Practice Management Alert

Question: Our practice has patients who have delinquent balances on their bills and keep calling for advice from our nurse. Can we decline to answer their questions until they pay the bill?

New York Subscriber

 
Answer: No, you cannot discharge patients by telling them on the phone that you're not going to treat them anymore because they haven't paid their bills. The patient who keeps calling for advice may have a problem that needs to be addressed by the physician. If the questions seem repetitive or unnecessary, the nurse says politely that most of the issues have been addressed, but if problems or questions remain, the patient should make an appointment to see the doctor.  
 
When the patient comes in for the visit, you will have an opportunity to collect the past-due balance. Assuming the nurse knows there is a delinquent account, another option is to answer the patient's questions and turn the call over to the billing department.
 
A patient can be discharged for nonpayment of bills, but the decision to do so must be made by the physician. Usually, such a drastic step involves a large debt. The physician would have to write a letter to the patient giving notice that care will be terminated in 30 days because the practice tried to work with the patient, but the bill remains unpaid.
 
The letter should state the specific date of termination of care. It should also state that the physician would be happy to forward medical records to the doctor of the patient's choice and that if the patient has no new doctor, the physician will recommend one. The letter has to give the patient enough notice to permit time to receive it and respond to it, find a new doctor and ask for forwarding of the records. It should be mailed certified with return receipt requested so you have a record that it was sent and delivered.
 
During the 30 days before the termination date, the discharging physician is still obligated to treat the patient. Failing to give notice of discharge and refusing to treat a patient can expose the physician to a malpractice lawsuit.