon as the records become available. Again, during the selection process, you should ascertain the provider’s practices regarding communications, and include them in the contract.

Speed Is Critical Too

Obtaining the medical records timely is critical, whether to respond to discovery, to make or oppose a motion for summary judgment, to get an expert up to speed, or to settle a case. A reliable MRR service will offer a quick turnaround. They have the experience working with medical locations to obtain records faster than a law firm’s in-house staff. After all, a law firm staff member may encounter (or, in truth, may feel like they have gotten stuck with) the occasional medical record search, but the MRR service is a specialist in the process of collecting information, including “no records found.” So, the MRR service’s very job is obtaining medical records, and therefore will have the process down to a set of specific steps, and can support their clients via a web interface.

Relationships With Healthcare Providers

Sometimes hospitals, physicians’ offices, and other healthcare providers may treat the occasional request by an attorney for medical records as an inconvenience, not respond as quickly or perhaps as completely as the attorney or client would like. A smart MRR service will develop long-term relationships with healthcare providers and their staff to get the data needed promptly and efficiently. This will improve the quality of the document production, reduce its cost, and speed the process up.

Database Strength

Medical records often can be in a different location or city than the healthcare provider. For example, billing records for hospitals are usually in an offsite facility, sometimes in another state. With the advent of electronic records, more healthcare providers are centralizing their records offsite with the umbrella company of their medical group/hospital. Without the information on how and where to request records, in-house staff can waste valuable time sending requests to the wrong locations or having to spend the time to find out where to send the requests. A strong database on where and how to request records from healthcare providers therefore is key to save time, ensure complete result, and save money. MRR services have the incentive and the resources to develop such a database. Law firms, especially solos and small firms, do not.

In addition the importance on the database in requesting medical records, it is equally important on the production side. Virtually all medical records are produced in digital format. Records are typically available in PDF or TIFF file format, making them searchable by many document management systems – including on premise, cloud-based, web-based or hybrid systems. They are usually made available for download and/or viewing from virtually anywhere on any device that supports a secure micro-browser. The MRR service maintains the medical records for ongoing access by the user and any authorized personnel.

MRR Costs and other Considerations

The MRR service will charge you for their services. However, because the firm’s resources are freed up to work on activities that generate revenue for the firm, the costs of using an MRR service will be offset at least in part, and perhaps in full. In addition, depending on your fee arrangement with your client, the invoices from the MRR service may be directly billable back to the client or at least accounted for as a recoverable cost. (Many MRR services charge no monthly fees for having an account, and thus the firm only incur fees on a usage basis, which can then be charged to the cases for which they are required.)

Summary

While many firms may continue the “do-it-yourself” approach, solos and small firms should consider using an MRR service. In addition to the higher costs of installing and maintaining one’s own record management system, the soft costs and resource consumption make this a less favorable alternative. A qualified, experienced MRR service offers a cost effective, robust platform for processing, monitoring, and tracking medical records requests. Record management and processing is HIPAA-compliant, always available, and secure-which in-house processes may not be, with the attendant risks. Use of an MRR service does not require capital expense to leverage digitally filed and maintained medical records. Firm resources can be repurposed from tracking record requests to meaningful and fee-generating activities. Client satisfaction may improve as matters are able to be processed more efficiently, and firm business may increase. The results of using an MRR service are measureable and immediate. It’s literally a one-click quantum leap from manual, resource-heavy processes to a modern, digital, secure web based management for your practice.

Doing Well by Doing Good: Law Firm Social Responsibility

Corporations increasingly subscribe to the principle of corporate social responsibility. CSR is based on the belief that a demonstration of concern for the environment, human rights, community development and the welfare of their employees can make a corporation more profitable. And if not more profitable, at least a better place to work.

Law firms can learn from corporate experience to create their own social responsibility programs. Such programs can help law firms to do well by doing good. They can strengthen the firm’s reputation and market position. They can help the firm identify with the culture and CSR activities of clients and potential clients. They can help lawyers and staff find more meaning in their work and improve as human beings.

In the words of the social responsibility Karma Committee at Brownstein Hyatt Farber Schreck: Be kind. Be generous. Be concerned. Donate time. Donate effort. Donate money. Just find a cause and give. You’ll quickly discover giving is also receiving.

A panel discussion about how law firms can learn about CSR and introduce some of its elements into their own models was sponsored by the Rocky Mountain Chapter of the Legal Marketing Association. The program was held May 8 at Maggiano’s Little Italy in downtown Denver.

Panelists included Sarah Hogan, vice president of Barefoot PR; Bruce DeBoskey, lawyer and founder of The DeBoskey Group, which focuses on philanthropic advising; Joyce Witte, Community Investment Advisor and director of the Encana Cares Foundation, Encana Oil & Gas (USA); and Amy Venturi, director of community relations & karma at Brownstein. Moderator was Cori Plotkin, president of Barefoot PR.

At law firms, the product is the people – the lawyers and support staff who provide high quality legal services. It is an easy fit. There are many ways that this ‘product’ can contribute time, talent and treasure to socially responsible activities.

Social responsibility: Focus and strategy

Law firm social responsibility is all about making a difference within the community and the profession, and within a firm. Even the best efforts will make no impact if spread too thin. You cannot maximize the value of your contributions or tell your story if your efforts are too diluted. To decide how to most effectively invest its resources, a law firm needs a social responsibility focus and a strategy.

Social responsibility efforts must be authentic. Law firms and other entities should always avoid ‘green-washing’ – telling a story that is aspirational, but not really true. Know yourself. Let your firm’s unique culture and skills determine which efforts to pursue and which to avoid.

When examining your culture, don’t limit yourself to partner input. Law firms are small communities, almost like families. Any effort to define culture and social responsibility should represent not only the interests of lawyers, but the interests of all levels of support staff. Efforts must be meaningful throughout the firm. The benefits to employee recruitment, retention and satisfaction can be remarkable.

DeBoskey outlined three types of community involvement and stated his belief that a good social responsibility plan includes elements of all three.

In a traditional model, an organization ‘gives back’ randomly to the community when asked – as a good citizen, rather than for any strategic purposes. In a social responsibility model, these efforts align with the capabilities of the business – like the legal skills of lawyers. Every non-profit needs legal advice.

At it’s most sophisticated, a social responsibility program involves using your core product – legal services – as a tool for social change. Volunteer with organizations like the Institute for the Advancement of the American Legal System at the University of Denver, or the Rocky Mountain Children’s Law Center.

A strong focus makes it much easier to make decisions. Encana, for example, focuses its charitable giving strategy on issues surrounding its product — natural gas. Brownstein will donate money only if the request comes from a client, or if one of their attorneys is a member of the organization and on the board.

Law firms looking for additional advice can find valuable resources within the Corporate Community Investment Network. CCIN is an association for professionals whose primary responsibility is to manage community investment programs in a for-profit business setting.

Many corporations and a few law firms have actually created separate foundations to mange some of their giving. A foundation comes with more restrictions and different tax methods. As entities with a life of their own, however, foundations are more likely than one-off efforts to continue a useful existence.

Social responsibility: Good policies make good decisions

Strategy and focus provide the foundation for an effective social responsibility policy. Most law firms are inundated with requests from good causes asking for their support. A policy helps you know when to say “yes” to and when to say “no.”

In the law firm model, where all partners are owners with a sense of entitlement to resources, it can be very difficult to say no. A keenly focused policy makes it much easier to do so and keep the firm’s efforts on track.

Encana, for example, uses a five-step tool to determine the level of fit between a request and the company’s strategic goals in the field of natural gas – with level five being the largest commitment and level one the lowest.

Level five efforts integrate core product or service and often involve natural gas vehicles and energy efficiency initiatives using natural gas. These efforts contribute to best practices and leading trends in the industry, while enhancing the company’s reputation as a leader.

Level four efforts focus on strategic partnerships and often involve sustainable and long-term solutions like workforce development initiatives, signature programs (which can be repeated in other markets) and multi-year grants.

Level three efforts include strategic grants to assist with projects, programs or initiatives made to local non-profits aligned with natural gas.

Level two efforts include responsive giving, which is a one-time gift for a broad community effort that has local support. Participation of company representatives is required.

Level one efforts include the “t-shirt and banner” category, which contains one-day items like dinners, receptions, golf tournaments, events and races. These offer the least impact and awareness for the money, and therefore the least support.

At Brownstein, requests made to the firm are judged by two factors. The firm considers only requests made by clients and requests made by organizations where one of its attorneys participates at the board level.

Social responsibility: Engagement

Effective social responsibility programs involve not only checkbook involvement, but personal and professional involvement.

At Brownstein, the brand has always been about being out in the community. Six years ago, Venturi was asked to formalize this essential component of the firm’s culture into a social responsibility program that would further energize lawyers.

She started by spending 15 minutes with each of the attorneys, to discover their passions – which were used to identify a good non-profit match. After all, lawyers and staff will stay involved and do their best only when an organization is something that they care deeply about. If there is no engagement, the placement will backfire.

Finally, Venturi offers the lawyer’s services to the non-profit in some capacity – but it must be at the board level. Otherwise, she won’t make the match.

Project Karma is a Brownstein program dedicated to volunteer opportunities, and maintains a committee in each of the firm’s 12 offices. It sponsors informal lunch & learn presentations by local non-profits to encourage interest.

The message about active engagement by lawyers and staff must come from the top. Brownstein makes it very clear that the path to partnership for a new attorney is based not only on legal skills, but also on engagement and involvement with the community.

It is important to add a community involvement component to lawyer reviews, even if it is only one goal a year. That lets the lawyers know that you are serious. The Colorado Supreme Court asks every lawyer in to contribute 50 hours of pro bono work each year. Integrating these programs leads to win/win results for the firm.

Not every firm can match the efforts of a large company like Encana or a large law firm like Brownstein. However, there are good matches for firms of every size. Once again, it is all a matter of focus.

In fact, it is much easier to get five members of a small firm to focus on a strategic initiative than 500 lawyers in a huge firm. If a law firm has $10,000 to donate, that money goes a lot father and has a lot more impact to one organization than do $100 donations spread across 100 organizations.

Smaller law firms can also multiply its impact by partnering with others in an industry, like vendors or clients, to support a particular non-profit.

Social responsibility: Return on investment

Corporations measure the results of their social responsibility programs, and use these results to make decisions on efforts going forward. Law firms should do the same.

At the end of the year, Encana uses its five-level model (outline above) to analyze our charitable giving. How much was given at each level? Then the company sends a form to each non-profit, asking the recipient to evaluate outcomes (statistics for what was accomplished), process (did efforts meet the intended audience) and impact (what difference did it make).

Encana asks recipients to reply within 60 days, and uses this information to calculate return on investment. Those who do not report back are not eligible for further contributions. The non-profits might gripe at first, but they seem to change their minds once they’ve been through the process – finding that it has useful strategic value.

It is entirely appropriate to ask a non-profit to document the results they’ve achieved based on your contribution. It lets them know that you are truly invested in the organization. They will see you more as partners and engage you differently.

Most corporations have created and benefited from well-thought-through and strategic social responsibility programs. Law firms are starting to do the same. A program with tight focus and strict guidelines guarantees maximum impact and awareness in exchange for a law firm’s commitment of time, talent and treasure.

Virtual Law Firms Offer the Next Big Thing – Online Wills Bundled With Attorney Review

Despite the proliferation of the many opportunities to purchase online legal documents, you should probably think again before buying do-it-yourself wills and the like. After all, legal documents are the most important items you’ll leave behind in the event of your demise. Rather than trust your intuition to handle the many details of a complicated legal document, you may want to take advantage of the numerous benefits of a virtual law firm.

You can buy anything online these days. The Internet offers so many choices, ranging from established, world-wide companies to local, single-owner businesses. In addition to brick-and-mortar stores, every company needs a web presence. Goods of all sorts are sold online, from jewelry to comic books, vintage guitars to designer clothing. After the successful sale of digital downloads for ebooks and music, legal documents were the next logical candidate for online sales.

Famous attorneys attached their names to the first few sites selling legal documents. However, those attorneys were merely representing the company selling the forms. They certainly weren’t there to represent their customers. That means that no matter who was the celebrity spokesperson, you still had to do all the research, enter all the data and take the chances if you didn’t complete the legal forms correctly.

A virtual law firm removes that risk by offering far more than a successful form download and directions. With a virtual law firm, you get valid advice from an attorney licensed in your state – an attorney who can handle all sorts of estate matters like wills, living trusts and powers of attorney. But that’s not all they do. They can also help you prepare living wills, health care proxies and deeds. Their advice is available to their customers for free by email and telephone. They also offer a review of your legal documents for free, adding expertise to the purchase.

Any estate planning is a serious undertaking. While it may be less-expensive to bypass the attorney fees and time spent in appointments, you surely don’t want to trust your will to a novice like yourself, unless your will is going to be as simple as bequeathing everything to one person. If you have a family, you want to be sure your will provides for everyone as you had intended. An attorney can assure your intentions are followed to the letter.

Some firms will even print your forms after you’ve filled them in online. That way, they can check them over for errors or omissions. If you decide you forgot something or want to make a change, most virtual law firms will permit changes and a reprinting of your documents within thirty days from the day of the document’s creation. They use expensive, official-looking paper to give your documents the legal appearance and feel you’d expect.

Like everything, virtual law firms aren’t for everyone. Here are some conditions for which you probably wouldn’t want to use a virtual law firm.

• If your will is likely to be contested.

• If you have substantial wealth.

• If you’re a citizen of a foreign country.

• If you plan to disinherit someone from your will.

• If you own a business that provides substantial income.

• If you want to establish a dedicated fund for a relative with special needs.

• If you are a property owner in a foreign country.

In some of the above instances, there are additional tax issues to consider when planning a will, so it’s best to not use a virtual law firm. In other cases, settling the estate may become complicated – more complicated than an online attorney can handle. But these cases are less common than the estate planning required by most folks, so most people are likely to be able to use an online attorney.

You’d expect that the fee charged for online attorney services is high. It’s not. It’s comparable to the fees charged by non-lawyer websites that offer forms without legal advice.

The obvious advantage to employing a virtual law firm is the same as for any Internet purchase. The convenience results in savings of both time and money – two things everybody can use. Why bother making an appointment and wasting gas and your afternoon by driving into the city to see an attorney? You can enjoy the same advantages of online shopping – 24 hour per day, seven days per week access – by using an online lawyer. You don’t have to miss time at work or sacrifice your weekend.

Of course, if you don’t need any advice or a review of your legal documents, you can simply get the desired legal forms to handle your estate planning on your own. Then, if you find yourself in a bind, you can always ask for assistance or a review of your document. The advice you need is only an email or phone call away.

The virtual law firm is an idea whose time has come. By working online, the attorney fees are lowered but the end-result remains the same – a legally sound document. Online attorneys are regulated by their State Bar. They’re required to follow the same rules as any other attorney in your state. Plus virtual law firms use SSL, the most robust, safest method of transmitting private information online. That guarantees a secure transmission of your personal data.

Unless you have a friendship with your local lawyer, the benefits of using a virtual law firm for your legal needs should be apparent. You can save time and money thanks to the convenience of their 24/7 service. An online attorney can help you make sure your will, power of attorney, deed or living trust is completed properly so it may be executed according to your wishes.

Estate planning is incredibly important. Why take a chance when you can have access to your own virtual law firm? If you’re already planning on buying legal documents online, step up and buy them from a virtual law firm. You’ll get value added to your purchase – the value of the expert advice of an online attorney.