Medical Practice Management
Jun 04

Professional courtesy: Collect from patient and insurance company, or no one

There was a time when pediatricians saw the children of other physicians for free. The ob-gyn across the street sent his children to you, and you went there for maternity care.

That quid pro quo evolved to waiving co-payments or deductibles. But now managed care has taken the evolution right into a brick wall: no more courtesy discounts. You must charge other physicians for care provided to their children, including collecting co-payments—and you should expect to pay for yourself when you see other physicians.

Among the legal problems with waiving co-payments as a courtesy: false claims, violations of anti-kickback, and, perhaps most significantly, violation of your managed care contract. Referral relationships are fine, but giving a patient a financial benefit to come to you is not.

The main problem occurs when physicians bill the insurance company for a service, but don’t collect the co-pay or deductible. So when it comes to professional courtesy, you have to choose: Collect from the patient and the insurance company, or don’t collect from either.

About Reed Tinsley, CPA

As a top advisor to physicians, I help increase practice profits by delivering hands-on, expert medical accounting/tax support, practice counsel, and revenue-building strategies. Read more →