The Idaho Patient Act went into effect on January 1, 2021. It sets new rules about what medical practices and health care facilities must do to communicate costs to their patients – and when to do them – in order to preserve their rights to pursue “extraordinary collection actions” such as transferring debts to a collection agency, reporting a patient’s delinquency to a consumer reporting agency, or filing a suit against a patient. Missing these new deadlines strictly limits your ability to recover costs and fees, so make sure your practice is in compliance with the following:
First, submit the claim to insurance.
Within 45 days of providing services (or the date of discharge), you must submit a claim to the patient’s insurance company. If no insurance information is available, this must be sent to the patient.
If you miss this deadline, you can cure the error within another 45-day period, but you can no longer recover collection costs or attorney fees.
Second, send a consolidated statement of services.
Within 60 days of providing services, the patient must receive a consolidated statement of services with specific information:
- The name and contact information of the patient;
- The name and contact information of the health care facility the patient visited to receive the services;
- The date and duration of the patient’s visit to the health care facility;
- A general description of the goods and services provided to the patient during the visit, including the name, address, and telephone number of each billing entity whose health care providers provided the goods and services to the patient; and
- At the top of the statement, a “clear and conspicuous” notification outlined in the statute that begins with “This Is Not a Bill.”
This consolidated statement must be received by the patient within 60 days. The statement can be emailed if you’ve received the patient’s permission to do so, or handed to the patient in person. If you mail statements, note that the statute presumes that a statement mailed to a patient via first class mail is received three days after it’s sent, so statements must be mailed within 57 days of providing services.
If you miss this deadline, you can cure the error within another 90-day period, but you can no longer recover collection costs or attorney fees.
Third, send a final statement.
The health care facility must send the patient a final statement that includes:
- The name and contact information of the patient and health care facility;
- A list of the goods and services provided to the patient, including the initial charges;
- A statement that a full itemized list of goods and services provided is available upon the patient’s request;
- The name of the third-party payors to which charges were submitted by the health care provider as well as the patient’s group and membership numbers;
- A detailed description of all reductions, adjustments, offsets, and payments received from third-party payors or the patient that adjust the initial charges; and
- The final amount the patient is liable to pay.
There’s no timeline required for sending the final statement, but you cannot start charging interest or fees until 60 days after the patient received it, and you cannot pursue “extraordinary collection actions” until 90 days after the patient received it and all appeals, internal reviews, and good faith disputes have been resolved.
If you have met all of the above requirements, you may pursue the “extraordinary collection actions” listed above. You, as the health care facility, bear the burden of proof that you have met all of the statutory requirements, so documentation is very important!
- Confirm the patient’s insurance information and contact information at every visit;
- Consider asking patients for written permission to send the consolidated statement and final statement via email;
- Document, document, document when and how all statements are sent; get patient signatures acknowledging receipt if delivered in person.
Attorneys’ fees are generally capped at $350 for an uncontested judgment and $750 for a contested judgment, though health care facilities can appeal if the amount awarded is grossly disproportionate to its costs and the patient is shown to have willfully tried to avoid paying a bona fide debt. Then the court has discretion to award supplemental costs, expenses and reasonable attorney’s fees.
Penalties for non-compliance can be steep. If a medical provider is found to have willfully or knowingly violated the statute, the court can award up to three times the amount of the patient’s actual damages or $3,000, whichever is greater, plus the patient can recover their costs and reasonable attorney’s fees.
One final twist: just last week, on March 1, Governor Brad Little signed a bill into law that amends the Idaho Patient Act. Effective immediately, this amendment gives medical providers an extension on meeting these requirements for any services provided before July 1, 2021. In other words, for any medical goods or service provided before July 1, 2021, medical providers can pursue the extraordinary collection actions even if they didn’t meet the timing requirements of the Idaho Patient Act as long as they complied with all of the other requirements of the Act. But watch the calendar; this is a one-time-only extension due to the COVID pandemic. As of July 1, 2021, medical providers must meet the timing requirements in order to preserve their right to pursue extraordinary collection actions.