Discounts

December 7th, 2016 - Wyn Staheli, Director of Research
Categories:   Reimbursement   Billing   Compliance  

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."

Links

Articles & Quick Questions

 

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

Artificial Intelligence in Healthcare - A Medical Coder's Perspective
December 26th, 2023 - Aimee Wilcox
We constantly hear how AI is creeping into every aspect of healthcare but what does that mean for medical coders and how can we better understand the language used in the codeset? Will AI take my place or will I learn with it and become an integral part of the process that uses AI to enhance my abilities? 
Specialization: Your Advantage as a Medical Coding Contractor
December 22nd, 2023 - Find-A-Code
Medical coding contractors offer a valuable service to healthcare providers who would rather outsource coding and billing rather than handling things in-house. Some contractors are better than others, but there is one thing they all have in common: the need to present some sort of value proposition in order to land new clients. As a contractor, your value proposition is the advantage you offer. And that advantage is specialization.
ICD-10-CM Coding of Chronic Obstructive Pulmonary Disease (COPD)
December 19th, 2023 - Aimee Wilcox
Chronic respiratory disease is on the top 10 chronic disease list published by the National Institutes of Health (NIH). Although it is a chronic condition, it may be stable for some time and then suddenly become exacerbated and even impacted by another acute respiratory illness, such as bronchitis, RSV, or COVID-19. Understanding the nuances associated with the condition and how to properly assign ICD-10-CM codes is beneficial.
Changes to COVID-19 Vaccines Strike Again
December 12th, 2023 - Aimee Wilcox
According to the FDA, CDC, and other alphabet soup entities, the old COVID-19 vaccines are no longer able to treat the variants experienced today so new vaccines have been given the emergency use authorization to take the place of the old vaccines. No sooner was the updated 2024 CPT codebook published when 50 of the codes in it were deleted, some of which were being newly added for 2024.
Updated ICD-10-CM Codes for Appendicitis
November 14th, 2023 - Aimee Wilcox
With approximately 250,000 cases of acute appendicitis diagnosed annually in the United States, coding updates were made to ensure high-specificity coding could be achieved when reporting these diagnoses. While appendicitis almost equally affects both men and women, the type of appendicitis varies, as dose the risk of infection, sepsis, and perforation.
COVID Vaccine Coding Changes as of November 1, 2023
October 26th, 2023 - Wyn Staheli
COVID vaccine changes due to the end of the PHE as of November 1, 2023 are addressed in this article.
Medicare Guidance Changes for E/M Services
October 11th, 2023 - Wyn Staheli
2023 brought quite a few changes to Evaluation and management (E/M) services. The significant revisions as noted in the CPT codebook were welcome changes to bring other E/M services more in line with the changes that took place with Office or Other Outpatient Services a few years ago. As part of CMS’ Medicare Learning Network, the “Evaluation and Management Services Guide” publication was finally updated as of August 2023 to include the changes that took place in 2023. If you take a look at the new publication (see references below),....



Home About Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2024 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association