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Cash Fees Vs. Insurance Fees

  1. Default Cash Fees Vs. Insurance Fees
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    I'm brand new to the group, I hope I'm posting this in the right forum. I deal with mostly out-of-network providers, across the country, so we don't usually have contracts to worry about. I have had insurance lawyers tell me that providers can offer discounted rates to their cash-pay clients but still bill full fees to insurance, as long as they aren't contracted. Is this true? Does anyone know where I can find the laws that govern this, if applicable? I have providers asking general questions about the rules governing their ability to offer discounts to their clients, cash pay or insurance. Do these laws vary by state? If someone can point me in the right direction, that would be wonderful.

    Thank you! ~ Christine

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    Quote Originally Posted by christine.larsen@larsenbilling.com View Post
    I'm brand new to the group, I hope I'm posting this in the right forum. I deal with mostly out-of-network providers, across the country, so we don't usually have contracts to worry about. I have had insurance lawyers tell me that providers can offer discounted rates to their cash-pay clients but still bill full fees to insurance, as long as they aren't contracted. Is this true? Does anyone know where I can find the laws that govern this, if applicable? I have providers asking general questions about the rules governing their ability to offer discounts to their clients, cash pay or insurance. Do these laws vary by state? If someone can point me in the right direction, that would be wonderful.

    Thank you! ~ Christine
    There is no law about providing cash discounts. There are guidelines that state it is best to keep the discounted cash pay rate at about the same as the Medicare allowable for your area. This exact discussion has been taking place in a couple of other forum threads. Basically you charge the patients all the same rate, but for cash pay you have a specific discount that is the same across the board. Most providers end up having to write off portions of their fees for commercial payors and for Medicare and Medicaid, so they can also have write offs for cash pay patients. You just have to be sure you don't go under the Medicare allowable rate. If you type a search into "google" or one of the other search engines you will find all kinds of information.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

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