Due to rising practice cost and declining reimbursements, most physicians are looking into charging for services that they have done for free for years. One of the new sources of revenue is charging patients for completing forms. Charging patients for forms comes with a risk. Patients are not accustomed to paying for it and this could strain doctor-patient relationships. Of course, charging patients additional fees makes the health plans uneasy. Payers regard many of physician services as “bundled”, or “included” with the payments made for other services, such as an office visit. The key to charging a patient is to make sure that a service is a “non-covered” service.  The same principle also applies for Medicare. If the service is unrelated to a service that has been billed to Medicare, the physician may bill the patient. If a service is considered part of another service, Medicare physician fee schedule already reimburses physicians for the administrative and overhead costs under the expense component of its fee schedule. In addition, you should also give an Advance Beneficiary Notice of Noncoverage (ABN) to the patients. An ABN form is a notice given to Medicare patients for services that may not be covered or considered medically necessary. To find the most current form, do an online search for “CMS Form CMS-R-131”. Generally, Medicare looks unfavorably at charging patients for services that physicians traditionally have not charged. Nevertheless, it is prudent to check with your local Medicare carrier and contracted health plans to see if charging for forms is acceptable. It is worth pointing out that the new changes under HIPAA (the Health Insurance Portability and Accountability Act) permit patients who choose to pay out of pocket for any health service not to allow their insurer to have access to information about the service. Some of the typical forms that physicians charge for are listed below:

• Disability forms
• DMV: Disability Form and Driver Exam Report
• School forms
• Camp forms
• Sports participation forms
• Family and Medical Leave Act (FMLA) forms
• Life insurance forms
• Paperwork for patient assistance programs

The charge for these forms depend on the extent of the forms. The forms could carry a price tag of $10 per form to $15 per page to $25 per hour. Some practices also charge a flat rate for these forms. To track these services, practices use internally, made-up codes such as “FORMS” or use the CPT’s existing code “99080” (Special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form). Most physicians feel charging for forms is justified since they spend their time and involves staff effort. They also argue that by signing their names on these forms, they are accepting the responsibility and risk. To start charging for forms, the practice should implement an efficient system or the cost of managing it will exceed the amount you are trying to collect. The first step is to inform your patients. For example, you could include the new charge in the practice “Financial Policy” which should be given to all new patients. You should also post a copy of your policy in your reception or waiting area. It is recommended that you charge for these forms before you complete them, whenever possible. Collecting for forms may not have a huge impact on your practice, but may make the extra hours spent doing the paperwork a little more bearable. Of course, the extra revenue will come in handy as well.