We sometimes receive calls to our Medico-legal Advisory Service (MLAS) from
members for advice about obtaining informed financial consent from patients. This
can help to minimise the need to chase patients for unpaid fees for services
they received, which can take up an enormous amount of time and energy.
It’s also important to note that issuing requests for patients to pay
outstanding fees can often result in patients making a complaint to a
regulatory authority.The time and resources spent dealing with the
complaint can in some cases exceed the amount of the unpaid fees. Therefore,
it’s preferable to avoid these situations altogether.
The good news is there are a number of strategies doctors and practices
can employ to minimise the number of patients who don’t pay their fees.
Informed financial consent
The first step is to think carefully about the information you provide
to patients before they decide and consent to treatment.In a well-run
practice, considering finances and informed financial consent from both the
doctor’s and the patient’s point of view is as important as informed consent for
treatment. Before they commit to the procedure, all patients should be advised
in writing of the fees that they will be liable for if consenting to a certain
procedure. The written quote should include the following:
- Your fee for the treatment/procedure – this should be
as accurate as possible given your expertise in terms of technicality and
associated charges. Any known risks, for example, complications that might occur,
should be stated and where possible, the estimated impact on fees.
- A statement acknowledging other fees – the patient should
be aware that they will have to pay hospital fees (or, at least, possibly part pay
depending on their private health insurance), the anaesthetist’s fees, costs
for prostheses or equipment, pathology fees, radiology fees, and possible
allied-health fees, in addition to your
fee. You do not have to accurately specify the amount of these fees, but acknowledge
that they exist and indicate how the patient can find out exactly what will be
- If you have another doctor acting as surgical
assistant during your procedures, you should always inform the patient that
there will be another doctor present, and the billing arrangements that will
apply. It is important to note that MBS regulations require patient consent for
bulk-billed medical services which would include surgical assistance.
- An indication regarding the contributions from
Medicare and/or a private health fund toward the fees and how to determine what gap (remaining fees) there
will be after these contributions.
Most practices will have systems that
identify the benefit the patient will receive from private health funds and
Medicare prior to a procedure.
- A statement that extra fees may be payable if the
patient requires additional procedures. Patients may be more receptive to these
extra fees if they are charged at the Medicare rebate level or a no gap health
fund amount. Especially, if the additional procedures and hence fees, relate to
complications from the initial procedure.
Minimising the cost when complications
Another strategy is considering reducing the cost to the patient when
complications occur.Some practices have an internal policy that the
practice will refund the gap paid by the patient if things do not go as
expected.However, this strategy should only be employed with a statement
that it is practice policy to do this so that it’s not seen as an admission of
Avant recommends that any additional treatment or revision surgery that
is required due to a complication should not put the patient out-of-pocket. This
may require liaising with colleagues and requesting that further treatment be
charged at refund amounts only.
Rewarding payment upfront
Requesting payment upfront ensures that where possible any gap payable
by the patient is paid before the procedure is performed.
It’s also a good idea to consider rewarding patients who pay upfront and
to encourage respectful behaviour in terms of fee payments. Sometimes, even a
small discount for early payments can make all the difference and lead to more
patients paying upfront and on time.
Greater fees, greater patient
It may sound obvious, but the greater the gap/fees the patient must pay,
the greater the expectations from the patient.Therefore, keeping the gap/fees
as low as possible is likely to reduce the possibility of a patient not wishing
to pay the fee, even if a minor complication occurs.
Drawing a line in the sand
Sometimes cutting your losses and not pursuing unpaid fees in situations
where you are aware that the patient is unhappy about the service or a
complication has occurred is the best strategy. As noted above, the cost to you
and the practice in terms of the time and resources required to deal with a
complaint can far exceed the amount of the unpaid fees.
Patient feedback mechanism
Implementing a good feedback process in your practice (both from GPs, as
well as patients) to establish how your patients perceived the service they received
(including fees), can also be very useful. The insights can be used to improve
practice management processes in terms of setting fees, the consent process and
recovering outstanding fees.
sufficient patient information regarding the procedure and fees to ensure the
patient has provided informed financial consent prior to having the treatment
- Minimise costs to the
patient when complications occur.For
example, refunding the gap paid.
patients to pay fees upfront and consider rewarding early payments to encourage
fees to be paid upfront and on time.
that the more the patient pays, the more they expect from the service they
not pursuing unpaid fees if the patient is unhappy about the procedure or a
complication has occurred.
- Use feedback processes to review
and improve your practice strategies.
For more advice on this issue, visit our website or if you
require immediate advice, call Avant’s MLAS on 1800 128 268.
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