Practice Management Alert

Question: When it is appropriate for a provider to give discounts? Should we give discounts for preventive physicals when a patient's insurance doesn't pay? Also, if a patient's primary insurance pays on a claim and his secondary insurance is filed but only pays a small amount, should the remaining balance be the patient's responsibility or a discount?

Indiana Subscriber

Answer: Discounts should be given only to patients who prove financial hardship. The only way a patient is not responsible for a remaining balance is if you are dealing with a contractual payer. With a contractual payer, your practice has agreed to accept the carrier's fee on covered services and not to balance bill the patient. Based on your question, it appears you are talking about a noncontractual payer. In this case, you should bill the patient for any remaining balance. The patient would also be responsible for the bill if you were dealing with a noncovered service under a contractual payer.

Many payers including Medicare do not pay for preventive exams. You should make it a standard policy to inform patients of this when they call to schedule a preventive exam.

While patients should know if the service is covered, they often do not. Ask the patient to check if the service is covered, or have your office staff check the patient's insurance policy to find out. If the preventive exam will not be covered, tell the patient you will expect payment at the time of the visit.

Caution: You need to be very careful about giving discounts because investigators may consider it discriminatory if you don't give them consistently across the board. Develop a written policy on discounts if your office doesn't already have one. The only circumstance that should merit a discount is financial hardship, and your policy should outline exactly what qualifies a patient for financial-hardship status. And offering discounts across the board for noncovered services is not a good policy because it could mean your practice will miss out on a lot of money.

-- The answers to the Reader Questions were provided by Catherine Brink, CMM, CPC, president of HealthCare Resource Management Inc. in Spring Lake, N.J.; Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia; and Judy Richardson, MSA, RN, CCS-P, senior consultant with Hill & Associates in Wilmington, N.C.