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Legal FAQs
Fees
Can physicians charge fees to complete paperwork and forms for patients (e.g., FMLA, disability, etc.)?

Medical Licensing Board Rule – Indiana law is silent on this specific issue.  Indiana’s general law on fees, 844 IAC 5-2-9, states, “Fees charged by a practitioner for his/her professional services shall be reasonable and shall reasonably compensate the practitioner only for services actually rendered.”  The rule also includes a series of factors to consider when determining reasonableness.

Contracts – Physicians should check their contracts with commercial insurance companies to see if the terms of the contracts prohibit such administrative fees.

Medicare – Physicians are required to provide patients advance notice before items or services are furnished.  Medicare allows physicians to charge Medicare beneficiaries (not Medicare itself) extra for items and services that are not covered by Medicare, as well as deductibles and coinsurance.  But, charging extra fees for already covered services violates Medicare rules.  The details of the Medicare rules violation are more fully discussed in a bulletin issued by the Office of Inspector General.  Providers should exercise caution.

Medicaid – Medicaid does not allow such fees.  See this Indiana Health Coverage Program document for more information.

FMLA – There is no prohibition against charging fees in the federal Family Medical Leave Act.

Disability – The Disability Determination Bureau (DDB) offers physicians $14 for compliance with medical record and disability report requests.  The ISMA is unaware of any law that requires physicians to accept the $14 as payment in full or that prohibits physicians from charging the patient the state law allowable fees for the copy charges and collecting the $14 from the DDB for creating a separate disability report.

EthicsAMA ethical policy E-6.07 states that physicians should complete simplified insurance claim forms without charge but may charge for more complex or multiple forms in conformity with local custom.  (Note that AMA ethical policies do not necessarily comply with state law).

Notice – As a practical matter, all patients should be notified of any such charges in advance.

Copy Fees – For information on copy fees, see our FAQs on medical records.

Can physicians charge a missed appointment fee?

Indiana law does not expressly address this issue. Indiana law states, “Fees charged by a practitioner for his/her professional services shall be reasonable and shall reasonably compensate the practitioner only for services actually rendered.” 844 IAC 5-2-9. No interpretation of this provision has been provided by the Medical Licensing Board of Indiana. One interpretation could be that physicians cannot charge a fee for patients who missed an appointment because they were not rendered services.

Medicare allows physicians to charge Medicare beneficiaries (not Medicare itself) extra for items and services that are not covered by Medicare, as well as deductibles and coinsurance. But, charging extra fees for already covered services violates Medicare rules.
See Office of Inspector General bulletin>>

Medicare also allows a practice to bill Medicare beneficiaries (not Medicare itself) for no shows as long as the practice does the same for non-Medicare patients. See the rule here>>

Additionally, physicians are required to provide patients advance notice before items or services are furnished. Missed appointments are not a Medicare covered service. However, as mentioned above, such a fee probably violates Indiana law.

Medicaid rules prohibit charging a missed appointment fee.
IHCP Banner Page BR200634, August 22, 2006>>

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