We believe that with a little transparency and better billing practices, patients will be better able to pay their bills in full. Fewer medical debts will end up in collections which will help patients and doctors alike.
Under IPACT
- Doctors will submit charges within 45 days of seeing a patient.
- Patients will receive a single list of everyone that’s going to bill them.
- Appropriate grace periods allow time to correct errors.
- Attorneys’ fees will be limited so patients are protected from outrageous medical debt collection fees.
- Doctors will be paid more timely because patients will understand their bills and can pay with confidence without delay.
Myths and Facts
MYTH: If a health care provider does not comply withIPACT, a patient does not have to pay for services.
FACT: A health care provider (HCP) can alwayssubmit charges to the third-party payor (“Insurance”) and collect remaining principal and interest throughnormal collection efforts such as sending bills, making phone calls, askingfor payment, arranging a payment plan, or using a collection agency 60 daysafter a patient receives a final statement.
MYTH: An HCP must provide thepatient a final statement (bill) 45 days after service.
FACT: Toengage in extraordinary collection actions*, HCPs must submit charges to a patient’sinsurance within 45 days. A final statement may be sent any timeafter the HCP and insurance have resolved the charges and amounts owed by thepatient. If the patient did not provide insurance at the time of service, HCPsshould submit charges to the patient within 45 days.
MYTH: If a patient has multiple third-party payors, HCPsmust submit the charges to all third-party payors within 45 days.
FACT: IPACT does not change current laws and regulationsregarding proper submission in the event of multiple third-party payors exceptas to the timing for submission to the first third-party payor. HCP should consult with the patient and/or exercise itsbest judgment in determining which third-party payor to submit charges to first.Supplemental or other third-party payor submissions can follow at any time. Inother words, an HCP should begin the insurance process by submitting charges toone of the third-party payors within 45 days. There is no time limit onsubsequent insurance submissions other than what is provided in the contracts.
MYTH: If an HCP misses the 45-day window to submit toinsurance, the HCP cannot collect.
FACT: IPACTdoes not affect contractual submission deadlines between third-party payors andHCPs. IPACT addresses the timing of submissions to third-party payorsand notifications to a patient when the HCP takes an extraordinary collectionaction against a patient.
If an HCP missed the 45-day window, IPACT provides for anadditional 45 days to submit the bill. Essentially, an HCP has 90 days tosubmit the bill and still use extraordinary collection actions. The onlydifference is that after the first 45 days, an HCP cannot shift any of thecosts and fees of extraordinary collection actionsto the patient.
If the submission to insurance has not occurred within 90 days ofthe date of medical service or discharge from a health care facility, the HCPcan still submit the bill to third-party payors and continue to make normalcollection efforts on any remaining balance but may not engage in extraordinarycollection actions.
MYTH: If the patient provides insurance 45 days afterservice or does not provide accurate insurance at the time of service, the HCPdoes not have to comply with IPACT.
FACT: Itis the patient’s responsibility to provide accurate insurance information atthe time of service. If the HCP submitted the bill to the insuranceprovided, and the claim is denied for any reason, for the purposes of IPACT,the HCP has met the timing requirements for the 45-day submission. Under thosecirc*mstances, the HCP is compliant even if the patient provides corrected orsupplemental information at a later day.
Please note:If thepatient does not provide insurance information at the time of service, tocomply with IPACT, the HCP should submit charges to the patient directly withinthe appropriate time frame.
CONSOLIDATED SUMMARY OF SERVICES
MYTH: All HCPs must provide a Consolidated Summary ofServices.
FACT: The healthcare facility at which the patient received services provides the consolidatedsummary for its own HCPs and any independent contracting HCPs who will billpatient separately.
IMPORTANT NOTE: If the health care facility and the HCPs whoprovided service are all billing on one final statement, then the health carefacility and HCPs do not need to provide a Consolidate Summary of Services.The health care facility must notify the patient in writing at the time ofservice that the patient will receive one bill for the services rendered at thehealth care facility.
MYTH: The Consolidated Summary of Services is a combinedbill with pricing information.
FACT: TheConsolidated Summary of Services must include the name and contact informationof the health care facility, the date(s) of service, the names and contactinformation of each HCP or entity billing the patient separately, and a generalsummary of services provided. The Consolidated Summary of Services is not acombined bill; it is a notification to a patient to expect more than one HCP tobill separately for services.
MYTH: If the health care facility misses the 60-daywindow to send the Consolidated Summary of Services, the HCP cannot collect.
FACT: AnHCP can always collect its principal and interest through normal collectionefforts (e.g., sending bills, making phone calls, and asking for payment).If a health care facility missed the 60-day window, IPACT provides for anadditional 90 days to provide the Consolidated Summary of Services. Essentially,a health care facility has 150 days (approximately 5 months) to inform thepatient of the HCPs that will be billing the patient separately. The onlydifference is that after the first 60 days the costs and fees of extraordinarycollection actions cannot be shifted to the patient.
If the Consolidated Summary of Services was not received within 150days of the date of medical service or discharge from a health care facility,normal collection efforts may always be used.
MYTH: Third-party payors are better suited to send theConsolidated Summary of Services.
FACT: Third-partypayors are only aware of bills that have been submitted by the HCP. Only the healthcare facility has full access to the services provided and, therefore, caninform the patient in a timely manner of those services. This provides apatient with the opportunity to confirm with the third-party payor that the HCPsidentified on the Consolidated Summary of Services have properly submittedtheir bills to the third-party payor.
MYTH: Once a patientreceives a final statement, an HCP must wait 90 days to collect.
FACT: The HCPcan always collect the principal balance and interest owed. During the90-day period before extraordinary collections actions can be taken, an HCP canask for payment, send multiple notices requesting payment, warn of thepossibility of collection actions in accordance with the Fair Debt CollectionAct, make phone calls, and after 60 days send the balance to a collectionagency.
An HCP or the third-party collection company may not engage inextraordinary collection actions unless the HCP has complied with the noticerequirements and 90 days have passed since the patient received a final statement.
PROVING RECIEPT
MYTH: The HCP or health care facility are required touse registered mail to send the notices.
FACT: The HCPcan deliver the notices however it sees fit including at the time of service,first-class mail to the address the patient provided, patient portal, or email.In the event of a court proceeding, the HCP has the burden to prove receipt—first-classmail to the address the patient provided at the time of service creates arebuttal presumption of receipt in favor of the HCP.
GENERAL
MYTH: IPACT caps how much interest an HCP can charge.
FACT:IPACT does not limit interest rates. IPACT stipulates that the outstandingdebt may not begin to accrue interest until 60 days after the final statement wasreceived by the patient.
MYTH: An HCP or its agent who never engages inextraordinary collection actions must still comply with IPACT.
FACT: No. HCPs are not required to satisfythe conditions of IPACT unless they intend to engage in extraordinarycollection actions.
MYTH: The Idaho Patient Act is mandatory regulation.
FACT: IPACT sets sideboards on extraordinary collection actions. There is no government agency that is tasked to implement this bill. No government funds need to be appropriated for this bill to operate. Rather, IPACT sets sideboards on extraordinary collection actions* and allows health care providers, collections agencies, and attorneys to choose whether they wish to avail themselves to the benefits of the use of those measures.
EXTRAORDINARY COLLECTION ACTIONS & ATTORNEY FEES
MYTH: The HCP may not use a third-party biller to sendout notices.
FACT: The HCPmay use a third-party biller. Nevertheless, the third-party biller mustadhere to the same requirements as an HCP before engaging in any extraordinary collectionactions.
MYTH: IPACT limits how mucha collection company can be paid.
FACT: IPACT does not regulate how much collectioncompanies can charge for their services or impact the rates and fees negotiatedbetween collection companies and their clients. IPACTonly limits how much of the creditor’s collections costs can be shifted to thepatient.
MYTH: IPACT preventscollection companies and doctors from hiring an attorney.
FACT: IPACTdoes not regulate or prohibit collection companies and doctors from hiring anattorney. As with any attorney-clienttransaction, collection companies and doctors can hire attorneys, negotiaterates, and pay attorneys’ fees as they see fit. IPACT only limits how much of the creditor’scollections costs can be shifted to the patient.
MYTH: In Idaho, court costs and services fees are atleast $350.
FACT: Collectioncompanies and doctors can obtain a default judgment for as little as $119 inmost instances. For example, in Ada countyfiling a case in small claims court (cases under $5,000) costs $69 and serviceof a small claims action is approximately $50.
MYTH: Even though more expensive, Magistrate Courts area better venue for patients.
FACT: Smallclaim court is specifically designed for cases under $5,000 and is more userfriendly than Magistrate Courts.
In small claims courts patients:
- do not pay a fee to file an answer,
- do not need an attorney, and
- can use court approved forms to participate inthe process.
* Extraordinary collection actionmeans suing a patient, reporting a patient’s failure to pay a debt to aconsumer credit agency, or not waiting at least 60 days after a final statementto use a third-party collection agency to recover the debt from a patient,among other things. Extraordinary collection action does not include normalcollection activities of health care providers such as sending bills, makingphone calls, asking for payment, arranging payment plans, or using a third-partycollection company 60 days after a final statement.
