Practice Management Alert

Question: When we don't receive timely payment from patients, we send them two letters informing them their account will be sent to a collection agency. When we do send patients to collections, we would like to stop offering medical services to patients who don't pay the money they owe us. Is that ethical?

Indiana Subscriber

Answer: Many practices do inform patients that if their accounts are sent to collections the practice will not offer health services except in an emergency. That either elicits quick payment from the patient or ends your relationship with him or her.

If you feel that stance doesn't fit your practice's mission, you can require cash payment in full before services are rendered. This in-between policy protects your financial interest but prevents you from turning away patients. However, don't forget that such a requirement may be prohibitive for indigent patients.

Talk with your practice administrator, though, before instituting either policy. Professional medical associations assert that physicians are obliged to provide care to their patients.

The American College of Physicians instructs physicians to terminate a professional relationship with a patient only after "genuine attempts" are made to resolve differences. If the physician wishes to terminate services, he or she must notify the patient in writing, and you must make sure the patient receives the letter. Send the letter with a return receipt so you get proof the patient received the letter. With the patient's approval, transfer the medical record to another physician.

The American Medical Association says that some states have laws governing whether and how physicians may terminate a relationship because of an unpaid bill.