Medicare Advantage Requires Patient Records To Be Kept for 10 Years?

Experts Recommend a Longer Retention Period for Medicare Fee-for-Service and Medicaid Claims

As you are aware, Massachusetts law requires healthcare providers, including chiropractors, to maintain a record for each patient they have provided services for. This includes a comprehensive record of tests, examinations, observations, and treatments, which must be kept for at least seven (7) years from the date of the service, unless a longer retention period is mandated by federal or state laws, regulations, or generally accepted standards of medical practice. But under what circumstances would a longer retention period be necessary?

Medicare Advantage – 10-Year Requirement

One clear example is Medicare Advantage.

While individual state laws typically govern how long medical records must be retained, the Health Insurance Portability and Accountability Act (HIPAA) requires that a covered entity, such as a physician billing Medicare, retain documentation for six (6) years from the date of creation or the last effective date, whichever is later.

However, Medicare Advantage program providers must retain medical records for 10 years. Providers and suppliers should maintain accurate, complete, accessible, and properly filed medical records for each Medicare beneficiary they treat. The Centers for Medicare & Medicaid Services (CMS) outlines this requirement in rule 42 CFR 422.504 [d][2][iii], which mandates a 10-year retention period for Medicare Advantage plans.

Medicare Fee-for-Service and Medicaid Claims

A 2019 Supreme Court ruling has led many experts in medical record retention to recommend extending retention periods beyond the minimum requirements.

Previously, the statute of limitations for actions under the False Claims Act was six (6) years. However, in Cochise Consultancy, Inc. v. United States ex rel. Hunt, the Supreme Court clarified that the statute of limitations could extend up to 10 years.

As a result, many experts now advise retaining Medicare and Medicaid patient records for at least 10 years to avoid potential liability and protect against claims brought under the federal False Claims Act. Well-maintained and documented records can provide crucial evidence in a provider’s defense should such a case arise.