You're Fired: Dismissing a Patient
By Melody S. Irvine, CPC, CEMC, CPMA, CPC-I, CCS-P, CMRS
Dismissing patients from a practice is not always an easy decision for physicians.
Proper documentation is extremely important to support reasons for dismissing patients from your practice. If the physician fails to document reasons for dismissal or properly notify the patient of dismissal, he/she incurs liability for patient abandonment and any resulting damages.
Reasons to dismiss patients
Patients can be dismissed for several reasons:
- Non-payment of services
- Non-compliance with medical treatments, i.e.; repeated refusals of follow-up testing
- Non-compliance with office policies, i.e.; consistently missed appointments
- Harmful behavior to office staff or patients
- Illegal patient behavior, i.e., altered prescriptions, drug abuse
Steps to terminate patient/physician relationship
- Face-to-face notification followed by a follow-up letter of dismissal. If face-to-face meeting is not possible, certified letter should be sent.
- Notify the patient in writing by certified mail, return receipt requested. Identify the reason(s) why you are terminating the relationship. Typically 30 days is given for the patient to locate a new provider.
- Document the reasons for termination in the patient’s medical record and your processes used to notify the patient
Information in letter of dismissal
- Date of notification
- Effective date of termination
- Reason for termination and attempts made to rectify the situation
- Balances due
- Termination of which family members, ie: Entire family or only certain family members
- Names of providers in their area and offer to assist them in locating a new physician
- Offer to transfer records to new provider
- Explaining the physician’s role in taking care of the patient during the 30 days prior to termination.
- Contact information for any additional questions to include:
- Phone numbers
- Email of the contact person
- Contact person’s name
Documentation of clear attempts to explain concerns to the patient and attempts to rectify non-compliant patients need to be well-documented in the medical record. Explain communication, i.e.; face-to-face, letters, practice policies, and conversations with the patient of the existing problems. Conversations must be explained in non-medical terms, so the patient distinctly understands the issues. These conversations must be included in the documentation.
- Check your own state laws for patient dismissal
- You may want to check with your own malpractice insurance carrier for their requirements
- Check your insurance contract (especially managed care contracts) to make sure there are no stipulations of your contract with the payer that may prohibit “patient dumping”.
- Once termination has occurred between doctor/patient, the doctor is not legally obligated to re-accept the patient
- Offer to assist patients in locating another provider and offer to transfer records
- Terminating a patient in an emergency or urgent care situation, pregnancy in the latter stages or mentally incompetent patients is not recommended.
- If the certified letter is returned and unclaimed by the patient, do not open the letter; file it in the patient’s medical record.