Cash Pay

[TXBiller]

Hi All

How do you determine what your cash prices are for services in your office?

TIA

[PMRNC]

The best option is ONE fee schedule and then your practice financial policy should indicate a discount for cash pay patients. One fee schedule is best so that you always have the ability to analyze the practices adjustments.

[TXBiller]

So do you mean take the allowable amount and offer the discount say 20% or whatever we decide upon?

[PMRNC]

When you are setting fees you can do so by setting them at 100%-300% of Medicare allowable. Once your fee is set and you have a cash pay patient you would give them discount off the actual billed amount. I'm assuming you mean for patients you are out of network with? If in network you need to look at your contract, you cannot discount the patient and not give carrier the same discount. 

For example:   You set fee for 99213 at $200  Your practice financial policy allows for 20% cash discount for those with no insurance or not using their insurance, you would give 20% off the $200.

[TXBiller]

Where can I go to learn more about the 100% to 300% you refer to?

TIA

[Michele]

What are you looking to find out?  Linda is stating that most providers use the Medicare allowed amount as a guide to setting their fees.  Most providers go somewhere from 140-200% but some go as low as 100% and some go as high as 300%.

For example if the Medicare allowed amount for 99213 is $80, a provider can choose to set their fee for 99213 from $80 - $240.  Most would fall into a range of $112 to $160.