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Charging patients for admin time, i.e., filing out disability paperwork

October 31, 2013

Question:

Jennifer,

As we move towards an electronic health record, I still find that I am getting more and more disability paperwork, often not accepting our records as adequate for their request. The most egregious form was 10 pages with detailed answers expected.

Clearly we providers want to provide for our patients, but filling out forms like this for 2-3 patients per day can add an hour to our day. Is it fair, and legal, to charge a fee for the service provided? And if so, do you recommend this to be part of the practice guidelines signed by patients ahead of time?

Thanks,
Dr. M

Answer:

Certain states regulate charges from providers for patient paperwork, NYS does not.  See  the NYS DOH frequently asked questions page on the website.  Which means, you may charge for administrative time so long as you are not subject to a contractual or other limitation prohibiting from you from charging.  For instance, if you are a participating provider you are contractually agreeing to accept a set, designated reimbursement (hopefully negotiated) for certain services to patients, for which such negotiated fee is contractually required to represent certain administrative work associated with such are - i.e., prescriptions.  Where a patient has paid a visit to your practice and you have been reimbursed for their visit your in-network rate, and you have prescribed related to that visit, the prescription may be deemed a part of the service you have been reimbursed for and any additional charge may be seen as a contractual violation.

Here, the paperwork specified is a disability form which in most instances calls for the patients treating provider to complete information related to the disability, which may be unrelated to insurance reimbursement or provider payment.  I am unaware of a specific prohibition against charging for filing out disability forms, however, I am reluctant to opine charging for same will not result in potential liability, inclusive of potential claim of discrimination if you regularly perform certain administrative duties for other patients who are not claiming disability - which is a protected class under federal and state statutes.  Of course there is a difference between complying with administrative duties for patients versus devoting hours of your time towards completing absurd forms.  While you may not wish to adopt a strict charging policy, you may also settle on defining a fine line of efforts expended complying with burdensome administrative requests.

Admin you absolutely can charge for - services not covered by any insurance - which is why colleagues of yours may successfully be charging for certain "concierge" services, including "exclusive" access, after hours care, email capability, etc.

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