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Balance Billing: Investigations are up, Do you have a policy in place?

Talk around the water cooler recently indicates that there is a significant   increase in investigations by both the State and private third party payors  into the payment of co-pays and deductibles.  As such, I'm writing, again,   to stress the need for your practice to develop and implement a standardized system of collecting co-pays.  I know that many physicians claim that their patient population cant afford co-pays or will not tolerate being charged co-pays and I understand that.  I hesitate when I reach my own hand into my wallet at the doctors office, wondering why my insurance doesn't cover my entire visit.  But, at the end of the day, failing to collect co-pays, whether you are a participating provider or a non-participating provider is insurance fraud, and the investigations are increasing in frequency.

So, again, I strongly recommend that you look into implementing a policy whereby you attempt to collect co-pays at the time of any visit and that you have a procedure for making a "good faith" effort to bill patients who do not pay thereafter.  Two exceptions to the rule that you have to collect a co-pay are: (1) treating an indigent patient who legitimately cant afford the co-pay (you're entire patient population is not allowed to fit into this category, it is the exception, not the rule); (2) professional courtesy (if you're partners wife comes in for a check-up, you do not need to charge her the co-pay).

For additional information on this topic, contact Jennifer Kirschenbaum at (516)-747-6700 ext. 302 or at


Copyright © 2011 by Kirschenbaum & Kirschenbaum, P.C.
All Rights Reserved. This email is provided for news and information purposes only and does not constitute legal advice or an invitation to an attorney-client relationship. While every effort has been made to ensure the accuracy of the information contained herein, Kirschenbaum & Kirschenbaum PC does not guarantee such accuracy and cannot be held liable for any errors in, any reliance upon this, or losses caused by the information. Under New York’s Code of Professional Responsibility, this material may constitute attorney advertising. Prior results do not guarantee a similar outcome.

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