I guess I should answer my own question about extending professional courtesy. I come from a family of physicians. My grandfather, father, uncles, cousins and husband always extended professional courtesy to other physicians and members of the clergy. It was never talked about it was just done and so that's what I've always done but I don't know if it's for the best. As a parent it has made me less likely to "bother" my doctor or my children's doctor and would really rather pay for the visit. Whenever my family sees a physician we have always sent a gift of the approximate value of the intervention. I truly do this because I appreciate their care but when I am extended the same by other physician families I feel uncomfortable. I also do not charge my employees' children but have started charging hospital employees including nurses- I think the parent-pediatrician relationship improved when I started doing this. Kim Burlingham, MD ---------- > From: Kenneth R Setter <> > To: PEDTALK Mailing List <> > Subject: Re: Professional Curtesy > Date: Sunday, August 24, 1997 1:08 PM > > > > > Does anyone know if, in fact, there is anything "illegal" about > > extending professional courtesy? One of our physicians attempted to > > extend professional courtesy to one of our internists in town who very > > politely declined. He later called back to inform me that this isn't > > "legit" and told us how he handles it in his office. > > > > He said he ended up composing a letter to be given to those friends or > > colleagues which stated that, even though he would like to be able to > > provide professional courtesy to them, he legally is kept from doing so. > > > > Any comments....does anyone know the "rules" of this game? > > > > Karen Kohlruss, BSN RN > > We recently have received letters from a large radiology group and an > anesthesiology group in town informing us that they were no longer going to > be able to extend professional courtesy because it was now illegal. They > cite the Health Insurance Portability Act of 1996. Their lawyers apparently > interpreted this legislation as covering both federal and private sector > health plans. > > We have, however, received information from our state and county medical > societies that contradict this: "Legal opinion has been obtained from three > sources, and although the wording may differ, all have concurred on the basic > interpretation of the law. The Health Insurance Portability and > Accountability Act of 1996 prohibits, and provides penalties for, waiving > coinsurance and deductible obligations of Medicare and Medicaid eligible > patients. The Antikickback Law (which prohibits remuneration in exchange for > referrals) was expanded by HIPAA to include all federal health benefit > programs (i.e. Medicare, Medicaid, Champus, VA) except the Federal Employee > Health Benefit Plan. Thus, if a physician waives the co-payment obligation > of an individual in one of the above federal programs who is in the position > to make referrals, the treating physician must fully and accurately report the > waiver on the claim for payment and on the individual's invoice. > > "Both the Medicare Antikickback Law and the Health Insurance Portability > and Accountability Act of 1996 limit a physician's right to waive coinsurance > and deductibles, but only where Medicare, Medicaid, or other government funds > are concerned. > "Currently, there is no federal statute prohibiting a physician from: > 1. Rendering medical services for free > 2. Forgiving a balance due from a patient in excess of insurance > collected. > 3. Rendering medical services at a reduced charge. > AS LONG AS GOVERNMENTAL FUNDS ARE NOT INVOLVED." > > I haven't read the actual legislation myself, so my knowledge is limited to > what we've been told. Have others received other legal opinions about this? > > Ken Setter MD > Tulsa, OK > group.