Discharging Non-Compliant Patients

Q. A medical practice sent out a discharge-from-care letter to a patient several months ago for non-compliance; however, the patient is now calling the practice to schedule an appointment. The patient claims that she was unaware of the discharge letter and is adamant that she never received it. The practice administrator informs us that she sent the letter out via first-class mail to the patient’s last known address and obtained a certificate of mailing showing the date the letter was accepted by the post office. The practice manager confirmed that both the certificate of mailing as well as the discharge-from-care letter are included within the patient’s medical record. Is the practice required to see this patient?

A. No, assuming the practice manager mailed the letter at the post office to the patient’s last known address and then obtained the certificate of mailing. The certificate proves that the letter was mailed at the post office and was delivered in the same manner as other regular, first-class mail. A copy of the letter and the certificate of mailing should be kept in the patient’s medical record. If the first-class letter is not returned, as was the case in the above, there is a legal presumption that the patient received the letter.