Physician's Guide to Medicine - Billing

Is a physician required to provide a patient an itemized bill?
May a physician charge a late fee or interest on an unpaid balance?
May a physician charge for missed appointments?
May a physician be sued by a patient for attempting to collect an unpaid balance?

Is a physician required to provide a patient an itemized bill?

When a physician renders professional services to a patient, the physician must, upon request, submit to the patient, the patient´s insurer, or the administrative agency for any federal or state health program under which the patient is entitled to benefits, an itemized statement of the specific services rendered and the charge for each.

May a physician charge a late fee or interest on an unpaid balance?

Yes. However, allowing payment in four or more installments, more than twenty-five times per year, would require the physician to comply with pertinent federal law. The patient should be notified in writing, through a sign placed in the office and/or a written disclosure on the bill if interest will accrue on unpaid balances or a late payment fee assessed. The Ethical Guidelines of the American Medical Association require the patient be notified prior to interest and finance charges being assessed, and exceptions are urged for hardship cases.

May a physician charge for missed appointments?

Although there is no legal prohibition per se against charging for a missed appointment, however before such a charge would be collectable, the physician would have to establish that he or she was damaged by the patient´s failure to keep the scheduled appointment. This is often difficult to show, since appointment vacancies may easily be filled by other patients who are waiting. If, however, the patient is a managed care subscriber, the physician´s contract with the managed care provider may prohibit this practice altogether.

May a physician be sued by a patient for attempting to collect an unpaid balance?

Anyone can file a lawsuit, at any time, for any reason winning is another matter. Even assuming a physician has complied with every federal and state legal requirement in connection with the collection activity, patients may still file a lawsuit. Such suits are more likely where the physician is collecting for non-covered services or services for which payment has been denied by a managed care provider.

Physicians should, at a minimum, inform patients that a service to be performed may not be covered. This can help minimize the possibility a patient will misunderstand his or her financial responsibility, and respond angrily to collection efforts by filing a lawsuit.