MHConcierge posted a 10 question survey to the Minnesota Board of Psychology mailing list, and 120 colleagues were generous enough to respond. 42 of them took the time to write a comment.  Thanks very much to all who responded, especially those who wrote some very thoughtful comments.

Here are the results for each question:

  1. 112, or 93.33%, of those who opened the link to the survey provide clinical services, and qualified to complete the rest of the survey. The rest of this report will discuss the responses of those 112 participants.
  2. About 55 % bill with their individual NPI, 12.5% bill with a group NPI, and 7.14% have their services billed for with an employer’s NPI. The rest of the respondents either bill with a combination of NPIs, probably due to working in multiple settings, or do not know how their services are billed.
  3. About 60% have a written policy about how to respond when a client/patient does not pay their bill.
  4. About 38% report having an unwritten policy – so almost everyone has a policy about how to respond to unpaid bills.  Having a written one is probably advisable.
  5. About 44% use a collections agency.
  6. About 65% responded “yes” to the question, “I believe that it is ethical to use a collections agency when m patients/clients do not pay their bill.”
  7. On the other hand, about 40% responded affirmatively to, “I am concerned that using a collections agency would leave me open to potential ethics complaints.” I wish that I had thought to ask a question that would clarify how many of these respondents do not use collections agencies- given the numbers for #6 and#7, it seems likely that that those who do not use collections agencies do so, at least in part, out of concern about having to defend an ethics complaint.
  8. Of the group that does not currently use a collections agency, only about 7% are considering use of one.
  9. About 7% of the respondents used a collections agency in the past, but discontinued this practice. They were given the opportunity to commend on why they discontinued, and I received 8 comments: most stated that they simply did not find that they collected enough money to make it “worth the hassle.” Several commented that they found ways to proactively collect “patient responsibility” funds (copays, co-insurances, and deductibles) that enabled them to avoid problems that might trigger use of a collections agency.
  10. The last question was an unstructured opportunity to comment on the issues related to use of a collections agency, and I received some wonderfully thoughtful responses. Here are the main themes:
    1. The question of whether it is ethical for mental health professionals to use a collections agency has been answered, at least by law– psychologists, physicians and other medical providers are not committing an ethical violation by using a collections agency.
    2. The concern about having to defend an ethics complaint due to use of a collections agency appears to be a version of what I call a “professional urban myth”- there is no actual current evidence for this concern. If anyone has evidence to dispute this – such as documentation that a MN board of professional practice has sanctioned, or even investigated, a MN mental health professional for using a collections agency – that would be very helpful to share.
    3. Clearly, the best approach is a proactive approach- to include information about your collections policy in your intake documents, perhaps to ask patients/clients to sign a form authorizing you to bill their credit card, and to consistently collect the “patient responsibility” portion of your bill in real time.
    4. Finally, several very thoughtful respondents noted that we need to carefully balance our needs with the needs of our patients/clients, including the need to be paid.




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