No Charge Visits & Insurance as Full Payment Billings

Title: “No Charge” Visits & Insurance as Full Payment Billings
Standard #:


Issued: 12/01/1997 Reviewed/Revision Date: 08/21/2000


“No charge visits” and “insurance as full payment” are exceptions to the normal billing process and require treating physician and faculty practice group authorization and approval.  The routine waiver of deductibles and co-payments is not permitted for any payor.  “No charge visits” and “insurance as payment” must be administered by each faculty practice group on an exception basis.

For Federal programs as well as other payers, a reasonable attempt must be made to collect the deductibles and co-payments for all patients.  All patients must be billed for deductibles and co-payments, regardless of financial status.  In cases where it appears that the patient might be unable to pay, collectors must request the patient to (1) state in writing that he or she is unable to pay for billed services and (2) provide specific information needed to determine if the patient qualifies for indigent status.  If feasible, a payment plan can be arranged based on interaction with the patient or other representative.  The financial determination of cases (hardship or indigent status) should be routed to the faculty practice group administrator and the treating physician, who may elect to waive further pursuit of charges for hardship cases.  Should the patient be deemed to be indigent, notification should be made to the physician and deductibles and co-insurance may be waived.  The faculty practice group should apply its customary methods for determining the indigence of patients for any federally funded program.

The above guidelines that are specific to Federal programs should be applied to all patients regardless of funding source.  However, there may be instances where a faculty practice group may construct guidelines for reduced billing rates.  These guidelines should only apply on an exception basis after review of the particular contract or circumstance.