Discount Fees for Cash Patients

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How do you handle cash patients to provide discounts without running afoul of state & federal law? There seem to be misconceptions regarding this topic. And as a result, some of you get frustrated attempting to handle this properly in ECLIPSE. So, here are a few facts & tips from Dr. Walters’ practice:

  • State laws vary with regard to the concept of multi-tier fee-for-service billing. In NJ, the law specifically prohibits healthcare providers from charging, as an example, one fee to Aetna & another [discounted] fee to cash patient John Smith for an office visit.
  • A common mistake is the notion that “adjusting” a fixed amount from your standard fee legally justifies the lower fee. This may be fine for occasional use with a small percentage of cash patients, but is otherwise “proof of fraud” from the perspective of a commercial payer. Auditors will simply review the overall percentage in your records, note the obvious pattern, and possibly refer you for prosecution.
  • One easy solution is to have an attorney create a contract that meets the laws in your state. The contract between you & your patient creates an alternative to the fee-for-service concept (e.g. a monthly charge without a visit limit, possibly for maintenance care).
  • Once you have a defined path, there are two ways to approach & record this information in ECLIPSE. First, create a billing profile for these patients. Then, if multi-tier billing is legal where you practice, create codes with the proper fees to avoid using adjustments to “fix” a problem that shouldn’t exist. Otherwise, create $0.00 versions of your visit codes & separately bill your patient with a new “contract’ code that properly represents the contracted fee structure (e.g. $250/quarter). You can create billing reminders to ensure you enter & bill out your contract codes.