Medicare_Carriers_Manual / 3307 / 3307

Why This Topic Matters

Medical record requests are a routine part of claims review, payment determination, and postpayment oversight. Understanding the carrier’s administrative approach helps staff manage record retrieval, respond to provider charges, and follow the proper escalation process when information is not voluntarily provided.

Article Sections

1. Ed. Note: For further information see

   A brief editorial reference points readers to related material on claims filing and information requests. It serves as a cross-reference rather than substantive policy guidance.

2. 3307. Obtaining Copies of Medical Records from Providers

   The main section discusses Medicare carrier policy for obtaining provider medical records, including payment considerations tied to the purpose of the request and handling situations where records are difficult to obtain.

3. A. Amount of Payment Is Directly Affected

   This subsection addresses situations in which the requested records are needed to determine payment amounts. It frames the provider’s obligation to furnish information and the administrative treatment of related costs.

4. B. Amount of Payment Is Not Affected

   This subsection covers situations where the records are requested for purposes that do not affect the payment amount. It describes the general approach to provider charges and onsite record review.

5. C. Subpoena of Medical Records

   This subsection addresses refusal situations and the escalation of record requests when other avenues have been exhausted. It mentions referral of cases for further action through the appropriate Medicare channels.

6. D. Nonparticipating Provider Refuses to Furnish Information

   This subsection discusses refusals by providers not participating in Medicare and emphasizes case-by-case handling. It notes that information may sometimes be obtained through other treating professionals.