business of Medicine

toolkit

Onboarding Advanced Practice Clinicians

Administrative management issues

Billing and collections

Many claims are made in response to billing and collection efforts. This may occur when a patient is not aware of the physician’s fees, the office’s collection policies or is dissatisfied with his/her treatment and has not received satisfactory explanations of his/her medical care be-fore receiving a bill. Having a policy in place that addresses related risk management concerns may help to avoid conflicts that frequently arise as a result of billing and collection efforts. All medical offices should develop a written policy that includes the following:

  • Explains the fees and payment requirements prior to the patient’s first visit. Include the explanation in the office’s patient information booklet.
  • Keeps a patient’s financial information separate from his/her medical record.
  • Establishes a review procedure for circumstances that may war-rant special consideration (patient complaints, hardship cases, unexpected outcomes, etc.)
  • Does not deny continued care or discharge a patient solely be-cause the patient filed bankruptcy.
  • Considers the patient’s past payment record.
  • Considers the patient’s payment attempts.
  • Evaluates the quality of patient care.
  • Considers the patient’s satisfaction with the treatment and/or outcome.
  • Determines the cost of legal action vs. the amount of money owed.
  • Requires the physician review the patients file prior to initiating aggressive collection action.
  • Does not send original patient financial information to a collection agency.
  • To enter into a HIPAA compliant Business Associate Agreement (BAA) with any billing or collection agency employed by the medical office.
  • Limits patient medical information given to the collection agency and provide information only in accordance with the BAA.
  • Maintain and dispose of patient information in compliance with applicable law and as noted in Section 3 of this Handbook.
  • Requires policyholders to immediately contact MAG Mutual’s Claims Department if an adverse event has occurred and the patient is demanding financial restitution.

Medical Office Coverage

In addition to being a leading insurer of medical professional liability insurance, MagMutual offers an extensive array of insurance solutions for your medical office. The coverages listed below represent those policies frequently requested by our insureds which have been designed with our policyholders in mind.

Practice Advertising and Publicity

Advertising for medical services has proliferated within the past twenty years. Social Media now offers medical practices a variety of ways that practices may promote their services. In general and from a risk management perspective it is important that the advertising of medical services not be misleading, or deceptive or likely to bring the medical profession into disrepute.

The American Medical Association, AMA Code of Ethics1 has set forth some standards of ethical advertising expected of medical practitioners. The Code specifically directs that advertising be confined to the presentation of information reasonably needed by patients or colleagues to make an informed decision about medical services, ensuring the advertisement is demonstrably true in all respects, and that it should not bring the profession into disrepute. It also directs that there should be no endorsement of therapeutic goods, and recommends caution in endorsing any commercial product not covered by that code.

Likewise, Medical Boards generally agree that advertising is permitted provided:

  • It is not misleading or deceptive
  • It is true and verifiable
  • It does not create an unjustified expectation of beneficial treatment
  • It does not use testimonials from patients
  • It does not involve claims of superiority of criticism of other colleagues
  • It does not promote unnecessary and inappropriate use of medical services

We suggest that our policyholders consult a licensed attorney to review the practice website and other electronic medical information. This review should be performed on an ongoing basis to reduce the risks of civil liability claims and potential federal regulatory liability related to advertising practices.

Disclaimer

The information provided in this resource does not constitute legal, medical or any other professional advice, nor does it establish a standard of care. This resource has been created as an aid to you in your practice. The ultimate decision on how to use the information provided rests solely with you, the PolicyOwner.