Office Financial Policies: Do you have one?

Management Corner
By Kathleen Wrolbel-Erlich CMOM, CPC

Office Financial Policies:  Do you have one?  How about some pointers to get you started?

Create a financial policy.  Have the doctor agree that this is his/her expectation of the patient.  Then have all of your patients sign a copy as they come in for visits.  You can also post copies by the front desk to remind patients if they forget. It is extremely important that the doctor, staff, and patients all have an understanding of your office’s financial policy.  Adjusting off money, because of a misunderstanding with a patient, is frustrating for both you and the patient.



Keep in mind that the clearer you make your financial policies, the easier it will be to avoid disagreements with your patients and staff(1).   Also, please bear in mind that the following are suggestions only.  All of these items may not be suited for your office, specialty, or practice style.  It is also not an all inclusive list of all possibilities, but it is a start.  Taking active control of your office finances from the beginning and following through with uniform application will not only make your office life easier, it will give your patients a feeling of confidence and well-being, because they know what is expected of them and nothing is being “sneaked in” or “surprising” them out of left field.

For a successful financial policy, consider including items like the following:

• Payment Responsibility –That the patient or legal representative is ultimately responsible for all charges that are incurred.  (Especially those providers whose patients are not responsible for co- pays.)
• Non-Discrimination of Services – That necessary medical services will be provided regardless of a patient’s ability to pay.
• Assignment of Benefits – That your office will bill insurance as a courtesy IF the patient supplies the required information to do so.
•  Partial Insurance Coverage – Patients with insurances that cover only a portion of a service, must pay the difference for services that are not covered. Patients are responsible to pay for services at the time of service.  A pre-treatment deposit may be required.
• Uninsured Patient – Insurance is verified prior to services.  If the insurance is not active, the patient is responsible for all charges incurred on that day.  Payment is expected on the date of service.  A pre-treatment deposit may be required.
• Verification of Information – All information regarding the ability to pay, third-party insurance, employment, etc. will be subject to verification.
• Unpaid Insurance Balance – Patients may be requested to make full payment of unpaid balances when an insurance payment is not received after XX days of the billing date.
• Third-party Litigations- The physician will not become involved in disputes arising from third-party claims (auto accidents, liability claims, etc.) with the exception of verified workers’ compensation claims or claims involving Medicare and Medical Assistance.
• Prior Unpaid Balances – Prior to providing services, payment may be required or payment arrangement must be approved by :  office manager, billing department, or physician (you choose).
• Delinquent Accounts- Patients with unpaid delinquent accounts, accounts that have been written off, or have been sent to a collection agency, may be denied treatment if not medically required.
• Payment Agreements – If a patient is unable to make a full payment of the patient balance for a previous service or balance from today’s services, the patient should work with (office manager, billing department or physician) to create a payment agreement.  A patient financial evaluation may be required to approve a payment agreement.
• Payment Methods – The following payment methods will be accepted: cash, check, money order, VISA, MasterCard.
• Returned Check Fee – A fee of $ ____ will be added for each returned check.
• Interest/Statement Fees-(see the next 3 bullets)

•    ** If Interest**  _____% will be added monthly to all accounts after a patient balance is more than ____ days old.
•    ** If statement fee** A fee of $ ____ will be added monthly to all accounts after the patient balance is more than _____days old.
•    ** Both**Interest/Statement Fees will/will not apply to patients who have an approved payment plan.  This will/will not apply to patients who have made a partial payment during the previous month.

• Referral for Outside Collection – Accounts that cannot be collect after ____ days may be referred to an outside collection agency, magistrate, or attorney for further collection action.
• Discounts – Accounts will not be reduced or discounted unless approved by the physician or delegated representative.
• Charity Allowance – All charity allowance (for patients who are unable to pay) must be approved by the physician or delegated representative.
• Refunds – Overpayments will be refunded to the appropriate party.  Patient refunds will not be provided until all active and past due accounts are paid in full.  Patient refunds of less than $ ____ will not be processed unless specifically requested.
• HMO Patients – It is your responsibility to make sure that you have proper authorization to be seen by this physician.
• No Show Appointments – Our office will charge $ ____ for all no show appointment.  A no-show appointment is any appointment that is not cancelled ___hours prior to your appointment.  More than ___no show appointments may result in termination of care for non-compliance.
• Insurance Contract – Your insurance contract is between you, your employer, and the insurance company.  We cannot guarantee payment of all claims.  If your insurance company only pays a portion of the bill or rejects the claim, an explanation should be made available to the policyholder.  Reductions or rejections do not relieve your financial obligation.
• Signature & Date:   Have the patient/legal guarantor sign and date that the financial policy was received.  I accept and understand this financial policy.

(1) Source PMI – Practice Management Certified Medical Office Manager Program