QUESTION:  How should I communicate with patients about fees and should they be posted in a public place in the clinic?

ANSWER:  Complete honesty and accuracy as well as a formal disclosure of charges are an important part of communications with all patients. This is a subject that requires careful attention, however, and can become very complicated, especially when Medicare and other public programs are involved, with their own non-negotiable fee schedules and procedures. Here are some things to consider:

Clinic fees are up to you and can be set at any level the market will sustain.  Once you establish your fee structure, you will need to maintain a consistent policy that is in full compliance with the regulations of the jurisdiction in which you practice.  ICA advises that you contact your state/province or national chiropractic regulatory body and ask to be provided any and all formal rules regarding fees, disclosure of fees and any policies and/or regulations that govern amending, discounting or waiving fees.  Such a step can save you a great deal of trouble simply by knowing exactly what the local regulations require.

On an initial visit, new patients should be given a summary of your services and fees.  This might be done in a simple disclosure form as part of the intake process.  It is highly preferable to have this done by a staff member, with the doctor not present. Such a discussion and/or disclosure should address charges for specific types of services, with any time-spent modifiers.  At no time should a doctor give any formal estimate of what the total course of care will or even might be.  At best, a vague ballpark estimate should be as far as any doctor should go, and only then after a thorough evaluation of the patient's status.  You should always talk to patients regarding their care in terms of their clinical needs, based on your clinical findings and best professional judgment, and not on any cost-related basis.

Fees should never be posted in your clinic in any chart or poster form.  This can easily change the patient's focus from a healing to a business frame of mind, diminish the clinical aspect of their visit and possibly add an unnecessary element of concern, anxiety or doubt in the patient's mind.  You should, however, always honestly and without hesitation, provide any information a patient requests regarding fees.  It is a good idea to avoid explaining how or why you set your fees at a certain level, or to attempt to justify your fees.  A simple declaration of what those fees are better serves both the patient and the practice.

For Medicare and Medicaid patients, it is appropriate to let patients know that the government establishes the fees, and that you have no role in setting those charges.  You need not, however, get into the complexities of "participating" versus "non-participating" provider issues and the differentials in fee levels or collection procedures.   It is important to remember that the Medicare and Medicaid programs are different and have different rules.  States are also heavily involved in Medicaid but have no role in the Medicare program.  ICA strongly advises that you formally request all information regarding fees from your regional Medicare carrier and from your state Medicaid agency (if applicable) and that those resources be carefully studied, kept on file for referral and regularly updated.  These government-established fee schedules are separate from the "normal and customary" fee schedule that you establish for patients not covered by these programs.

It is also important to keep clinical and financial records separate.