Wiki Advise on Billing patient for additional fee Leaving against medical advise

[tshannon]

Hello All,
I have a provider that would like to implement a new policy. The physician admitted a patient for Observation 48 hours , patient was started on 1st dose of Cardizem. The patient was not allowed to leave the floor to smoke and left the hospital against medical advise without prescriptions or follow-up appointment. The provider turned in charge for Admit Level 3. The providers question to me is can I bill an extra fee of $1000.00 ? Please provide me with your experience regarding LAMA Policies.

Thank you all,

Tshannon

 

[thomas7331]

In theory the provider can bill whatever they want, but in practice, it would be pointless because this won't ever be paid. For starters, there is no code for this - what would the provider be billing for? The provider can only bill for the professional work that they have documenting actually doing. If the patient's leaves the facility, that is not going to change the documentation - leaving AMA is no different from any other type of discharge (in fact it is probably less costly than an actual discharge because in this case the patient is gone and the hospital staff are relieved of the responsibilities of doing a lot of the discharge planning). In addition, no payer is going to reimburse this because there is no medically necessary service attached to this fee.

It sounds like the provider is perhaps upset with patients who irresponsibly leave AMA, which is understandable. But a patient is completely within their rights to choose to refuse treatment and leave a facility. There is no legitimate reason to try to impose a penalty on them for doing this.

 

[tshannon]

Thank you very much for the advise Thomas.

 

[mmiscoe]

I would advise against such a fee as it creates a financial impediment to the patient being able to freely choose to determine whether they will accept the recommended care or not. This is a primary right of any patient to reject care. Charging them for exercising this choice, especially an arbitrary fee that is quite substantial, would likely create a cause of action by the patient with the physician's licensure board.