Breaking federal anti-kickback laws is only one of the obstacles anesthesia providers face when considering providing discounts for services.
Tony Mira, founder of MiraMed's subsidiary Anesthesia Business Consultants, laid out what to consider when "browsing the discount rack."
Insurance-only discounts:
Providing discounts to insured patients often means the provider bills the insurer for the full allowable amount, but forgives the patient's portion. This is against the federal Anti-Kickback Statute, Mr. Mira said.
Waiving copayment obligations for commercial insurance, however, can also be tricky because private health plans have successfully challenged waiving copayments in the courts for claims of "false billing" or "breach of contract."
Mr. Mira recommends steering clear of these discounts.
Professional courtesy discounts:
There is no federal exception that allows providers to waive or reduce the patient's financial responsibility because the patient is a medical professional or a member of their family, he said. Providers could offer reduced pricing for commercial insurance beneficiaries for professional courtesy if they have followed these three steps:
- The provider group adopts a professional courtesy policy.
- The discount applies to an entire class of patients in that market area, and not just their typical referral sources.
- The percentage of discount given to the beneficiary is applied to the insurer as well.
Most providers have ended this practice, however.
Prompt pay discounts:
Some providers offer a discount for early payment of the bulk of the patient balance, in order to avoid the cost of collection on the back end. But there is no provision that explicitly allows an individual practitioner to offer a prompt pay discount to beneficiaries of a federal health program, Mr. Mira said.
For commercial payers that do not prohibit this practice, these discounts may be a possibility. But there is still the potential for fraud depending on state or federal law, so Mr. Mira recommends avoiding these as well.
The hardship discount exception:
A discount or waiver of the patient's portion of the bill can occur — for both federal and commercial health plan beneficiaries — where the provider has made "reasonable efforts" to collect and where the beneficiary has provided notification to the provider of their "financial hardship."
Mr. Mira recommends attempting to contact the patient two to three times before considering the discount, and for a beneficiary to send documentation of their hardship.
Read a more detailed report of Mr. Mira's recommendations here.