Wiki Billing employees that are patients

[corikr77]

Our clinic wants to include medical services as a part of our benefit package for employees and their immediate family members. The intent is essentially to bill the employee's insurance company for services they received from our clinic, but any co-insurance/co-pay/deductible that the employee/patient would normally be responsible for would be written off as an employee courtesy. I have put many, many hours researching this and the information that I have found so far is that this should not be done for Medicare and private payers alike. (Anti-kickback laws, mis-representation of physician fees, fraud/abuse etc.) Our manager has checked with a lawyer and another clinic and they are saying that this intended policy is allowed, but I cannot find any actual documentation to support this. Does anyone have any clear documentation that they can provide either for or against this?

I look forward to your feedback! Thanks for your help

 

[mitchellde]

What I have found with talking to health care attorneys on this is, it is legal as long as it is in writing and all are treated the same AND you keep track of all amounts written off for each employee and include it as income on they W2 at the end of the year, a benefit is compensation earned but not received as money. This keeps it across the board fair, if you have a single employee that is say the boss and makes 35K, her direct subordinate makes say 30K but has 4 children and a husband, there can be a huge disparity of income when it comes down to it at the end of the year, due to benfits the actual income of the single person is still 35K as he/she does not require much but the subordinate now has an income of 38K due to hospitalizations and such. You need to keep it fair and legal

 

[corikr77]

Thanks Debra! I didn't even think about the income piece of that and involving the W-2. I will bring that point up to my manager just in case.

Did the lawyers that you spoke to have documentation to support that it was ok to bill this way? All I can find is documentation against billing this way, but it doesn't talk specifically talk about employees as patients of course, just patients in general.

 

[mitchellde]

just employee law and taxable benefits is where they were coming from.. as long as you track it and report it as taxable income there is no foul. In effect the patient did pay the copay/deductible, they just paid it out as work hours which is like a barter and that too is legal.