Home Forums Discussions General Discussion Professional Courtesy

Is there a method to have a no charge encounter with a patient?

I have always been told that it is OK to no charge anyone you desire, but that it will get you in trouble if you take only what an insurance company pays and you waive a copay...When I see local physicians as patients I write PC on the superbill. A zero is entered in the computer ledger and we move on. If there is a better way I would like to learn it.

I enter the copay as paid and post it to the account for PC visits. It looks paid to the back office and the insurance company is none the wiser. The only person who takes a hit for not collecting the copay is the doctor.

I have been told that if I was to do that...then I was being fraudulent...I suppose by charging his insurance company you are adding to his deductible. What if he has a 5k deductible, do you bill the PC patient for it when the insurance company doesn't pay?

If they have a deductible plan and they haven't met it yet, then yes, I will send them a statement. Usually they're in the same boat we are and they pay their bill without a fuss. I've never had a physician expect to not have to pay their bill if they haven't met their deductible. Some physician's will send me the copay after the fact anyways since they know the deal with insurance.
Or we may send them a statement and adjust off everything BUT the copay. We try to be as accomodating and professional as possible to other providers.

Waiving a co-pay or deductible is clearly fraudulent, and a violation of PPO agreements. It is a common practice, but you will be in trouble with an audit.

My understanding is that you can give any discount you want to cash paying patients, as we are not yet under a level of tyranny that would prevent free trade in that situation. However, we are close. You cannot routinely provide free care as Medicare considers this fraudulent. They see you are giving free care to one person, but not to their seniors, and thus you "are defrauding the government." If you quit Medicare all together, I imagine you could. I know of one Med School Prof who quit Medicare for the sake of continuing an indigent free clinic, which Medicare was trying to shut down on these grounds. I never waive deductible, co-pays, or Medicare charges. That being said, no one can force you to go after a patient for an unpaid balance, so there are times when I've told patients I will never send them to collections.

Disclaimer: I'm not a lawyer. You should consult your own lawyer for advice. The above does not constitute medical advice, and is posted for entertainment purposes only. The lawyers made me say this.

I created a few "Dummy" CPTs, one of which is No Charge CPT 9000 with a fee of 0.00, I also have a Quick Check 90001 for $20 for use with uninsured that just needed something simple. The Dummy CPT placeholdsers would be rejected as an uncovered service if a claim were inadvertently submitted.

"Professional courtesy" is a curious phenomenon.

Early in my career, it was held up as a standard, and even the clergy came to expect no-charge visits or at least discounts. When it was occasional and voluntary it was fine.

As time went on, it became more of a burden, and sometimes it was a problem do determine who was doctor (dentist? chiropractor? podiatrist? naturopath?) or clergyman (I had a few pull out their Doctor of Divinity by mail cards), and whether his/her entire extended family was also entitled to discounts. When it reached the stage of "entitlement" I became resentful.

Medicare to the rescue! -- Medicare decided that the practice was fraudulent. That was good enough for me. After all, physicians can for the most part pay their bills. When my dentist kept offering "professional courtesy", I would say -- "thank you very much, but I can afford my bill, and I prefer to pay it. It might be better if you put the fee in a separate account to help someone who is indigent."

If you look at the "Hippocratic Oath" -- where I believe this whole thing started -- it isn't about giving away professional services, but about controlling professional information and training. It also binds the student to care for his teacher should he fall on hard times -- not just for professional services, but for all needs.