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Thread: Same day discounts

  1. #1

    Default Same day discounts

    AAPC: Back to School
    Would like feed-back from other clinics an/or links to regulations regarding discounted fees.

    We offer a 20% discount for anyone who wishes to pay at the time of service. I feel we should bill their insurance the discounted fee. Other people in my office feel we should bill insurance the undiscounted fee.

  2. #2

    Default insurance

    Do you participate with the insurance companies you would be billing?

  3. #3
    Join Date
    Apr 2007
    Milwaukee WI

    Default Discounts = NO insurance bill

    If we offer a patient a "prompt pay" discount it is because the account will be self-pay.

    In those cases we will NOT bill insurance. Patient will receive a statement showing the fee, the discount and the payment with zero balance.

    If patient chooses to then submit to their insurance, they are on their own.

    NOTE: This scenario usually happens when we have already determined that the procedure is not covered by insurance. Or when we know in advance that the patient has no insurance coverage. Prompt pay discounts do NOT apply to prompt payment of statements for the balance due after insurance payment has been received (deductibles, co-pays).

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  4. #4

    Thumbs down Discounts

    In the scenario you described, whether you participate or not with a carrier, it is FRAUD to not give the carrier the discount as well. Pure and simple.

    And, under HIPAA CMP's, anyone that conspires to defraud ANY insurance (not just Medicare/Medicaid) can be fined and or imprisoned. This would include the biller and the provider and anyone else the was in on the decision to NOT give the carrier the discount.
    Much too risky if you ask me.
    Cyndee Weston, CPC, CMC, CMRS
    American Medical Billing Association
    AMBACode Coding Software
    2015 AMBA National Medical Billing Conference

  5. #5
    Join Date
    Apr 2007
    Charlotte, NC


    Pymnt in full and up front w/a discount is usually reserved for self-pay pt's as Tessa stated. The discount a patient receives if they have insurance is the contracted rate and pymnt reduction a provider has with a payor.

    Hence many practices do not offer a chance for a discount after the payor has paid, even if the patient is going to pay the balance in full. "You already received a discount when your 'insurance' processed and reimbursed our practice."

    As Cyndee said, if you give an insured patient a discount upfront for paying in full, then send the claim to the insurance for reimbursement w/o the discount, you are committing fraud. Practices have contracts w/insurances. Patients have contracts w/insurances including deductibles and co-insurance. You cannot forgive the patient their deductible or co-insurance or parts thereof unless the insurance did. Copays on the other hand can be forgiven (to my knowledge, but it's an across the board thing and has to be offered to everyone and also another argument for another time) but best not since that's "freeflowing" money collected up front and can be a lifeline of cash.

    Look at it like this, Medicare only allows so much, you can't bill the patient the leftover, that's balance billing. Same thing here in reverse, You allow the patient only so much but then bill the insurance, balance billing, and it's against most contracts.

  6. #6

    Wink Reduced charge for paying at time of service

    This was my thought exactly. "It is fraudulent to bill the insurance company for an amount greater than you are charging the patient". Thank you all for your responses.

    Eva Sorensen, CPC

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