Discounts

December 7th, 2016 - Wyn Staheli, Director of Research
Categories:   Reimbursement   Billing   Compliance  
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All healthcare providers need to be aware that there are both appropriate and inappropriate ways to discount your fees. Both state and federal laws can impact your practice financial policy regarding fee discounts. Additionally, we recommend carefully reviewing Chapter 1.5 - Establishing Fees of a specialty specific Reimbursement Guide book for important information on fee schedules and discounts.

Different types of healthcare discount programs are available in the market today and providers need to understand that discount programs are NOT health insurance. Not all discount programs are created equal. Some are not entirely legitimate.

Before signing up; carefully evaluate any healthcare discount program by asking the following questions:

  1. Are they properly registered, approved or licensed if required in your state and do they meet all state regulations?
  2. What are the enrollment costs/fees? The costs for either the provider and/or the patient might not balance out any benefits.
  3. What are the provider's renewal and cancellation fees? Do you have the ability to opt-out at any time?
  4. Do they offer refunds as required by state regulations? If so, what are those refund policies for both the patient and the provider?
  5. What does the BBB say about them? Not every business has a BBB rating, but if they have complaints, that could be a red flag.
  6. What about Medicare? If you see patient's over age 65, you need to be aware of all Medicare rules and regulations and how this plan affects your Medicare patients and your practice billing policies.
  7. Is the plan owned by an insurance carrier?
  8. Are the discounts set by the plan or do the providers have the options to choose the level of discounts and services that will be discounted?
  9. Does the plan have the ability to "sell or rent" your name creating silent PPO activity?

TIP:  Do your homework before signing up for anything.  If you exercise proper due diligence, you can avoid "buyers remorse."

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