Wiki Non Medicare Medicaid provider wants to give discount to patient

[thejamesgang3@gmail.com]

I have searched all over for definite answers to questions regarding discounting or waiving copays for a patient. The office I work in doesn't accept Medicare or Medicaid. Everything I have found states you cannot do this if you bill either of them. My provider feels that if he wants to discount a service, he should have that right. Can someone please clear this up for me or point me in the direction if you know where to find the answers.

We have the proper forms for patients to fill out and sign when they don't want us to bill their insurance. Luckily, we haven't had anyone ask to do this. Everything I have read states that patients can choose to not bill their ins but if they do, they are required to pay in full for their visit at the time of service. Does anyone know where to find this in writing so that i can show my provider? Also, if they do choose to pay, can he discount that amount or do they have to pay the full charge?

We had a patient who we billed their ins and they weren't effective on the dos. I was dropping this to patient responsibility but my provider didn't want to charge the full amount. Can he give them a discount in this situation?

I have also heard somewhere that even if we aren't contracted with an insurance, we are still obligated to bill our services to them but we are not obligated to take an adjustment as we would with a contracted insurance. Any thoughts on this?

I am working on policies and procedures, which i have never done before and I am trying to figure this all out and make sure we are being compliant. Any info would be greatly appreciated. Thanks!

 

[SharonCollachi]

Accepting or not accepting Medicare is not at issue here. What IS at issue is whether your provider has officially opted out of Medicare (there are forms to fill out). If they have opted out of Medicare, then they can enter into a private pay situation with the patient. If they have not opted out, then they cannot do so. You can find opt-out info here: https://data.cms.gov/provider-chara...ovider-supplier-enrollment/opt-out-affidavits

You can make whatever policies you want to make for private pay patients. Someone whose insurance was not in effect is a private pay patient.

If you are not contracted with an insurance (other than workers comp or government situations), you are NOT obligated to bill them and you are not obligated to take adjustments.