What can I charge my patients?
Reprinted by permission from the Ohio State Chiropractic Association’s newsletter, Just the Facts, January/February 1998
If you know anything about anti-trust laws, you’re probably surprised by the title of this article. Anti-trust laws forbid the Ohio State Chiropractic Association (OSCA) from discussing fees. But OSCA can offer some guidance since we receive many questions about the legality of different payment plans that doctors create to allow them to better compete in today’s difficult marketplace.
Here are some of those questions: Q: Can I increase my charges to insurance carriers?
A: No. You cannot increase your fees if you are billing third parties. Even though the cost of billing to insurance carriers has greatly increased over the years, Ohio law precludes you from increasing fees billed to third-party payers.
Q: Can I offer my patients a cash discount?
A: Erase the words “cash discount” from your vocabulary. Cash discounts invite charges that you are increasing fees billed to insurance carriers. Instead of offering a cash discount, you can offer your patients a time-of-service discount (TOS). This TOS discount simply means that the patient pays when the services are provided.
It is critical to understand that if the patient submits his or her bill to the insurance carrier after paying at the time of service, the amount billed to the carrier must be the amount paid by the patient at the time of service. In other words, you are providing the same TOS discount to the insurance carrier. There is no increase of fees to the third party.
Q: How much can I discount for TOS if I decide to make this an option?
A: OSCA cannot suggest an amount. However, if the amount is out of proportion to the administrative costs of submitting paperwork and the hassles associated with waiting for your money, you could be accused of offering a discount that is a de facto increase to insurance carriers.
Q: Can I reduce fees for patients who can’t afford care?
A: You may always offer a hardship discount on an individual basis to your patients.
Q: What documentation do I have to complete to offer a hardship discount?
A: There is no hard and fast rule that says each hardship case requires a disclosure of certain information. Some practice management groups offer hardship forms that request disclosure of some financial information to demonstrate that you are making individual decisions as to hardship discounts.
Q: Can I offer a hardship discount to all cash patients?
A: No. You should individualize your hardship decisions. If every cash patient is a “hardship,” you open yourself up to accusations that you are increasing fees for insurance.
Approaching patients about financial hardship may be difficult. You may want to include this statement in your intake form: The doctors of Chiropractic Office want to know if you have any financial hardship that makes it difficult for you to complete your treatment plan. Please feel free to discuss this matter with and we will do our utmost to accommodate you.
Q: Can I wave deductibles and copayments?
A: Most state laws provide that you cannot waive deductibles and copayments as an enticement to attract patients. This law applies to all providers and effectively has stopped the advertising of NOOPE. You should be careful if you consider waiving co-payments and deductibles under any circumstance. Many insurance contracts provide that you must attempt to collect these amounts from the patient, or the carrier is not liable to pay you.
Q: Can I offer patients the right to prepay for their care at a discounted rate?
A: There has been a great deal of discussion in the chiropractic press regarding patient prepaid discount plans. We feel comfortable advising our doctors that prepaid plans are acceptable if they offer patients a specific number of visits and then give a discount for prepayment.
These types of plans do not appear to be the business of insurance in Ohio. However, plans that offer unlimited care may violate Ohio insurance laws since the doctor is theoretically accepting the “risk” of unlimited care. Doctors should avoid these plans.
Q: Are there any risks when offering these plans?
A: Defense attorneys in personal injury cases look for differences in payment plans to give an appearance that the doctor has raised fees because it is an accident case. Fraud investigators have asked doctors about their billing practices.
Q: Can I offer “free” services to patients but bill the insurance carrier?
A: No. “Free” is free. IS it is offered to patients at no charge, the insurance carrier should not receive a bill.
What you charge your patients is a personal decision. Consistency and reasonableness should serve as your guide.
BY OSCA ETHICS CHAIRPESON DR. GREG GOFFE AND OSCA GENERAL COUNSEL ROB SHERMAN
Copyright American Chiropractic Association Jan 1999
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