Criterion C1.5 – Costs associated with care initiated by the practice

Why this is important

Providing information in advance about costs that patients will or might incur (including costs in addition to consultation fees) is one way you can help patients make an informed decision about their own healthcare. If the patient indicates, or you otherwise know or suspect, that the costs of a suggested referral or test pose a barrier to the patient, discuss alternatives with them, such as referral to public services.

Meeting this Criterion

Costs at your practice

Inform patients of the possible cost of additional treatments or procedures before beginning the treatment or procedure. To make sure that a patient understands these possible costs, consider their communication abilities and needs (eg they might need an interpreter or materials that are in their preferred language or in plain English).

Costs for referred services

You do not need to know or provide the exact costs of referred and investigative services. Before you make a referral or request for investigation, inform patients that these services could attract an out-of-pocket cost. This means explaining the extent to which the service will be covered by Medicare and whether the patient can expect to pay a gap payment or private fee. If a patient asks for exact information about the costs of such services, encourage them to contact the service provider.

Meeting each Indicator

C1.5 A Our patients are informed about out-of-pocket costs for healthcare they receive from our practice.

You must:

You could:

• place information about the practice’s billing policy on your website
• display billing information in waiting areas
• explain the billing policy in person to patients.

C1.5 B Our patients are informed that there are potential out-of-pocket costs for referred services.

You must:

You could:

• provide the contact details of the referred service provider so the patient can find out about the costs for that service
• develop a contact list of local service providers that you can give patients so that they can find out about costs and select the service provider of their choice.