The COVID-19 crisis has put many practices under great stress as far as payments as patients lose insurance coverage or cannot cover bills. However, it is essential to remember that the underlying principles in these situations have not changed. Let’s look at a few questions that came in before the crisis to reinforce these basic points.

Q: I converted my family practice to all-cash last year and it has worked out well in most cases – I off er very competitive pricing and the time I don’t spend dealing with paperwork I can spend with my patients. However, I have one patient who is always behind, and this has continued even on a $20 per month payment plan. I see him at least every 3 months to follow his diabetes, so this is really backing up. He is actually a great patient otherwise, but this non-payment cannot just continue. Can I terminate him now just for non-payment? Can I make payment a requirement for a new appointment?

 Yes, to your first question but no to your second. _ e situation in which a patient is under active care that cannot be suddenly discontinued, which would be what most doctors understand to be abandonment, does not apply here. With enough notice, termination is possible. As long as you do not breach your fiduciary duty to not abandon your patient, you may withdraw for any reason. However, keeping him in your practice but refusing to see him until he pays is “internal abandonment”—the patient is kept on the rolls of the practice but gets no care. If you keep him on, he is to be treated as any patient would be, regardless of payment status.

Q: As a small-town doctor, I have always been lenient on collecting co-pays and dealing with deductibles when patients really cannot afford them. I put a note in the chart of any patient I don’t collect on explaining the circumstances. However, I have colleagues who say that it is fraud.

This is can be very risky for you. While AMA Opinion 6.12 says that when the share the patient is responsible for “is a barrier to needed care because of financial hardship, physicians should forgive or waive” it, that is an aspirational ethics statement, and you are still bound by the payor relationships that you have that bind you to collect. If you waive a co-pay, correct your billing to reflect it. There is also the problem of violation of the Anti-Kickback Statute if you do not collect co-pays or apply deductibles to patients in federal healthcare programs. Following the rules with both private and governmental payors should let you keep on helping your patients without risk to yourself.

Q: How come a hospital can get a patient set up with Medicaid so they can get paid, but I can’t pay a premium on a patient’s insurance so that it doesn’t lapse so that I can get paid?

You cannot pay for a policy under which you will benefit by the insurer paying you. The hospital, by contrast, is not making a payment and is just assisting the patient to obtain access to what they are eligible for.

This article was written by Dr. Medlaw, a physician and medical malpractice attorney. It originally appeared on SERMO, which retains all rights to it.