Charging Patients for Services
2009
American Academy of Pediatrics Pediatric Practice Manager Association
A Pediatric Practice Manager Association Peer-to-Peer Survey May 2008 This document is a summary of a peer-to-peer survey distributed over the Pediatric Practice Manager Association e-mail list and the results collected using SurveyMonkey. This particular survey addressed trends in pediatric practices related to charging patients for services beyond medical care, such as completion of forms and missed appointments. Disclosure: Please note the low response rate. Overview The American Academy of Pediatrics Pediatric Practice Manager Association (PPMA) implemented a survey in February and March of 2008, requesting information from PPMA members related to charging patients for a variety of services. The survey consisted of 18 questions, with a total of 53 individuals from 25 different states completing at least a portion of the survey. The majority (52%) of respondents were from practices with 4 to 8 full-time equivalent (FTE) physicians. The remaining respondents were equally split between practices with 3 or fewer FTE physicians (24%) and 9 or more FTE physicians (24%) (Q1-Q2). Summary of Results While most practices (88.6%) do not charge for the completion of forms during a physical examination (Q3), more than half (52.3%) do charge for forms at other times (Q4). Most (77.3%) charged fees in the $5 to $10 range, with only approximately 9% charging $11 to $25. Some practices varied their fees based on requests for same-day completion or the type of form that needed to be completed (Q6). More than half of the respondents’ practices (52.3%) do charge for missed appointments (Q7). The majority (66.7%) waited until the second occurrence to implement a charge, while approximately 17% waited until the third occurrence. Only 4.2% charged on the first occurrence (Q9). Many practices (77.8%) provide notification prior to the occurrence, such as warning letters, signed financial policies, and posted signs in patient areas (Q10). In the event of multiple missed appointments, 75.6% of practices do have a policy in place to discharge the patient from the practice (Q11). All of the respondents indicated that this would only occur after 3 or more visits (Q12). Some practices (32.6%) are beginning to charge for non–face-to-face care, but most are not (Q13). Most practices (88.2%) that did charge, charged the insurance carrier first (Q14). The services being billed for are those of the physician most of the time (Q15). No practices have yet billed for e-mail consultation (Q16). Only 39.5% of practices have an additional charge for walk-in visits (Q17). Lessons Learned This is the first survey developed by the PPMA leadership team. It was clear that questions related to Medicaid should be separated out in future surveys, as many practices do not serve those with Medicaid and state regulations vary greatly. Question format was also reviewed and modifications will be made for future surveys. A follow-up question will be posted to the electronic mailing list. Finally, the PPMA leaders acknowledge that the nurse triage service (Q16) isn’t truly a consultation and should not have been included as is. CLICK HERE to see the data collected from the survey, outlined by question. Note: The comments in this article are the views and opinions of those who stated them and may not represent American Academy of Pediatrics policy. | 
