Administrative and Professional Services

THIRD-PARTY PAYORS / REIMBURSEMENT

Administrative and Professional Services

RESOLVED, That the North Carolina Medical Society supports charging patients for services that typically are not reimbursed by third party payors, provided that the following conditions are met:

  1. There are no third party payor or other applicable contractual prohibitions on billing the individual patient for such services;
  2. The practice has a clear policy outlining what services will be billed to the patient and how much;
  3. The patient is notified in writing of the practice’s policy, either at the initial visit or at the first visit after the policy is adopted by the practice; updated versions of the policy are provided as necessary; and
  4. The amount charged is reasonable under the circumstances and is limited to costs incurred by the practice in performing the service.

Examples of services that typically are not reimbursed by third party payors include, but are not limited to: copying medical records; filling out lengthy insurance and other forms; telephone, email, and telemedicine consultations and prescription refills; and be it further

RESOLVED, That the North Carolina Medical Society supports waiving charges to patients for services that typically are not reimbursed by third party payors if such charges would impede access to care; and be it further

RESOLVED, That the North Carolina Medical Society supports third party reimbursement for services that are not reimbursed by third party payors such as telephone, email, and telemedicine consultations and prescription refills.

(Report D – 2004, adopted 11/14/2004)
(reaffirmed, Report J-2010, Item 2-17, adopted 10/24/2010) (reaffirmed, NCMS Policy Review 2015 Report, Item 103, adopted 10/24/2015)

 
 

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