Establish written policies on discounts, waivers, and other collection variables.

Medical practices need to review all collection, discount, and write-off policies to remain compliant with the law. Any practice that does not have any written policies should establish some and have them reviewed by a healthcare attorney.

If your practice's policy on billing financially needy patients is uniformly applied, consistent with federal poverty guidelines, and within state regulations, you may be legally permitted to offer cash discounts to uninsured patients. Such a policy should specify that discounts might be provided if there is proof of financial need. Policies on discounts for full cash payment at the time of service and policies for waivers of copays should be put in writing to avoid any suspicion of inducement. Keep in mind, however, that some managed care contracts do not permit waivers of copays or deductibles.

If you are considering providing a specific service to a Medicare patient (e.g., excision of a facial lesion) and you are not certain that Medicare will pay for the service (Medicare pays for the excision of only malignant skin lesions), you should have the patient sign an Advance Beneficiary Notice (figure) if you expect to collect some type of payment (this form can be downloaded in PDF format from www.cms.hhs.gov/home/medicare. asp). You will need to provide the patient with the estimated cost of the particular service. You are also responsible for explaining why Medicare might not cover the procedure.

[FIGURE OMITTED]

Steven F. Isenberg, MD

Dr. Isenberg is an otolaryngologist in private practice in Indianapolis; [e-mail]