By Katharine C. Rathbun, M.D., and Edward P. Richards, III, J.D. Originally printed in Missouri Medicine 1998;95:18-20 Introduction Professional courtesy – taking care of the families of other physicians without charge – is a tradition that dates back to Hippocrates.
The practice served to build bonds between physicians, and to reduce the incentive for physicians to treat their own families. This article discusses the legal issues posed by professional courtesy and discounts for medical care. While the authors believe that, on balance, professional courtesy is good for the medical profession, the congress and private insurance companies have greatly reduced the permissible scope for reducing charges for medical care.
Since the penalties for violating these restrictions include denial of the claim, deselection from the plan, fines, and imprisonment, physicians must review their practices to assure that they are in compliance. Private insurers and the federal government have basic restrictions on how you charge patients for medical care.
- Neither creates an exception for professional courtesy: in general, if you cannot reduce the cost of care for anyone else in your practice, you cannot reduce it for physicians.
- As we discuss later, there are also situations where it is permissible to reduce the cost of care for everyone except physicians.
Waiving Co-Pays The most common ways physicians reduce the cost of care for patients are waiving the co-pay (“insurance only”) and giving the patient a discount on the care. In most situations, both private insurers and the federal government ban waiving the co-pay.
- Medicare has some provisions allowing the co-pay to be waived for documented indigency.) They do this because the co-pay is meant to discourage casual trips to the physician.
- The theory is that making the patient share the cost of treatment will make the patient a more sophisticated health care consumer.
The reality is that the co-pay limits access to care for many people. The less care the patient seeks, the less money the health plan has to pay to physicians and hospitals for that care. Both private insurers and Medicare require the physician to make reasonable efforts to collect co-pays that are billed to the patient.
- Discounts A discount is a reduction in the normal charge based on a specific amount of money or a percentage of the charge.
- Just as the hardware store can give you $5 off on all tools or a 10% discount on your total purchase, a physician may take $5 off or 10% off of the bill for an office visit or a surgery.
However, there are things that the physician must beware of in doing this. The discount must apply to the total bill, not just the part that is paid by the patient. If the patient owes a 20% co-pay on a $25 charge ($5) and you are giving a discount of $5 then the patient pays $4 and the insurance company pays $16.
- If the patient owes a $5 co-pay regardless of the amount of the charge then the patient must pay $5 and the insurance company pays $15.
- In this situation, the discount would only benefit the insurance company.
- Discounts raise the issue of the physician’s customary charges for a procedure.
- Many private insurance plans and some federal programs have a “most favored nation” clause in the contract with the physician.
This entitles the plan to pay the lowest charge the physician bills to anyone. Any systematic pattern of discounts could trigger a reduction in the physician’s allowable reimbursement schedule to the discounted price. “No Charge” As far as the authors have determined, none of the private insurers bans waiving the entire charge for the care.
- You may also charge for some visits and not for others.
- Many pediatricians do not charge for the first follow-up visit for otitis media.
- This increases the likelihood that the child will be brought back for the recheck The insurance company is also getting a free visit, but at least the patient is getting the care.
“No charge” visits are prohibited if they are part of a fraudulent scheme. For example, a no charge visit is still a patient care encounter and must be fully documented. Assume that a patient has severe asthma and is waiting out a one year preexisting illness exclusion in a health insurance policy.
- If that patient requires treatment a month before the end of the year waiting period, you have to fully document the treatment even if you do not charge the insurance company for it.
- You cannot use “no charge” to hide medical information.
- You may also deliver non-reimbursable care as part of an otherwise justified office visit and bill the company for the authorized part of the visit.
For example, if the insurance doesn’t cover immunizations, then you could do the immunizations at the time you do an authorized well-child check up, or when the child is in for some other medical condition that is not a contra-indication for immunizations.
- You cannot, however, bill for an office visit when the only reason the patient is being seen is to deliver care that is not authorized under the policy.
- It would also be improper to “no charge” as a way to waive a co-pay in order to generate ancillary business for the physician’s office lab or other health services business.
In other words, you cannot no charge for the visit and bill the insurance company for $100 worth of lab work that it would not have approved as part of a reimbursed visit. “Kickbacks” and Inducements to Refer Patients The Federal government, and several of the states, have specific laws governing financial transactions between health care providers.
These laws include the Medicare Fraud and Abuse laws and the Stark I and Stark II, which apply to care paid for in whole or in part by the Federal government. These laws prohibit any inducements or kickbacks that could influence the decision of a physician (or others) to refer patients, or affect a patient’s decision to seek care.
Violations of these laws are punishable with fines and imprisonment. They also make any claims submitted for the care of the patients gotten through the scheme false claims. These laws have been construed very broadly by the courts. Any payment or inducement that might have a tendency to affect referral decisions is prohibited, even if it has other valid purposes.
- For example, one of the lead cases involved a lab that provided Holter monitor services.
- The lab charged a fee for providing the monitor and hired outside cardiologists to provide the professional component by reading the record.
- This was perfectly proper.
- The lab got in trouble because it allowed the ordering cardiologist to also be the reading cardiologist.
There was no allegation that the service cost more or was not properly done – it was illegal solely because paying the ordering physician could induce the physician to order the test. The court made it clear that an otherwise proper payment is illegal if it can also have the purpose of affecting referrals.
These laws can prohibit otherwise permissible discounts or “no charges.” For example, a surgeon who only gave professional courtesy to physicians who referred her business would clearly violate the law. Professional courtesy based on being on the same hospital staff would raise the same issues, although the link to referrals is more tenuous.
Giving professional courtesy to all physicians without conditions would be more defensible, but if the government could show that a disproportionate number of physicians receiving the courtesy were also referring physicians, the court would probably rule that this was a prohibited inducement.
- Penalties Traditionally, if physicians violated the terms of their contracts with private insurers, the insurer can refuse to pay the claim and/or deselect the physician from the plan.
- The insurer could also sue the physician for fraud.
- In extreme cases, the local district attorney or U.S.
- Attorney could prosecute the physician for mail and wire fraud for using the mail and electronic communications to file the fraudulent claims.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA), better known as the Kennedy-Kassebaum bill, now makes it a federal crime to defraud private insurance companies. Violations of the contracts with private insurer are criminal fraud under HIPAA and could result in fines and criminal prosecution.
The Federal government can also refuse to pay the claim and can ban the physician from participation in Medicare and Medicaid. In addition, when the physician files a claim for services that were provided in ways that violate the federal regulations, that claim violates the False Claims Act (FCA). Violations of the FCA are punishable by a $5000 per claim fine and imprisonment.
The large financial settlements that have been paid to the Federal government recently, such as the $17.5 million paid by Baptist Medical Center in Kansas City, are based on false claims allegations. To date, there have been no reported cases, prosecutions, or settlements solely based on professional courtesy to health care providers.
Looking at general patient care, rather than just professional courtesy, there have been private insurance fraud actions based on illegally waiving co-pays and/or providing discounts that were not passed on to the insurer. There have been Federal actions for the same violations, as well as for using waivers and discounts to induce Medicare patients to use other health care services.
Conclusions Professional courtesy means making no charge to anyone, patient or insurance, for medical care. There are no special exceptions in the law that allow professional courtesy to physicians in situations where the same courtesy could not be extended to all patients.
Conversely, there are some situations where such courtesy can be extended to all patients except physicians and other health care providers. Physicians must examine their professional courtesy policies to assure that they do not violate either the contractual terms in private insurance policies or the Medicare/Medicaid laws and regulations.
While there may be situations where it is defensible to “no charge” for services to health care professionals, the physician should assure that this professional courtesy is not linked to referrals, either in reality or in appearance. Law and the Physician Homepage The Climate Change and Public Health Law Site The Best on the WWW Since 1995! Copyright as to non-public domain materials See DR-KATE.COM for home hurricane and disaster preparation See WWW.EPR-ART.COM for photography of southern Louisiana and Hurricane Katrina Professor Edward P.
What is the meaning of professional courtesy?
Professional courtesy is in the tank, But it doesn’t need to be that way. – Professional courtesy is the practiced standards of conduct, patterns of behaviors, and values which is extended to all members in the organization. There are many dimensions of professional courtesy: honesty, dignity, respect, trust, inspiration, recognition, and many other attributes.
The degree to which these attributes of professional courtesy are consciously practiced defines leadership and culture. What’s happening in the global workplace today? To remain competitive, companies have become even more short-term numbers focused, technology-powered, disruptive, frazzled, reactionary, virtual, impersonal,
and yes, viral in terms of developing and nurturing the right success-enabling culture. This is not intended to be a conviction on leadership but just the facts of a competitive world gone wild.
What are three examples of courtesy?
Other forms: courtesies A courtesy is a polite remark or respectful act. Complain about a bad meal, and you might get kicked out. But the common courtesy is usually an apology from the manager and, if you’re lucky, a free dinner. Courtesy is all about using your good manners, which is why it shares roots with the word courteous,
- Holding the door open for someone, writing a thank-you note for a gift, and letting the pregnant lady have the last seat on the bus are all courtesies that would make your parents proud.
- And if something is kindly presented to you free of charge, the gift-giver may say it’s “courtesy of” someone special.
Definitions of courtesy
synonyms: good manners see more see less Antonyms: discourtesy, rudeness a manner that is rude and insulting types: show 7 types. hide 7 types. niceness, politeness a courteous manner that respects accepted social usage urbanity polished courtesy; elegance of manner graciousness excellence of manners or social conduct chivalry, gallantry, politesse courtesy towards women deference, respect, respectfulness courteous regard for people’s feelings civility formal or perfunctory politeness blandness, smoothness, suaveness, suavity the quality of being bland and gracious or ingratiating in manner type of: manner, personal manner a way of acting or behaving noun a courteous or respectful or considerate act noun a courteous or respectful or considerate remark
DISCLAIMER: These example sentences appear in various news sources and books to reflect the usage of the word ‘courtesy’, Views expressed in the examples do not represent the opinion of Vocabulary.com or its editors. Send us feedback EDITOR’S CHOICE
What are courtesy or professionalism guidelines?
Show Common Courtesy –
Common courtesies of professionalism include greeting others with a handshake, using professional titles and formal writing styles in correspondence, and using niceties such as “please” and “thank-you” when making requests. Refrain from foul or inappropriate language as well as rude or off-color, insensitive jokes. Don’t interrupt others, take phone calls in meetings or take attention from a client or colleague to check text messages or emails.
What is the highest form of courtesy?
Begin With the Highest Form of Courtesy – Are You Listening? Superstars are courteous, friendly, and helpful. Are you listening? Listening is the highest form of courtesy, and the baseline for exemplary service is human interaction, treating others with respect, dignity, and care.
- We mentioned already that poor employee attitudes and a lack of courtesy drive customers away.
- So ask yourself: Is that something I want for my company? There are two general approaches when dealing with people and customers.
- The first is a self-centered approach when relating to people.
- Your focus is on you, not others.
In a self-centered approach, what’s most important, : Superstar Customer Service
What is courtesy as a polite behavior?
Back to: Civic Education Primary 2 Welcome to class. Courtesy is the state of excellent manners. The definition of courtesy is polite behavior and the showing of proper manners or is a polite and socially proper act. Courtesy is behaving in a way that benefits others- it means thinking of the effect of your behavior.
- Courtesy is politeness, respect, and consideration for others.
- Politeness is the practical application of good manners or etiquette so as not to offend others.
- It is behavior that is socially correct and shows understanding of and care for other people’s feelings.
- While the goal of politeness is to refrain from behaving in an offensive way so as not to offend others and make all people feel relaxed and comfortable with one another, these culturally defined standards at times may be manipulated.
Etiquette is following rules that govern behavior- it might be the reason that causes you to behave a certain way. Etiquette is the customs or rules governing behaviour regarded as correct or acceptable in social or official life Etiquette is merely a set of guidelines for politeness and good manners, the kindnesses with which we should always treat each other.
It will always matter! It reflects our cultural norms, generally accepted ethical codes, and the rules of various groups we belong to. It helps us show respect and consideration to others and makes others glad that we are with them. Without proper manners and etiquette, the customs of polite society would soon disappear and we would act more like animals and less like people.
Aggressiveness and an “every man for himself” attitude would take the lead. Importance of Etiquette Today’s etiquette serves several important functions:
Etiquette provides personal security. Knowing how to behave appropriately in a given situation makes you more comfortable. It protects the feelings of others. Proper etiquette requires that you make others comfortable and protect their feelings. You do not point out their errors or draw attention to their mistakes. It makes communication clearer. Etiquette enhances communication by breaking down barriers, not erecting them. It will enhance your status at work. It makes good first impressions.
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What is the meaning of being courtesy?
Adjective. cour·te·ous ˈkərt-ē-əs. : marked by good manners suitable to a court. : marked by respect for and consideration of others.
What is the literal meaning of courtesy?
1. excellence of manners or social conduct; polite behavior.2. a courteous, respectful, or considerate act or expression.
What are the different meanings of courtesy?
Different, diverse, divergent, disparate, various mean unlike in kind or character. different may imply little more than separateness but it may also imply contrast or contrariness. different foods. diverse implies both distinctness and marked contrast.