We’ve received questions about the length of time a provider has to keep medical records. Usually the question includes a statement of how long the person asking believes they have to keep them. Most often, we hear 7 years—although 5 years and 3 years come up. It’s no wonder there’s confusion.
There are likely multiple record-keeping requirements that apply to your organization, each of which your organization must comply.
For example, if your organization is a downstream contractor of a Medicare Advantage Plan, Centers for Medicare & Medicaid Services (CMS) specifically requires that your organization agree that:
· Department of Health and Human Services, the Comptroller General, or their designees have the right to inspect, evaluate, and audit any pertinent contracts, books, documents, papers, and records involving transactions related to the Medicare Advantage contract; and
· Department of Health and Human Services', the Comptroller General's, or their designee's right to inspect, evaluate, and audit any pertinent information for any particular contract period will exist through 10 years from the final date of the contract period [meaning the contract between CMS and the Medicare Advantage plan] or from the date of completion of any audit, whichever is later.
Source: 42 CFR 422.504 (e) (4) and Medicare Managed Care Manual, Chapter 11 - Medicare Advantage Application Procedures and Contract Requirements, section 110.1.
Ultimately, the determination of which legal requirements apply to your organization is a complicated issue that depends on a variety of factors. As always, readers should consult qualified counsel for assistance. This article does not constitute legal advice.
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