Downcoding Alternatives to Help Your Self-Pay Patients
Published on Mon Jun 01, 1998
Pediatricians tend to be a soft-hearted group -- after all, they have chosen to spend their entire working lives almost exclusively with children. And they also see a lot of young, growing families, many of whom are struggling to make ends meet. So its understandable if they want to try to make things easier for these parents. However, giving discounts can upset their fee schedule.
Andrew Sinder, MD, a pediatrician with Mandarin Internal Medicine and Pediatrics of Jacksonville, FL, is worried about this. I have a dilemma on my medical billing , he writes. When parents are paying out of pocket because they are self-pay, or they have not met their deductible, I find myself downcoding. With managed care, I bill it as accurately as possible. Although this may seem unethical, it is difficult for me to resolve this problem. What do you suggest?
First of all, stop downcoding. Secondly, stop feeling guilty -- your heart is in the right place.
Here are some points to keep in mind when struggling with this dilemma.
1. The fairness trap. Dont confuse what you view as fair or not fair with your emotions. We do feel sorry for them, says Melanie Hartley, office manager for Batesburg-Leesville Pediatrics of Batesburg, SC. But we dont downcode, she contends. Its not fair. Not fair to whom? Not to anybody -- the practice, the insurance companies or the other patients who are actually paying.
2. Offer a hardship fee reduction instead. Parents who really dont have the money can be offered a reduced fee if they can provide evidence of hardship. Even HCFA allows this, says Peg Stevenson, CPC, coder for Providence St. Peters Family Practice in Olympia, WA, a residency program with two pediatricians on staff. Unfortunately, this means asking the parents to bring in a pay stub, if they are employed, she adds.
3. Just because a patient is self-pay doesnt mean the money isnt there. If a pediatrician just has a gut feeling a parent cant afford the visit, the pediatrician should step back and ask why he or she feels that way, says Stevenson. Many people who have insurance are actually paying more in monthly premiums than the parent who doesnt have insurance and who brings in a child for a well visit once a year and an occasional illness, she notes. Maybe the fact that theyre self-pay means they dont mind paying medical bills, she relates.
4. Connect with a public health program. Stevenson believes that if a parent is paying out of pocket, its because they dont [...]
