How to get Medical Records Errors amended
By Martine G. Brousse (not AI!)
"The Medical Bill Whisperer"™
Patient Advocate, Certified Mediator
AdvimedPro
February 24, 2025
You have noticed some medical records are incorrect, causing you clinical or financial nuisance. Can they be amended? What should you do? Let’s investigate.
A. Rights and Consequences
1. Under HIPAA law, patients have a right to request corrections and amendments to their medical records. This is called the “Right to amend”.
2. How do incorrect demographic data, wrong insurance information or erroneous or missing medical data affect patients?
· Incorrect demographics or insurance information lead to payment delays or denials
· Charge coding can be affected, causing underpayments or incorrect claim processing
· Clinical outcomes can also become an issue due to duplicate services, tests or labs and medical errors (i.e interaction between prescription drugs)
· Incorrect or missing medical information could also negatively affect your ability to obtain or keep a job, apply somewhere for benefits or even affect legal action.
· Medical record errors or omissions cost you money.
B. Steps for corrections and amendments
1. Review your medical records for potential errors, especially after you receive a denial explanation of benefit.
· Provider or hospital portals should give you access to reports and medical info on file, as well as demographic and insurance information
· You can request, in writing, that medical records be sent to you.
· Contacting your insurance is helpful. Ask why was the claim denied or underpaid? How was it billed in the first place? Does it show this was an emergency? Is this the diagnosis code used? What level of care was billed?
2. Contact the provider through the portal’s message center, or through direct written communication with the office or hospital’s medical records. (Many hospitals have a special form)
· Indicate the specific information or doctor's note that needs amending.
· Why should it be corrected?
· Mention the legal 60-day deadline for a response has now started
· Date and sign your request
3. Don’t be surprised if that request is denied: (a) doctors don't like to admit wrongdoing or errors and (b) fear of malpractice rules their response.
· Filing a “statement of disagreement” is the next step
· that statement will eventually be added to your medical records, showing your side of the story, and available for review and consideration by this or other medical providers.
C. Other actions on your part can help
1. Correct demographics and update insurance info directly, through the portal or with a billing department or service. Do follow up with insurance to make sure an updated or corrected claim has been submitted.
2. Express your unhappiness:
· with the State's medical board or State's Department of Health, if this has caused evident damage
· However,I would suggest first contacting your insurance and filing a grievance if that provider is contracted and In Network. There are special forms (don't file an appeal but a “Grievance”, it’s not the same thing).
· If a provider works within a medical group or within a hospital, there should be a specific grievance or complaint form you can file the Patient Satisfaction Department, Patient Advocacy Department, or the Complaint Dept. Forms and contact info should be indicated on the website.
· Although the Complaint Department may not have much authority over the medical records department or provider’s action, you may get a reduced bill, a complete write off and certainly an apology in return.
· As for bad clinical outcomes, should that occur, all the steps you have undertaken will help you and your attorney build a strong and hopefully successful case against that provider.
As always, Trust but Verify!
Martine Brousse was a long-time Billing Manager for Physicians before switching to the side of patients in 2013. The move has allowed her to apply her deep expertise and vast experience of the intricacies of resolving all types of medical bill and claim payment issues in ways that directly and positively impact her clientsʻ finances.
(424) 999 4705 - F (424) 226 1330
@martine brousse 2025 @ the medical bill whisperer 2025™
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