Professional Courtesy Has Severe Limits
Martin, Virginia, Medical Economics
Q: We know "professional courtesy" has been allowed for some time and that there are rules to follow. Our specialty practice has discussed using professional courtesy as a way to say "thank you" to the physicians who refer patients to us, but we are concerned we may run into compliance issues. We already give professional courtesy discounts to all physicians, but want to have a special event to thank the pediatricians who refer to us. Our plan is to rent a movie theater and provide tickets to a first-run family film for the physicians, staff, and their families. Can we do this, and what, exactly, are the rules?
A: Indeed, there are rules to follow when extending professional courtesy. The first is that it cannot be used as a "reward" or "incentive" to physicians, their families, or office staff for referring patients to you. This violates anti-kickback rules. Other considerations:
* Professional courtesy must be extended to all physicians - regardless of their ability to refer patients to you.
* You need to have a written policy that is applied unequivocally to all physicians, as well as their families and office staff. The healthcare items or services must be of a type routinely provided in your office, so gratis theater tickets would definitely fall outside that exception.
* Professional courtesy cannot be offered to any physician (or family member) who is a federal healthcare program beneficiary, unless there has been a good-faith effort to show financial need.
* If the professional courtesy involves any complete or partial waiver of copay or deductible amounts, the insurer must be notified in writing of the reduction. The most common way to do this is to adjust the claim you submit by the amount of the discount.
The answer to your question is that the movie theater outing cannot be used to reward your referring physicians.
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