Medicare Compliance & Reimbursement

If you have a patient who continues to break the terms of your payment agreements, you need to know how you can dismiss that patient and keep your practice's legal bases covered.

While your practice can end the physician"patient relationship at any time, for a variety of reasons, nonpayment is a valid reason to do so. When you do arrive at the point of sending a letter, be sure to incorporate the following elements to dismiss a patient in a fair, straightforward manner.

When your practice decides to end the physician"patient relationship, you shouldn't put the patient in a situation that could compromise her health.

Key: Failure to offer care could give the patient the opportunity to accuse you of abandonment. If the patient is discharged, then it is his responsibility to find another physician, but it may take time to find another provider, says Linda Huckaby, CMA (AAMA) with Carolina Medical Rehabilitation in Greenville, S.C. Standard practice is to give the patient a 30-day time window in which to find a new provider.

The 30-day window doesn't mean you should continue to give your services for free, however. "If the patient doesn't have the co-pay or means to pay that day, you don't have to see that patient in the 30 days," says Jetton Torix, CCS-P, CPC-H, course director of Knowledge Source Seminars in Star, Idaho.

Note: If the patient does not have any immediate health risks and you're still operating within the 30-day window, you might provide a referral to another provider, Torix says.

Keep in mind that any written correspondence the patient receives from your office could potentially be used against you down the road. So above all, do not include any reasons for why you're dismissing the patient. "I would not give them a reason to call," says Torix.

For an important document like a dismissal letter, many experts suggest sending it via certified mail with a return receipt. You will then have a record of who signed for the letter. Torix suggests keeping the receipt with the patient's chart. If the patient does call the office to question the dismissal letter, then whoever takes the call will be able to explain to the patient the reason for dismissal.

Warning: If you do receive a phone call, verify that you are speaking directly to the patient by confirming their birthday, address, and last four digits of their social security number before disclosing any dismissal information, says Bill Mittrick, CMA (AAMA), CMOM, with Carolina Medical Rehabilitation in Greenville, S.C.

5. Make Your Statement Upfront

In sports, they say the best defense is a good offence. You can put this motto to use by having your financial policy well documented and easily visible. "You can avoid sending letters of termination if you have a good written financial policy upfront," advises Torix. The purpose of a good financial policy "is to communicate to the patient 'this is what we expect of you in this office,'" Torix says.