Foundations of the Billing and Collections Process

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No Surprises

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As healthcare costs rise, some patients are left without health insurance coverage and are unable to afford out of pocket costs for much-needed chiropractic care. The provision for a hardship fee schedule within a practice’s fee system is perfectly legal when set up properly with policy and procedure.

For your hardship fee schedule to appropriately co-exist with other fee schedules in your practice fee system, you must set the standard up front, have qualifying factors, and verify eligibility. Use a standardized form and procedure when a hardship consideration is requested. Keep in mind, not everything qualifies as a financial hardship. For example, the following client statements are NOT considered financial hardships and DON’T qualify for discounted fees:

  • “I don’t have insurance”
  • “I have a high deductible on my insurance plan and can’t afford it”
  • “I don’t wanna pay that much”
  • “My other doctor didn’t charge for my copayments or deductible. He wrote off whatever I had to pay”
  • “Every patient on Medicaid, Medicare or with both a pulse and a spine gets hardship”
  • “The usual time of service discount for everyone is what I call a hardship discount”
    Hardship Fee Schedule

The regulations for hardship fees are quite broad and can be customized to your practice situation on a sliding scale. The most common sliding scale is the Federal Poverty Guidelines, as used in KMC University’s customizable Hardship Form. This sliding scale allows discounted fees according to need, up to the level of your actual fee or, if you are a ChiroHealthUSA member, its discounted fee.

A patient may request hardship assistance on an initial visit without providing the necessary documentation and verification but s/he should formally request hardship assistance and provide verification on the next regular visit. Hardship consideration for copayments, coinsurance and deductibles should be used sparingly and only after confirmation that the payer allows for these discounts.

A hardship fee schedule should never be set independently from the remainder of your practice fee system. It is a component that is part of an overall structure for compliant fees in the office. Hardship discounts should be discounted from the actual fee charged by the practice. When restructuring your practice’s fees, consider whether your patient demographics will benefit from a hardship option.


By Kathy Weidner

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