Medical Billing & Coding: Don't Let Your Compassion Wreck Havoc on Your Payments

If your compassion's letting patients off the payment hook, it's time you took some action. Here's a medical billing and coding case study to help your understanding.

In a particular scenario, a physician tends to quite a few patients who were released because a local company shut shop. However, the physician wants to see those patients and also wants to ignore their copayments and deductibles.

Healthcare billing predicament: The physician wants to send the patient two bills, however he also wants them to ignore them. He wants the biller to write off the 'bad debt' after the second bill's sent out.

Here are three tips to ensure you are not setting yourself up for major troubles:

Stay away from potentially fraudulent exceptions

You should never tell patients to ignore the bills you send because you will write off the charges sooner or later. Although waiving of a fee for a professional courtesy or financial hardship may be nice, you may land yourself in a soup.

Reason: You must make a good faith effort in order to collect from your patients. Most practices send at least three statements to a patient to try to collect on an outstanding bill. It depends on your practice of how you make the good faith attempt.


What you need to do: Document your efforts – that's what you need to do.

Not only do you run the risk of hurting other patients who could not find out about the unfair policy, you could also be violating your payer contracts or even anti-kickback laws. You need to check your contracts with the insurers. Find out whether it's a violation to let go of these fees. You should not try this with federal programs. You may end up paying a heavy amount as the anti-kickback statute carries stiff fines.

In case you do waive payments, keep proof of financial hardship

You shouldn't think that you can write off a patient balance. If you have patients who cannot pay their balances owing to financial hardship, then you might want to consider writing off the balance after you've made an attempt to try to collect and you have got proof of financial hardship.

If your practice wants to write off a patient's bill owing to financial hardship, the patient needs to be able to prove he's unable to pay. For this, you should ask the patient to provide you with information like gross monthly income, assets, monthly household expenditures and number of dependants.

Your collection processes should be consistent

You also need to apply a consistent collections policy to all of your patients. If your normal process is to send a patient to collections if they do not shell out money, you have to follow the same medical coding guidelines( source "http://www.supercoder.com") with this patient.