If you’ve spent any length of time in a rehab therapy clinic’s front office, you’ve probably witnessed—or participated in—some uncomfortable conversations concerning a patient’s inability to make a payment. While these frank discussions are never fun, if your clinic doesn’t have a written payment policy, you’re gonna have a bad time. Fortunately, you can avoid those “well, this is awkward” moments with this guide to developing a foolproof policy for collecting patient balances.

1. Contact New Patients Before the First Visit

The initial “make or break” moment in any relationship is the first impression, and the relationship between a clinic and its patients is no exception. And in this case, it’s completely okay for you to make the first move. Contacting new patients—whether it be via email or over the phone—is a good way to break the ice, so to speak, and to let patients know that they should be prepared to uphold their financial responsibility at the time of the appointment. This is also a perfect opportunity to get a head-start on collecting a patient’s insurance and demographic information (one less thing to worry about on the day of the visit).

2. Collect at the Time of Service

These days, you’d be hard-pressed to find a clinic that doesn’t require patient payments to be collected at the time services are rendered. And really, there’s no shame in it. After all, when patients handle their financial responsibility upfront—at every visit—it prevents the amount owed from accumulating and becoming overwhelming. Let’s face it: generally speaking, insurance companies expect patients to pay their copays, and they expect practices to collect them—and it’s super important to make sure your patients are aware of those expectations.

Of course, that doesn’t mean you can’t work with a patient to create a payment plan that works with his or her budget. And if you decide to do so, make an effort to firm up the details of that plan before the patient begins treatment.

3. Cover Your Critical Payment Policy Bases

Provide a List of Your In-Network Insurances

As a patient, there are few things more anxiety-inducing than finding out your chosen provider is out-of-network after you receive an outrageous bill. And as a provider, you can help patients avoid that sticker shock by presenting all new clients with a list of accepted insurance payers. In addition to publishing this list within your payment policy, you may also want to include it on your practice’s website; that way, it’s available to prospective patients as well. Finally, I’d recommend training your front office staff to confirm in-network carriers when patients call to set up their initial visit.

It’s also important that patients understand they will be responsible for any leftover costs. So, make sure you highlight that responsibility within your practice’s payment policy.

Include a Refund Policy

Does your practice sell cold packs, tape, or maybe some of those amazing foam pillows? Then having a refund policy within your overarching payment policy is must. Refund policy timeframes can range anywhere from one week to 60 days after the date of purchase, depending on the item. You should also check with your individual vendors to see what their return policies are, as this could factor into your own guidelines.

Address Cancellations and Missed Appointments

Life has a way of, well, getting in the way—car problems, long-running soccer/dance/fencing practices, dogs getting into the trash can (again). And sometimes, this means appointments get put on the back burner. However, frequent cancellations and missed appointments can add up—and have a significant impact on your business. As such, it’s wise to include a cancellation/no-show section in your payment policy. Specifically, I would recommend:

  • Setting a specific timeframe for patients to reach out and notify you ahead of time (24 hours is standard).
  • Clearly stating the consequences of not notifying your clinic within the given timeframe.
  • For late cancels and no-shows, charging the amount (or a portion of the amount) you would have billed for the appointment.

Download the PT Patient’s Guide to Understanding Insurance

Patients confused about their insurance coverage? Avoid uncomfortable conversations later. Enter your email address below and give them the PT Patient’s Guide to Understanding Insurance.

Please enable JavaScript to submit form.

4. Overcome Objections

Even with the most meticulous and well-written of payment policies, there will certainly still be instances in which patients can’t—or claim they can’t—provide payment. When this happens, it’s important to remain empathetic, but firm. Have a script handy (like these ones from the American Medical Association) for your front office staff to use when these situations arise. If you don’t accept all credit cards, you may also want to make a note of the nearest ATM. And if the patient truly cannot make a payment on a particular date of service, it’s vital that you require him or her to pay in full on or before the date of his or her next appointment.

5. Obtain Patient Acknowledgement

All of that being said, the perfect policy is meaningless if the patient never sees it. So, be sure to provide a copy of the policy to all new patients, along with any other forms that require patient completion and signature. When patients sign and acknowledge your payment policy, it covers both of you in the event of any “surprises.” It’s also smart to post additional signage at the front desk reminding patients that you require payment on the date services are rendered.


Most folks don’t get into health care because they love collecting copayments and outstanding patient balances. But, it doesn’t have to be the elephant in the room. Having a solid payment procedure—and keeping your patients in the know about your policies—not only empowers your front office staff, but also makes this seemingly awkward facet of private practice a no-biggie. Have you implemented a payment policy in your practice? What are some elements you’ve included to make it a success? Share your thoughts in the comment section below.