Payments > Patient Billing

self pay prices


Does anyone know if there is a "rule" about how much you can bill a self pay patient?

I have some people saying the minimum we have to charge is the Medicare allowable amount (fee schedule) and others saying the maximum we can charge is the Medicare allowable....

Does anyone have in input on this?


Here is a nice article about this subject:

Here is where it addresses your main question, I have bolded the key part:

"Furthermore, regardless of a practice’s participation status with commercial carriers, if the practice is a Medicare provider, then it must not discount below the fee charged to Medicare – and most especially, the Medicare allowable, as Medicare law prohibits you from submitting Medicare claims that contain charges substantially in excess of your usual charges.  If the discounts consistently dipped below the billed fees, then Medicare would deem that new lower price to be the practice’s standard/customary fee."

So you can go maximum or minimum, but not under minimum for Medicare.

The practices I bill for all have a set self-pay fee schedule, and it is always the Medicare allowable, it is just easiest that way. To my knowledge, you cannot charge different self-pay amounts to different patients, it has to be the same across the board. If anyone has other info, I hope they chime in.

We do the same "self pay" prices for any and all self pay patients that come in.  We use the Medicare allowable for our area and then mark it up some to an even dollar amount.  My providers were curious how others did their self pay fee schedules and to make sure we aren't under/over charging anyone.

Jennifer  8)


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