Attempting to create some clarity around issues like when and how to discuss payment for services with patients, the Healthcare Financial Management Association (HFMA) has issued a set of guidelines as part of its Patient Financial Interactions Best Practices Project. The HFMA wants to refine the guidelines through input from outsiders and has created a comment period that runs from now until July 31. With patients increasingly being asked to share part of the burden of care costs through high deductible or high co-pay insurance plans, questions about the price of various procedures and how patients may pay are becoming ever more urgent. Last year, the Minnesota attorney general investigated revenue management firm Accretive Health for its collection practices, which many thought to be abusive but others found understandable in an era where providers often get stuck with unpaid bills. The guidelines aim to start the conversation about how health care providers should ideally discuss costs with patients. Health care is by its nature sensitive and emotional, and discussions about billing-related issues can be easily misconstrued by patients as either talking them out of needed care or threatening that care will be withheld until a billing issue is settled. According to the best practices, discussions about financial matters should happen as early in the process as possible and be based on well-defined publicly available organizational guidelines. In addition, organizations should have public lists of all elective services that can be withheld if a patient has an outstanding balance. Services not on the list are essential services and patients cannot be made to feel these will be withheld if they are unable to pay. Read and comment on the guidelines.