Practice Management Q&As

A service fee for copay deadbeats

Q. When patients don't have their copay at the time of their visit, we'd like to charge them a $5 service fee when we send the bill. Is this a good idea?

A. No. They'll probably just ignore the service fee. Instead, give them a statement at checkout along with a pre-addressed envelope, and ask them to mail the payment when they get home. Remind them that copays are due at the time of service-in the form of cash, check, or credit card. Be sure that you have a policy for repeat offenders-possibly including termination for hard-core cases-and that your staff applies it consistently. Copays make up about 20 percent of a practice's income, so lost copays can cost your practice several thousand dollars per month.

Q. When I open my new practice, I plan to see Medicare patients as a nonparticipating provider who doesn't accept assignment. Will this affect my ability to attract patients?

A. Possibly. Medicare patients won't be too happy to learn that a basic office visit could cost them about 65 percent more if they see you instead of a participating provider. However, because a nonparticipating provider can accept assignment on a case-by-case basis, you can accommodate patients who otherwise can't afford your higher fee. By accepting assignment, you agree to accept the Medicare Physician Fee Schedule amount (less 5 percent) for your services, so the visit will cost the patient a little less than if he saw a participating provider.

Tossing copies of test results?

Q. Do we have to keep copies of physician-ordered studies, like pathology and X-ray reports, in patient charts? Can't we just note the results in the chart, discard the paperwork, and then, if we need the copies later, just request them from the office that performed the test?

A. No. The patient and her insurer have a right to the complete chart containing all the original entries and lab results, and you should be able to provide it promptly.

Moreover, it's always a bad idea to destroy test results-even with a backup plan to obtain copies from the original provider, if necessary. In case of a lawsuit, it could look as if you had tried to destroy evidence, in which case the judge could instruct the jury to assume that you were trying to hide something.

When you leave hospital employment

Q. I'm employed by a hospital, but I'll soon be leaving to practice in another state. Who's responsible for the care of my patients after I go? How should I let patients know that I'm leaving, and what should I instruct them to do so their care won't be interrupted?

A. It's the hospital's responsibility to assure that patients will receive continuing care when a doctor leaves. Your employer should inform your patients of your departure, let them know who is replacing you, or else who will provide their care until the hospital finds another doctor. The hospital should also tell patients how to find their own physician, if they want. Check with the hospital to make sure it's taking care of these matters.

An ad hoc "affirmative action" plan?

Q. My office manager would like to start an informal "affirmative action" program to try to hire more minority employees. I agree with her intentions, but is this a good idea?