Talking Money with Clients – What Not To Do
A friend relayed a story to me last week about an incident that happened to him at his dentist’s office. He was going in to see his dentist every two weeks for a series of treatments and had made arrangements with the dentist when he started treatment to pay $500 every time he came in until both the treatments and the bill were paid in full. On about his fourth visit as he was checking in, he was told that the doctor would not see him for his next round of procedures until his account was paid in full. Naturally, this coming as a complete surprise to my friend, there was a bit of a discussion between he and the office manager as to why the sudden turn of events and the demand for payment contrary to the agreed upon payment schedule. My friend wrote a check for the $1000 balance and left. The office manager seemed amazed that he didn’t want to continue his treatments after this confrontation.
There are so many things wrong with this scenario that it is difficult to know where to start. For today, however, I believe I’ll concentrate on the physical arrangement of the office and where this entire discussion occurred as this has a direct bearing both on dental office design and regulatory compliance. According to my friend the entire scene that I described took place right at the check in window in full ear-shot of everyone else in the waiting room. Under HIPAA’s privacy rule, “…all “individually identifiable health information” held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral,” is protected. “Individually identifiable health information” is information, including demographic data, that relates to:
• the individual’s past, present or future physical or mental health or condition,
• the provision of health care to the individual, or
• the past, present, or future payment for the provision of health care to the individual,
and that identifies the individual or for which there is a reasonable basis to believe it can be used to identify the individual.
Obviously, holding a conversation about money and treatment plans in the waiting room in full visible and audible proximity to others is a clear violation of HIPAA’s privacy rule as it relates to, “…the past, present, or future payment for the provision of health care…”
This conversation needed to be taken into a private office or consultation room out of ear shot of the rest of the patients. Unfortunately, my friend said that in this particular office, no such private consultation room exists. Perhaps his former dentist should be giving me a call to assist him with a remodel of his dental office so a consultation room can be added to his dental office design before he loses any more patients or incurs a fine for violation of HIPAA regulations?
