Wiki Discounts

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kpennington

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My provider will discount services to patients without insurance. Sometimes 20%, 25% sometimes 50%. Just depends. There is no current office policy to address this. Are there any legal guidelines that I can make him aware of?

Any input is appreciated.

Karolyn P
 
The False Claims Act, The Anti-kickback Statue, the OIG compliance regulation 101 and 103, HIPPA 1996, and the Most Favored Nation Clause. That is for starters, also there may be state statute and regulations for your state regarding this activity.
 
Equal treatment and written policies

You can certainly discount your services for self-pay patient (no insurance of any kind), but you need to have written policies in place and you need to treat every patient equally.

Our practice policy is to discount all self-pay without insurance by 10%. We also will accept a written request, with proof of income/expenses, for further charity discount. There are specific guidelines our financial office uses to determine what (and how much) additional adjustment can be made on a patient's case based on financial hardship.

I don't personally get involved in this, so can't give any more details, but I've referred many a patient to our financial counselors.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
Tessa's comment is great. We once averaged the allowed amounts from the insurances we participated with and gave a percentage off based on that average. Example is if the charge is $100 and the insurance average is $78, we gave a 22% discount. We reevaluated this yearly and adjusted as needed.

We had a written policy and everyone was treated the same. The were requied to supply documentation. Just another idea.
 
mmorningstarcpc said:
Tessa's comment is great. We once averaged the allowed amounts from the insurances we participated with and gave a percentage off based on that average. Example is if the charge is $100 and the insurance average is $78, we gave a 22% discount. We reevaluated this yearly and adjusted as needed.

We had a written policy and everyone was treated the same. The were requied to supply documentation. Just another idea.
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The company I work for does the same thing, our self pay patients have a set fee schedule which is based off our "highest" payor. This is evaluated every 6 months.
 
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