Many offices lose money by not collecting all of the money that is due to them from patient responsibilities. Some do it by choice, and others because they don’t have a system for their patient billing. They don’t even realize that the patient’s aren’t paying the portion they owe.
In any case, it is important to know that you could get into trouble. With Medicare, it is illegal to not bill the patient for their portion, whether it is the deductible or the coinsurance. It is also illegal to bill for more than Medicare allows you to, so you must make sure you understand what the patient’s portion is. If Medicare finds out that you are billing Medicare for services, but not billing the patient’s for the patient responsibility, you can be investigated for Medicare fraud.
Of course there are exceptions. If a patient has a financial hardship you can waive the patient responsibility, but you must document this in the patient’s chart. And you can’t claim that every Medicare patient that you treat has a financial hardship. There are also other ways around this. You must bill the patient for their responsibility, but there is no law on how far you have to go to collect it. So if you send them a patient statement and they do not pay the bill, there is nothing that says you have to send a second one. As long as you can show that you billed them.
With commercial insurances, there is usually a clause in the contract that you sign that states you will bill patient’s for all copays and/or any other patient responsibility. If the insurance carrier finds that you are not charging the patients, they can consider it a violation of your contract with them and terminate your participation. They do not usually go any further than that, such as investigate for fraud, unless there are other violations going on as well.
If you have a couple of patients, friends, relatives or people with true financial difficulties that you are not charging that will probably not hurt you. But if you pretty much across the board don’t charge your patients, you could get into some trouble. Some people have a difficult time charging their patients. These laws are a good excuse for them. “I don’t want to have to charge you, but if I get caught I could be removed from the insurance carrier’s panel or investigated.”
If you have not been charging your patients, you will be surprised how much your receivables can go up when you do. It doesn’t seem like much, but it really adds up.