Author Topic: self pay  (Read 3364 times)

wharta

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self pay
« on: July 26, 2011, 02:23:48 PM »
My drs office wants to have a fee schedule for a self pay pt. Are there any guidelines that we have to follow? Can we charge whatever we like, lets say we charge 100 for a procedure, insurance pays us 90, can we charge the pt 50? Or can we only charge a percentage less than our standard fee? I think I heard somewhere you can only charge no less than what insurance pays?

Billergirlnyc

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Re: self pay
« Reply #1 on: July 27, 2011, 12:11:42 AM »
The short answer is no, but let me explain why:

1. Your office news to put into place a hardship agreement for patients w/financial hardships. All offices need a written policy in place for this, and And you then need to apply that policy to all patients, including those with insurance.

2. I've never seen a separate fee schedule just for self-pay patients, and honestly since every single patient's financial situation is different, there shouldn't be a "one size fits all" policy in place, but there should be a written policy/hardship agreements, etc on how to handle self-paying patients. My clients are instructed to charge patients the same fee across the board meaning if they charge $150 for a consult to an insurance company, then they need to charge the same price to self-paying Non-Medicare patients. You basically can't charge less than you would charge insurance companies. You can check your state law on this, but I'm pretty sure this is the rule-of-thumb across the board. But, in order for you to offer a discount on your fees you need to also check with you state to see if there are any medical indigent provisions in place, which basically tell you how much you can discount based on the patient's income.

3. The hardship agreements I've seen my clients create involve extensive information from the patient, like proof of income, etc. Patients have a right to provide this information or not, but if they don't then most offices will seek full payment, but again the fee is not more or less than what they charge insurances. They also have provisions that protect the doctor and the patient. But in the case of reducing your fees these measures need to be taken to ensure you don't get accused of undercharging patients or routinely writing off balances for patients without health insurance.

4. You can't under-code the encounters/superbillers/chargemasters, etc so the SP patient is charged less, and in the case of Medicare patients you can't charge them them less than MC.
Don't worry. Be happy.
~Dalia, CPC, CPC-H, RHIT.

wharta

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Re: self pay
« Reply #2 on: July 27, 2011, 10:10:27 AM »
thats what i was thinking, we have to charge the same amount as our regular fee schedule, but we can offer  per say a courtesy dicount of about 20%?

DMK

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Re: self pay
« Reply #3 on: July 27, 2011, 11:51:15 AM »
You can have a cash rate for payment AT TIME OF SERVICE.  That means you can't invoice them for it and wait for payment, then you have to bill the same rate as the insurance company since you're waiting for them to pay as well.  It's a cash rate for payment the day of their appointment.  It can be a 30% discount, 50% discount etc.