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Florida Medicaid Records Requirements
Records must be retained for a period of at least five (5) years from the date of service.
Types of Records That Must be Retained
Medicaid requires that the following types of records, as appropriate for the type of service provided, must be retained (the list is not all inclusive):
Requirements for Medical Records Medical records must state the necessity for and the extent of services provided. The following requirements may vary according to the service rendered:
Right to Review Records
Authorized state and federal agencies and their authorized representatives may audit or examine a provider’s or facility’s records. This examination includes all records that the agency finds necessary to determine whether Medicaid payment amounts were or are due. This requirement applies to the provider’s records and records for which the provider is the custodian. The provider must give authorized state and federal agencies, and their authorized representatives, access to all Medicaid patient records and to other information that cannot be separated from Medicaid-related records.
The provider must send, at his expense, legible copies of all Medicaid-related information to the authorized state and federal agencies and their authorized representatives upon request of AHCA. At the time of the request, all records must be provided regardless of the media format on which the original records are retained by the provider. All medical records must be reproduced onto paper copies unless otherwise authorized by the requestor.
Copying or Transferring Records
The provider may bill the recipient for copying medical records at the recipient’s request if it is the provider’s standard policy to bill all patients for copying medical records, and the recipient was notified of the copying charge before the records were copied.
The provider may not bill the recipient or AHCA for copying records requested by AHCA or any other state or federal agency.
The provider may not bill a MediPass recipient, AHCA, or the new primary care provider for the transfer of the recipient’s medical records to a new primary care provider, if the recipient requested and authorized the transfer in writing.
Providers who are not in compliance with the Medicaid documentation and record retention policies described in this chapter may be subject to administrative sanctions and recoupment of Medicaid payments.
Medicaid payments for services that lack required documentation or appropriate signatures will be recouped.
Florida Medicaid Provider General Handbook