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Patient Finances FAQ

Finances FAQ

Q: I have heard of doctors who do Free exams in order to get patients to come to their office. Is this legal?

A: Performing a health care service and not collecting your full fee for that service could be considered gifting or inducement which can indeed be considered a violation. Your fee is your fee. If you are charging anyone $X for a service, you must charge everyone that same fee, unless you have a contracted fee schedule in place which dictates a lower fee for that patient. Accepting a lower fee or no fee for that service is considered a dual fee schedule and puts your practice at risk.

Q: Sometimes we have patients come into the office who ask if we can discount their services because they have a reduced income. The doctor wants to help them. Is this okay?

A: Your office must have a written Financial Hardship policy which outlines how the fees are calculated based on the patient’s ability to pay. You cannot just discount fees based on what a patient tells you. You must be able to prove you reviewed their financial statements, such as a tax return or a bank statement and you compared that data to your Financial Hardship policy guidelines to determine what discount the patient might be eligible to receive.

Q: When we bill a carrier whom we are not contracted with, and the insurance does not allow the full amount of the charge, do we have to balance bill the patient for the difference between what we billed and the allowed amount, or can some of that money be written off if we choose to do so?

A: It sounds like you are submitting bills to insurance companies on the patient’s behalf even though you are non-participating with that carrier. If that is the case, you are not contractually obligated to write off the difference between the total charge and the allowed amount. If you choose not to collect the full fee that you billed and to write off the balance, this could be considered a dual fee schedule which is not compliant.

If you want to discount the fee for the patient, a true Discount Medical Plan Organization like ChiroHealthUSA is the safe way to do that.

Q: If you charge a patient the same amount for all services but do not make them pay the full amount is that legal. In other words, their insurance runs out and you charge them on the books $122.00 but only make them pay $65.00.

A: No, this is considered a dual fee schedule. If you are stating that your fees for these services are $122, then you must account for the patient paying the total $122. The only exceptions to this are any contracted fee schedules you have in place, like In Network Participation with an insurance carrier or enrollment in a Discount Medical Plan Organization like ChiroHealthUSA.

Q: How can we effectively explain to Medicare patients that exams and re-exams are a requirement under Medicare rules even though they’re not a covered service?

A: We really like to use the Patient Media Medicare brochures and the Medicare Worksheet. Both offer succinct, easy-to-understand language for patients.

Q: I offer free consultations to patients to familiarize them with chiropractic and it also allows us to help a patient determine if they are a good fit for our care. Unfortunately, they occasionally end up turning into “free initial visits.” What can I do to avoid this situation from happening? The patient often wants to move forward with an exam the day of consultation, but they have “free” stuck in their head, and seem shocked when expected to pay for the actual exam.

A: One of the most dangerous compliance violations we see is offering free consultations that turn into free first visits. It’s important to distinguish what will be at no charge on an initial visit and what must be billable. The pre-acceptance interview process is excellent for practices that wish to offer a patient the chance to find out if they are a good candidate for chiropractic care. We can help you establish a process and scripting to help you avoid the risky pitfall of inducement. 


Q: My patients often have uncovered services that we charge a discounted price for. We're implementing pay plans, and this will cause us to no longer be able to offer the “time-of-service” discount. Is there any way to help the patient get a discount?

A: We recommend using a Discount Medical Plan Organization (DMPO). The cost to you is free, and patients can join for just $49 per year per family in order to receive legal discounts based on your actual fee schedule We highly recommend ChiroHealthUSA.


Q: My patient was sent to collections and is now saying we never even billed her after we billed her three times with no response! What can we do?

A: The practice’s collection efforts should be documented in the patient’s file with copies of the bill(s), follow-up letters, reports of telephone and personal contact, etc. There should be extensive notes of any payment arrangements that were made and/or defaulted on or any reasons patient has given you for non-payment. All notes should be date- and time-stamped for accuracy. If these actions are not documented, you may want to decide if you're willing to eat this one due to lack of information on your part, then work quickly to get your policy and procedures in order to ensure this doesn’t happen again! DOCUMENT, DOCUMENT, DOCUMENT!