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