Otolaryngology Coding Alert

Question: A patient presented for his appointment and got belligerent when we showed him a past due bill that he needed to pay. He started to get aggressive with our check-in team so we weren’t sure what to do and let him see the ENT physician as planned and then leave without paying. What should we have done?

Oregon Subscriber

Answer: You most likely did the right thing. When a patient makes it clear that they have no intention of paying their bill, you should not refuse service at that time. Let the patient see the physician for their scheduled appointment, and make sure you don’t antagonize the patient or get argumentative.

Do this: Remind the patient of the financial responsibility agreement they signed (if the practice has one). Then, calmly advise the patient “If you are not prepared to pay today, it’s understandable. In the future, we’re not going to book you an appointment unless the balance is taken care of.” Keep in mind, however, that you should check with your legal counsel before discontinuing care if it puts the patient at risk. You may also want to check state regulations regarding “abandonment” of the patient.

After the noncompliant patient leaves the office, you should note in their file that they haven’t paid. Then, continue your collection efforts for a couple months. The individual practice must decide how long it wants to try to collect from the patient, but most experts recommend a combination of phone calls and letters for a maximum of three months.

It can be too costly for a practice to continue collection efforts after three months, so once you pass the three-month point, it’s typically too labor-intensive to chase money.

Exception: If your practice uses a billing company, then it will make the decision as to how to collect the outstanding copay.

The absolute last option is handing the matter over to a collection agency. The agencies are a last resort because you’ll have to pay the collection firm for their efforts. If you decide to terminate your relationship with the patient, cover your bases by getting it in writing. Send the patient a certified letter with signature confirmation that informs the patient that you are terminating future care of the patient with your practice for failure to pay financial obligations. Again, verify this with your legal counsel so you’re sure you aren’t abandoning a patient with a chronic condition.

You should also include a “one last visit” clause in the certified letter. This clause should clearly state that if the patient is in need medical care and doesn’t have a new physician to continue their care, then the practice will see them one last time before severing patient care.