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Insurance Fee Schedule/Self Pay Fee schedule

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mforgione:
Question: My clients (client 1) bill to insurance a set fee schedule. They charge their patients who do not have insurance or who have insurance for which they do not par with the same rate...however, since it is the same price (self pay and insurance rate)it seems legit to me...I have another client who bills out services to the insurance company at one rate which is coded appropriately and for self pay patients she states ie, 99205 is 275-she calls this a new patient visit and a 99214 is 150 and she calls this a follow up.
If she makes the financial hardship income $250,000 can she (second client I mentioned) do a sliding scale for patients? Does she have to have this policy written up in a handbook? The second client stated that she felt she can charge cash patients whatever she wanted. I read some other posts in the forum and am slightly confused now.
Please advise

DMK:
Financial policies should absolutely be written up and strictly adhered to.  There should be a set rate for patient pay and a policy for hardship.  It should NOT be different rates for different people.

Patient's do get frustrated when they change insurance and their portion changes.  Blue Cross pays much less to contracted providers than Blue Shield does.  So if the patient has a high deductible, they end up paying a lot more out of pocket and they want to know why.  It's a hard discussion.  It's easier, though, when they present their card and you tell them right up front what they can expect to pay out of pocket.  Then there's no surprises.

sandyb52:
Do I understand correctly that it is ok to charge self-pay patients a certain amount that is lower/different than that charged an insurance?

DMK:
You can have a cash discount.  You should still enter the SAME charges as your insurance fee schedule (which should be them same rate you charge ALL insurance other than worker's comp), then have a line item showing the cash discount.

mforgione:
Thank you! :)

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