# Promissory note



## codedog (May 5, 2011)

How many of ASC 'S  have a patient sign a  promissory note before patient has surgery. How do you know what to charge? say example  insurance will cover 90 % so patient  owes10 % .Are you doing the promissory based on cpt booking , if so it seems like this could be wrong. How many times do we see that operative report differ from the booking, quite a few times  if I say.? Am I over looking something ?please comment-thanks


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## mattamyc (May 5, 2011)

We have them sign a promissory note based on what is scheduled.  In the note it states these charges are ESTIMATED based upon what the physician has scheduled and actual charges could increase/decreased depending on what is actually performed.


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## codedog (May 6, 2011)

That is perfect Amy, but what if it does not say that  ?


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## anwalden (Jun 13, 2011)

I would highly recommend having the language in the note about the cost being an estimation. If you can't do that, I would document in detail the conversation your staff has with the patients regarding the price and the fact that they were informed that it was an estimate only and subject to change based on procedures actually performed.

What we've done in our office, is encourage the use of our credit card authorization form. It's a form that we fill out with the patient's card information, amount the authorization is not to exceed, and the amount they authorize to be charged per month. This not only helps with the chance that the cost will end up either higher or lower based on performed procedures, but we have the authority to charge their card as soon as we know the exact amount. Assuming of course, it's not greater than the total amount authorized.

We also offer the courtesy of sending them a statement first, allowing them to pay by check (that saves us the charge to run the card). If they don't pay before the due date on the statement we run the card.

Payment agreements are a sticky situation...good luck!


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