Author Topic: "Time of Service" Discounts?  (Read 5773 times)

PMRNC

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Re: "Time of Service" Discounts?
« Reply #15 on: February 05, 2013, 02:27:50 PM »
Dear Christy, did you take my advice to be that of a legal opinion?  I don't think you did, I pretty much think people realize this is not an attorney's forum and that indeed many situations call for just a common sense answer above a legal one. Everyone is WELCOME to do their own research, seek their own legal opinions. I'm not going to modify my answer in any regards because I still say common sense prevails over legal ones. I've never even had a client push like that, they are welcome to check my answers with their own attorney at their own cost. I'm not going to play lawyer just to appease one person in a public forum. Christy is pretty smart and I'm pretty sure she figured this one out.
Linda Walker
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Christy

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Re: "Time of Service" Discounts?
« Reply #16 on: February 05, 2013, 04:33:11 PM »
Quote
It really isn't illegal as long as the cash patient is not billing a diff rate to an insurance carrier. I've seen providers who provide this discount and then give patient a superbill with the regular contracted rates to which they submit and get MORE back. THAT is illegal on both provider and patient's part.   Providers can indeed give a cash discount, they just have to show it on the bill as a courtesy cash payment and they also have to adhere to ONE policy in their office financial policy. For example they can't just charge Mrs. Smith $50 (no insurance, cash pay) and then charge Mr. Black $40 (also no insurance cash pay)   ONE policy for all cash pay discounts.

Linda- this answered my question perfectly! It made perfect "real life scenario" sense....

I am always appreciative of your no nonsense, easy to interpret advice! Rock on, lady! ;D

PMRNC

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Re: "Time of Service" Discounts?
« Reply #17 on: February 05, 2013, 05:07:03 PM »
Oh Christy.. I just realized. I did say
Quote
It really isn't illegal

Linda Walker
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RichardP

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Re: "Time of Service" Discounts?
« Reply #18 on: February 06, 2013, 07:15:10 PM »
Christy said:  Linda- this answered my question perfectly! It made perfect "real life scenario" sense....

Christy - just as long as you realize that the following part of what you quoted is not a correct statement.  Physicians and hospitals are allowed to discriminate in pricing within the constraints mentioned above.

Providers ... just have to show it on the bill as a courtesy cash payment and they also have to adhere to ONE policy in their office financial policy. For example they can't just charge Mrs. Smith $50 (no insurance, cash pay) and then charge Mr. Black $40 (also no insurance cash pay)   ONE policy for all cash pay discounts.

There is no such requirement, as stated in that quote,  for cash patients in the law.  Which, of course, is a point completely separate from what procedure you might wish to impose on your client.

And Linda - I made my point, which was really a simple one, and I'll let the issue go with this.  The question asked was what is the legality.  An answer was provided to that question.  Future readers, particularly newbies, might have taken your response to be the law, since you did not say it was only your personal opinion.

I've made my point.  I assume we all care about the credibility of this site.  When someone asks about the legality of something, it helps our credibility to label our response as personal opinion when it is personal opinion.  And it helps when we can provide links to supporting documentation when our response is not just personal opinion.  I assume you agree with me that this is a useful point for everybody to keep in mind.

Beyond that, thanks for the civil discourse - and I'm done with this particular thread.
« Last Edit: February 06, 2013, 07:24:39 PM by RichardP »

RichardP

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Re: "Time of Service" Discounts?
« Reply #19 on: February 06, 2013, 07:57:52 PM »
Linda - I have a question that is sort of related to what we have been discussing here - so I'll ask my question here.

The thing that prompted my question is this.  You said:  It really isn't illegal as long as the cash patient is not billing a diff rate to an insurance carrier.  The assumption being that is IS illegal if the cash patient IS billing a different rate to an insurance carrier.

Question:  Can a provider let a patient be a cash patient if the provider is a participating provider with the same insurance that the cash patient has?

Perhaps this is an issue of semantics??  Perhaps your definition of cash patient is different from mine?  Some of our clients' patients pay the doctor cash for the visit, and we bill the insurance as a courtesy for the patient - even when the doctor is not participating in their insurance plan.  Because we bill the insurance on their behalf, we do not call these patients cash patients, even though they paid the bill in full on the date of service.  Cash patients for us are only those patients who have no insurance, we do no billing, and they pay the doctor in full on the date of service.  All of my comments above use this definition.  All of my comments about the doctor is free to discriminate in the pricing of his services to cash patients use this definition - the cash patient has no insurance.  If your definition is different, that would explain some crossed wires in this thread.

PMRNC

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Re: "Time of Service" Discounts?
« Reply #20 on: February 07, 2013, 10:45:45 AM »
I was referencing cash pay patients only NO insurance at all as that would be completely different.   If a provider is taking cash, insurance is non par the provider can provide a cash pay discount but that same discount has to be billed to the insurance. If you want to question that legality, go to any insurance policy booklet under "cost sharing"   If a doctor has two patients with same insurance and one pays cash and the other just pays their out of pocket, the doctor has to just make sure he is billing the same fee to both carriers and reporting each payment. A patient's "COST SHARING" is a provision / contractual provision of their policy.
Linda Walker
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www.billerswebsite.com

RichardP

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Re: "Time of Service" Discounts?
« Reply #21 on: February 07, 2013, 02:19:36 PM »
Thanks.

My point was, a doctor or hospital is free to disciminate in pricing except where constrained by state, Federal, or insurance carrier regulations.  The point you make is valid.  It is an example of a restraint / constraint placed on price discrimination.

And because we bill insurance as a courtesy to those who pay cash but have insurance, we are ensuring that the patient will not try to bill the insurance company for a fee different from what the doctor charged him.  This type of billing is a courtesy to the patient, but it is also insurance for us against any sort of snafu developing from leaving the patient to bill on his own.
« Last Edit: February 07, 2013, 02:25:13 PM by RichardP »