Every pediatric practice deserves a financial policy. A thoughtful financial policy establishes expectations before questions become conflicts. It also creates consistency, which only adds to the trust that matters so much to delivering high-quality care. Whether you're creating your first policy or revisiting one that hasn't been updated in years, taking the time to create or refine policy documents can prevent confusion, reduce payment disputes, and strengthen your revenue cycle.
In this guide, we'll cover the essential components of a pediatric financial policy. Since every practice is different, your practice can select the policies that make sense for you, such as keeping credit cards on file, sending an account to collections, or sharing your practice’s financial assistance policies.
Disclaimer: This article is intended for educational purposes. PCC recommends that you consult qualified legal or financial professionals when implementing policies for your practice.
Why Every Pediatric Practice Should Have a Financial Policy
Policies that protect your practice aren’t just good business sense. Financial policies help build trust between practices and families, and establish payment responsibility for as long as the family is in your care. These policies aren't just for large healthcare organizations or hospitals, either. Financial policies benefit practices of every size. They ensure every family receives the same information, every staff member sets the same expectations, and difficult financial conversations have a clear foundation.
Policies Help Identify Financial Responsibility
Financial responsibility for a patient’s account can change over time. Whether your patients’ households are experiencing divorce, guardianship changes, foster placement, or another situation, your financial policy should explain how your practice navigates those changes.
As PCC billing expert Ben Brandt explains:
"A financial policy also defines responsibility... when you have someone who signed the policy, [and] someone else is going to be taking over the responsibility for future finances... that person also needs to sign something saying, 'As of this date, any new time that child comes in, I am now the person who is responsible.'"
Unlike systems that organize billing around individual patients, pediatric workflows like the ones in PCC EHR often revolve around the family account. Keeping financial responsibility clearly documented protects both your practice and your patients’ families from misunderstandings.
Who Should Explain Your Financial Policy to Families?
While the front desk should be familiar with the basics of your policy to assist families, your practice should establish a point person who is prepared to answer more detailed questions. A financial policy gives your team an objective reference instead of relying on memory, exceptions, or individual judgment, but a qualified staff member such as an office manager should be available to meet with families privately to discuss the policy in detail.
Every practice’s policy will look slightly different, accounting for size, culture, and priorities. A solo pediatrician may choose to allow more flexibility based on long-standing relationships with families — although Ben cautions that pediatricians should be cautious when offering exceptions, as these waived or delayed balances can affect the broader revenue cycle. On the other hand, a larger practice with multiple providers and front desk staff may need firmer, more standardized expectations to ensure every patient receives the same experience regardless of which clinician they see.
A signed financial policy documents the agreement between your practice and your patients' families, which helps guide conversations, should questions arise later.
What’s In Your Financial Policy?
Every practice is different, but most financial policies cover the same core topics.
Financial Responsibility
Clearly state who is ultimately responsible for all balances, including copays, deductibles, coinsurance, and services not covered by insurance. Typically, practices identify the primary caregiver, or the responsible adult who accompanies the child to the practice, as responsible for that date of service’s personal responsibility balance.
Using clear, plain language helps families understand exactly what they're agreeing to before questions arise. For example, instead of “patients are responsible for any remaining balance,” try getting specific: “If your insurance does not pay for a service, you are responsible for the remaining balance.” Based on your knowledge of your patient population, consider adding financial policies in languages other than English, or in large font for accessibility.
Copays at Time of Service
Explain that copays are due at the time of service, in accordance with the family's insurance plan. Collecting copays during the visit helps avoid unnecessary follow-up billing and supports a healthier revenue cycle.
Insurance Participation
Outline how your practice handles out-of-network insurance, claims submission timelines, and situations where insurance does not pay as expected. If families may become responsible for balances after insurance processes a claim, explain that upfront.
Good Faith Estimate
If a family does not have insurance, your policy should outline your practice’s process for a “good faith estimate” prior to time of service. A good faith estimate is required under the No Surprises Act.
Billing Practices
Let families know what to expect after their visit. Include information such as:
- When statements are generated
- Available payment methods
- Online payment options
- Who to contact with billing questions
Predictability reduces confusion, builds a trusting relationship, and encourages prompt payment.
Collections Policies
If unpaid balances may eventually be referred to a collections service, explain the process clearly and respectfully. Include any applicable collection fees if allowed under your state laws.
Credit Card on File (CCoF)
Many pediatric practices now offer to keep a credit card on file, allowing balances to be paid automatically after insurance has processed a claim. PCC practices can set up Credit Card on File (CCoF) functionality to offer families convenience and save your billers hours of valuable time.
When introducing CCoF, explain:
- That their card information is securely stored
- When charges may occur
- Whether participation is optional or not
- Whom to contact with questions about charges
- Maximum amount the office will charge a card at one time
Framing CCoF as a convenience rather than yet another payment requirement can help families feel more comfortable enrolling.
Additional Fees
If your practice charges fees for missed appointments, late cancellations, returned checks, medical record requests, or other administrative services, list them clearly. Fees can be effective for practices for many different reasons, and transparency with families facilitates understanding.
Medicaid and State Requirements
Practices serving Medicaid patients should ensure that their financial policies comply with all applicable federal and state regulations. Certain charges or collection practices that are appropriate for commercially insured patients may not be permitted for Medicaid beneficiaries.
Financial Assistance
If your practice offers payment plans, hardship accommodations, or other financial resources, include them in your policy documents. Families appreciate knowing that your goal is to work with them if they find themselves struggling.
Be sure to consult a legal expert as you construct financial assistance policies, as it’s important to comply with OIG rules. For example, the financial assistance offered should be “not routine, not advertised, and made on the basis of a good-faith, individualized assessment of financial need.”
If your practice cannot offer financial assistance, consider referencing community resources, such as 211.org’s resources for healthcare expenses. This kind of support reinforces that your practice understands how stressful healthcare costs can be while still communicating clear expectations and upholding your practice’s values and mission.
Example Pediatric Practice Financial Policies
If you're starting from scratch, don't feel like you have to reinvent the wheel.
Many pediatric practices publish their financial policies online, offering useful examples of how topics such as CCoF, payment expectations, cancellations, and billing procedures can be communicated clearly.
You can also learn from discussions among other pediatric practices about introducing CCoF, encouraging enrollment, and developing workflows that guide understanding for both staff and families. Organizations like the American Academy of Pediatrics’ Section on Administration and Practice Management (SOAPM) are a great resource, too.
It sometimes helps to refer to a template when creating a new policy. One Family Pediatrics in Cumming, Georgia was kind enough to offer this example financial policy that you can reference. The financial policy is on pages 2 and 3. Notice how the practice outlines CCoF, collections, Georgia Medicaid, returned checks, and more.
Your financial policy may look similar to many others, but a great policy isn't copied word-for-word. It's adapted to fit your practice, your patients, and your team's workflow. PCC also recommends that you consult financial or legal professionals before instituting any new practice policies.
Need More Help?
Developing a financial policy is only one part of creating a healthy revenue cycle.
Whether you're just getting started with PCC or refining your existing workflows, PCC offers training, guidance, and consulting resources to help practices establish financial expectations that support both excellent patient experiences and strong financial outcomes. For example, billers of all skill levels welcome to join our monthly Billing Drop-In sessions, where common issues are brought to a group of peers to discuss. Check the PCC Events page for the next event date. You don’t have to be a PCC client to join us!
The AAP also provides valuable practice management resources that may help inform your policies.
Your Practice Deserves a Financial Policy
A financial policy creates transparency your staff and patients deserve, as this documentation serves them well in tough financial conversations. It helps families understand their responsibilities, gives staff confidence, and provides your practice with a consistent framework for managing payments. Your families deserve to understand your expectations, as well as learn about any support resources you may offer. It’s all a part of the important work you do in providing care to children and families!
If you're looking for more ways to strengthen your practice's financial performance, check out our webinar hosted by PCC’s Chip Hart, Where Am I Losing Money?, to learn practical strategies for identifying revenue leaks and building a healthier revenue cycle. You can also read the previous post in this revenue cycle management series, It Starts with Hello: The Inside Secrets to RCM in Your Practice.
