Patient Billing Challenges: Frequently Asked Questions

Richard Cahill, JD, Vice President and Associate General Counsel, The Doctors Company

This article answers common questions about billing concerns and addresses problems that can occur when a patient is unable to (or doesn’t) pay a copay or refuses to pay a bill for services provided.

Patient Safety Strategies

  • Ensure your office staff recognizes correspondence regarding disputed credit card charges and brings all notices to your attention promptly. The inquiries often have a specific deadline for responding, and failure to comply with the deadline may impair your ability to collect the outstanding balance. It is necessary to make a response that is in accordance with federal and state privacy laws.
  • Set a limit on allowable credit card charges (if your practice accepts credit cards). The limit can be a dollar amount or a percentage of the total treatment charge; for example, $3,500, $5,000, or not more than 50 percent of the procedure cost.
  • Obtain the patient’s signature on an appropriate HIPAA-compliant authorization prior to any procedure or treatment charged on a credit card to ensure that you can provide the credit card company with any information requested regarding the nature and scope of the service in the event of a subsequent dispute.
  • Secure written payment plans, signed by the patient, and witnessed by an employee of the practice.
  • Obtain a reference for patient credit applications. This will ultimately assist you in locating the patient if the account needs to be sent to a collection agency.
  • Set a specific time limit on any adjustments or revisions to the original procedure (such as 60 or 90 days from the original procedure date). Otherwise, a patient could return years later and request a revision that was discussed when the procedure was first done.
  • Select a reputable collection agency. HIPAA privacy rules permit the use of collection agencies to recover payments for healthcare services. The privacy rules require that healthcare providers disclose only the minimum information necessary for such purposes. States also have very specific laws about dealing with fair debt collection. A provider who selects an agency that violates state or federal laws could face liability for negligent selection and risk any chance of recovering some or all of an outstanding bill.
  • Follow the good practice of resolving financial disputes in an amicable and professional manner when possible. Clear communication of financial responsibility is critical.
  • Identify poor payers early and deal with the problem proactively. Do not wait until the situation reaches a crisis point that jeopardizes your provider-patient relationship and creates a risk of adverse comments on social media. Maintaining a good provider-patient relationship may help you avoid negative comments posted online or retaliatory lawsuits for professional

If you have additional questions, contact the Department of Patient Safety and Risk Management at (800) 421-2368 or by email.

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

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