Recently, one of our team members came back from an event frustrated. After speaking about the risks associated with improper discounting and faulty financial and collection policies, she was told more than once, “I don’t care what the regulations say. My state says I can charge whatever I want.” And some states do, but the Office of Inspector General and many provider agreements disagree. When a provider presents a lower fee schedule for cash patients and bills their higher “usual and customary” fees to insurance companies, it has clear implications of a dual fee schedule at the least, and at the worst, potential violation of provider agreements or inducement regulations. And more recently, creates scrutiny by PI carriers who find out you have lower fees for cash patients.
I have never shied away from sharing my most painful day in practice. I treated Mrs. Jones and her family for years. She did not have insurance and I charged her my “cash” fee. One day, Mrs. Jones was in an automobile accident and I began treating her for her accident-related injuries. So what was the problem? I billed my “normal fees” to her auto insurance which most all of us would do. When I walked into the treatment room to see Mrs. Jones on her next visit, I could tell instantly that something was wrong. She quickly crossed the room, pointed her finger in my face and said, “It is doctors like you, ripping off insurance companies, that keep me and my family from affording insurance.”
I was stunned. Where had this come from? I had been treating this family for years. Then I noticed the EOB in her other hand. I took a deep breath, “Mrs. Jones, the only mistake I made was in not letting you know that I was helping you and your family by charging you my ‘cash fee’ and you never knew what my normal fees were.”
At that time, my state did not have a rule against dual fee schedules. Technically, my state allowed me to charge whatever I wanted, but that did not stop me from being reported to my State Attorney General. I also lost a really good patient.
51% of US Adults have seen a chiropractor in the last 5 years, yet only 10-15% of the population is seeking regular chiropractic care. What if, when we think we are helping patients, we are unknowingly causing a negative impact on their perception of our profession. There is a right way and a wrong way to help your patients. I did it the wrong way with Mrs. Jones.
Today, my intentions are to help other chiropractors avoid the mistakes I made and help their patients in the right way. We have found a transparent way to help all of your patients get the care they need at a price they can afford. The network approach to discounts reduces the risks of compliance and OIG violations related to inducements, improper down-coding, dual fee schedules, and potentially inappropriate time-of-service discounts. To learn more about how we are helping clinics throughout the country protect and grow their practices, visit https://www.chirohealthusa.com/show.
Dr. Ray Foxworth is the President of ChiroHealthUSA and is a certified Medical Compliance Specialist. He has served for over 20 years on the Medicare Carrier Advisory Committee and served 4 years as Staff Chiropractor for the G.V. Sonny Montgomery VA Medical Center. He is past president of ConservaCareCorp, a network selected by the State of Mississippi to serve over 195K State employees and teachers. He maintains his practice on NewSouth Professional Campus, which is home to a large multidisciplinary spine center offering services ranging from chiropractic to neurosurgery. He is “in the trenches” on a daily basis facing the same challenges with billing, coding and compliance issues just like many of you.