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LouiseR1

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I read an article that stated many physician practices are charging "surcharges" of $5-$10 when the patient cannot pay copay "forgot wallet, etc". The surcharge is to cover admin costs for statements, employee time, etc. So if copay is $40, they tack on an additional amount ($5-$10) this makes sense and sounds good, but makes me wonder -- Is anyone doing this? and more importantly is it legal?
any input is appreciated :)

thanks,
Louise CPC
 
Legal?

I'd have more concerns about the appropriatness of surcharging the co-pay if not the legality. Co-Pays are established by the payor not the physician practice. They are also regulated. A major compliance/OIG issue of the last decade was forgiveness of co-pays. So the opposite, adding a surcharge to a regulated co-pay dollar amount is questionable. Better if the practice makes it clear co-pays are due at time of service.

Jim
 
Better if the practice makes it clear co-pays are due at time of service.


I have been to many practices where there are signs posted all over the office about the copay due at time of service policy. The schedulers will even remind you several times during the call to schedule. As well as in the reminder call. You'd be amazed that after all the "reminding", patients still show up without the copay.
 
Can you post the link to that article, Louise?

I've always thought a small past-due fee was a good idea for patients who were made aware of their copay responsibilities but still "couldn't" pay. Many of my past employers would use the billing fee and it was amazing how often people "remembered" that they had a credit card with them.

On the other hand, there's a grey area when it comes to Medicare. They say you can't bill the patient for something you've already billed for. The jury seems to be out on whether a late payment fee or billing fee falls under that category. They do now allow the provider to charge the patient a no-show fee, but I'm not sure how the law is interpreted when money is being collected for other services while at the same time trying to collect an administrative fee.

The best way around this might be to collect copays from all patients before they are seen.
 
Are you saying Medicare does not allow you to charge a no show fee?

If the patient shows up without their copay, are you making the patient reschedule? We are having a hard time with this issue at our practice and the doctors are considering doing a trial to see how much potential business we would lose by forcing patients to R/S until they can pay their copay.
 
yes you can charge a no show to Medicare patient as long as you are charge a no show fee across the board. You are also allowed to charge interest on the unpaid amounts, I am not sure nor have I read that it is allowable to charge a flat fee for late payment. I feel it is acceptable to have patients reschedule the visit if they do not have they copay for non emergent issues. However be certain of the insurance requirements, for instance the particular insurance I have does not allow the practice to collect the copay at the time of the encounter it must be billed. It says it right on the card and in the payer agreement.
 
ok this is probably going to sound bad, but what if you really just arent sure what your contracts say? We are a small practice and have been through 4 office managers in the almost 5 years that I have been here. I have tried to help the current administrator go through contracts because apparently several of them were lost somehow or thrown away?? I really dont think, actually I'm probably 99.9% certain that the contracts have not been checked to see what we can/cannot do in these circumstances. Any suggestions on how this should be handled?
 
I hear this all the time, you need to call all of the payers you deal with and request from the rep a copy of the most recent contract. This is important on many levels, many contracts have an automatic roll over clause, that if you do not make any adjustments by a certain time the contract will auto roll for another so many years and you miss the opportunity to negotiate better rates or terms. Plus if you do not know what the contracted rates are then how do you know if you are being paid properly. Payers do downcode line items and if you do not catch it then they assume that was OK with you.
 
MaryBeth,

While you are obtaining all of those old contracts, don't forget to research the RVU's that may have been increased. As a former provider vendor for BCBS, practices can renegotiate their contracted fee's for procedures and visits if they have not increase in the past five years. The physicians will be impressed with you. Good Luck!
 
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