Ron:
I do believe that Ann is right. To the best of my knowledge, since you are
enrolled in the Medicare program, you cannot discriminate between medicare
patients and private-pays. You wil have to charge them the same or no
greater than I believe 115% (non-par value) of the fee-schedule. I can't
find the exact citations currently. I also remember reading that exceptions
are allowed if you can prove the client's financial inabilities to pay
(i.e., you waived it based on financial proof) or you made all honest
attempts (3) to obtain the correct payment.
I found one other exception on the Medlearn site:
" As provided in ยง4507 of the Balanced Budget Act of 1997, a "private
contract" is a contract between a Medicare beneficiary and a physician or
other practitioner who has "opted out" of Medicare for 2 years for all
covered items and services he/she furnishes to Medicare beneficiaries. In a
private contract, the Medicare beneficiary agrees to give up Medicare
payment for services furnished by the physician or practitioner and to pay
the physician or practitioner without regard to any limits that would
otherwise apply to what the physician or practitioner could charge."
Joe
----- Original Message -----
From: "Wendy, Dynamic Learning Online, Inc." <[EMAIL PROTECTED]>
To: <[email protected]>
Sent: Monday, July 25, 2005 3:23 PM
Subject: Re: [OTlist] Conflict question
>Can I legally and ethically bill the patient for
less than what I would bill Medicare?
I have an example that isn't the exact same situation but may be helpful.
My chiropractor has a special "cash" patient rate of $40 per visit, which
covers everything he does and every modality he uses during a particular
session. The same session billed to insurance would include separate
charges for each technique and modality and might be, for example, $80.
With cash patients, he doesn't have to bother with extra paperwork and
filing with insurance, and he also receives payment immediately, so a
discount for patients paying cash is appropriate. Also, he doesn't
necessarily receive the full billed amount from insurance companies -- he
only receives the contracted rate. So, perhaps he would receive $50 from
a patient's insurance company but $40 from a patient with no insurance.
It doesn't end up being much of a difference.
I actually have insurance coverage for chiropractic, but it ends up being
a better deal for me to just pay cash! : )
Hope this helps you. In short, I say yes, it would be legal, ethical and
appropriate to bill this patient less for cash services for several
reasons. : )
~Wendy B. (MS,OTR)
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