I am trying to find a way to apply a discount to procedure fees by patient (i.e. sliding scale). For example, I would like to give one patient a 25% discount on all of our procedures across the board, and perhaps a 30% discount to another patient. I want to find a way to save that discount level so that every time there is an encounter, billing staff need only to select the procedure, and the discount is automatically applied. Can anyone think of a way to apply that discount across all procedures? Thanks!
If coding is not done, you could have 2 additional fee schedules for the discounts. In the place of the usual and customary fee, say $100 for 92012; there can be 92012A with a fee of $75.
Two big problems come to mind however.
First, staff will have to keep the fee schedules separate in their mind for insurance billing. Don’t want to give the insurance carriers more discount than necessary.
Second, Medicare and insurers frown heavily on different fee schedules. If they catch wind of this, they will insist upon using the most heavily discounted fee schedule as the usual and customary fees. If this is done once in a blue moon for a patient in extreme financial difficulties, a practice can probably get away with it. If it’s done on a routine basis, Medicare may demand a refund for “overpayment”.
It may be wiser to give the occasional break to a needy patient discretely than to institute a change across the board and subject the practice to entanglement with Medicare and insurers.