Practice Management Q&As

August 3, 2007

Refunding a reimbursement; dead beat patients

Refunding a reimbursement

Your experts said that when an insurance carrier asks you to refund reimbursement sent in error, you should do so and then bill the patient. But what if the patient came to you out-of-network and assigned his benefits to you? Shouldn't returning the payment be his responsibility?

That's correct. In that case, it's the patient who has the agreement with the carrier, not you. Send the plan a letter directing them to seek the refund from their insured. Send copies of your letter and the carrier's refund request to the patient.

Recently a patient with a large overdue balance called to schedule an appointment. He's been ignoring the collection agency for a year, and it's hard to believe he has any intention of ever paying me. How do I handle him?

You probably have to see him. If you haven't formally dismissed him from your practice, he's still your patient. Withholding treatment may constitute abandonment.

So first find out why he wants an appointment. Of course, if it's an emergency, tell him to come in at once-or go to the ER if you can't manage his problem in your office.

If it's a nonemergency condition you've treated him for previously, tell him you'll work him in. But say that he'll have to pay for the service up front. If he demurs, bite the bullet, and see him anyway. It's not worth an abandonment charge. (Also, never turn away a sick child-it's too dangerous, medically and legally.)

If it's a new problem you've never treated him for, you have no obligation to see him.

But whether or not you see him this time, you should officially dismiss him from your practice as soon as possible. Send him a letter by certified mail, return receipt requested, explaining that you're discharging him and will provide emergency care only for the next 30 days while he finds a new physician.

To avoid such problems in the future, make it your policy to dismiss the patient at the same time you send his account to the collection agency. Do this by sending a final request for payment in which you notify the patient that if he doesn't send full payment in 30 days, the account will be sent to a collection agency, and on that same date, he is no longer a patient of the practice.

In this issue, the answers to our readers' questions were provided by: Michael Brown, CHBC, Health Care Economics, Indianapolis, IN; Charles Davant III, MD, Blowing Rock, NC; Barry S. Pillow, CHBC, Healthcare Consulting, Greensboro, NC; Patricia J. Roy, DO, Muskegon, MI.

Do you have a practice management question that may be stumping other doctors, too? Write:PMQAEditor, Medical Economics, 123 Tice Blvd., Suite 300, Woodcliff Lake, NJ 07677-7664, or send an e-mail to mepractice@advanstar.com (please include your regular postal address). Sorry, but we're not able to answer readers individually.