Table 5

Ethical Billing Practices

1. Help patients to understand their bill, their financial responsibilities and opportunities for financial counseling. When possible, do this before medical services are provided.
2. Use billing practices that in no way mislead patients or insurers about their responsibilities for payment of charges.
3. If a billing error is discovered, rectify the mistake as soon as possible. Pay back money received due to payment errors.
4. Bill consistently across all types of patients and insurers. Do not vary charges for particular patients or insurers from standard charges, or mislead them about standard charges.
5. Charge the usual copayment mandated by Medicare. Failure to do so may be unethical according to the American Medical Association (AMA) (10). Under Medicare law it is a felony to knowingly offer remuneration or anything of value to a patient in exchange for that patient’s purchasing a service. Medicare may consider waiving a copayment to be remuneration offered to the patient in exchange for the patient’s purchasing the physician’s services. In addition to criminal penalties, a physician may also be subject to civil monetary penalties for waiving a Medicare patient’s copayment obligation if the physician knows or should know that such a waiver is likely to influence that patient’s selection of physician services. (A physician may waive a copayment when it is not part of an advertisement or solicitation, it is not a routine practice and either the patient is in financial need or the copayment is not collectible after a reasonable collection effort.)
6. Frequently physicians provide charity care. The AMA recognizes this as an ethical responsibility of the physician (10). Forgiving part or all of usual charges for patients without financial resources is consistent with this responsibility.