Check contracts before charging fees

Contract Language. By Steven M. Harris, AMNews contributor. Oct. 4, 2004.

CONTRACT LANGUAGE

A column examining the ins and outs of contract issues

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If you're thinking of charging patients administrative fees to cover extraneous paperwork or other nonmedical activities, think hard. Notwithstanding how this may affect your relationship with patients, you need to ensure that your Medicare and private plan contracts don't bar you from charging extra fees.

Administrative fees have not been specially defined by state or federal regulation. But the Health and Human Services Office of Inspector General recently issued an advisory about which services physicians can attach a fee to. The OIG says physicians risk substantial penalties and expulsion from Medicare and other federal programs if they charge fees for services already covered. Private health plans also make clear that physicians cannot charge patients extra for services already included in a contract.

The idea of administrative fees has grown at physician offices nationwide as doctors find themselves squeezed by lower reimbursements or reimbursements that aren't keeping up with expenses, and by the rapid rise in liability insurance premiums.

While administrative fees for returned checks or missed appointments have been widely accepted, physicians have considered charging patients for completion of insurance paperwork that extends beyond health claims filing, telephone and e-mail consultations, and other services. Or some physicians have told patients they will have to pay an annual fee to cover all anticipated administrative work.