Your collection policies should clearly state that ALL co-pays are due at the time the clinical services are rendered.  The forgiveness of co-pays must be considered a "no-no" and front desk staff must clearly support and carry out the office policy. 

Once any policy is compromised, the practice is on a slippery slope to collection and cash flow problems.

When the patient is first introduced to the practice, it is incumbent on you (or your designated staff person) to ensure the patient has clarity around the subject of payment for service.  To do otherwise is unfair to the patient and the practice.

Make no mistake about it ... although you are in a health care profession, you are also in the business of health care and failure to learn and embrace the principles of business will lead to economic challenges of the highest order.

You are responsible for the establishment of policy.  If you or your staff fail to take full ownership of those policies and are not congruent in that regard, danger is on the horizon.

Take full view of the way you and your staff approach the financial side of the practice and if change is the order of the day DO IT NOW!  You will be happy that you did.