I've always told my clients sometimes it makes sense to pay cash for a test instead of going through insurance on a case by case basis. My client's doctor said the client is not allowed to do it because it is illegal. Has anyone ever heard of this that it is illegal to do?
Choosing to self pay
- Thread starter SamIam
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Although the Centers for Medicare and Medicaid Services (CMS) and the Office of Inspector General for the Department of Health and Human Services (OIG) are not alarmed by the occasional waiver of copayment obligations – due to financial hardship or uncollectibility – the routine waiver of copayment obligations under Medicare is clearly problematic.
The federal antikickback statute prohibits the offering of any remuneration to induce a person to purchase or order any service for which payment may be made under Medicare. The routine waiver of a patient's copayment obligations implicates this prohibition because it reduces the amount that the patient pays for services, and may therefore induce the patient to seek more services that are payable by Medicare. The OIG has promulgated regulations defining and further specifying those payment practices which will not subject providers to penalties under the antikickback statute – so-called safe harbors. When discussing the propriety of discounts, the OIG stated unequivocally that safe harbor protection does not apply to any discount offered to beneficiaries in the form of "a reduction in price offered to a beneficiary (such as a routine reduction or waiver of any coinsurance or deductible amount owed by a program beneficiary)." 42 C.F.R. § 1001.952(h)(5)(iv).
Based on these concerns, offering any type of discount to Medicare beneficiaries is inadvisable. The OIG may take the position that the waiver of copayment obligations on the basis of anything other than specific determinations of indigence, hardship or uncollectibility is offered to induce the purchasing or ordering of Medicare reimbursable services, and this can lead to prosecution under the antikickback statute. Alternatively, it risks the determination that your actual charges are less than the Medicare fee schedule and that your reimbursement should be reduced accordingly.
www.bakerdonelson.com
The federal antikickback statute prohibits the offering of any remuneration to induce a person to purchase or order any service for which payment may be made under Medicare. The routine waiver of a patient's copayment obligations implicates this prohibition because it reduces the amount that the patient pays for services, and may therefore induce the patient to seek more services that are payable by Medicare. The OIG has promulgated regulations defining and further specifying those payment practices which will not subject providers to penalties under the antikickback statute – so-called safe harbors. When discussing the propriety of discounts, the OIG stated unequivocally that safe harbor protection does not apply to any discount offered to beneficiaries in the form of "a reduction in price offered to a beneficiary (such as a routine reduction or waiver of any coinsurance or deductible amount owed by a program beneficiary)." 42 C.F.R. § 1001.952(h)(5)(iv).
Based on these concerns, offering any type of discount to Medicare beneficiaries is inadvisable. The OIG may take the position that the waiver of copayment obligations on the basis of anything other than specific determinations of indigence, hardship or uncollectibility is offered to induce the purchasing or ordering of Medicare reimbursable services, and this can lead to prosecution under the antikickback statute. Alternatively, it risks the determination that your actual charges are less than the Medicare fee schedule and that your reimbursement should be reduced accordingly.
Health Care Providers May Waive Patients' Copayment Obligations, But...
In a difficult economic environment, many health care providers are actively trying to increase cash flow and reduce administrative expenses.
Apparently in California not having insurance is a good idea
A father calls about his daughter's ambulance bill…
If he was uninsured… $600
Insured: $1300
California's Healthcare system is punishing people who have insurance
Is $1300 the gross amount billed before repricing? (Assumes the ambulance is in network)
If he was uninsured… $600
Insured: $1300
California's Healthcare system is punishing people who have insurance
Is $1300 the gross amount billed before repricing? (Assumes the ambulance is in network)
- 31,149
I thought I heard the ambulance company say that his insurance company was billed $2,700, and after they paid, the balance was $1,300.
I didn't play the video,only read the summary.
Playing the video reveals that guy is not playing with a full deck. He wants to cancel his insurance to get a lower rate . . .
But it also begs the question about CA rules for uninsured patients.
My wife recently had outpatient surgery. The provider had a published price for self pay (but not for insured patients . . . which is logical).
Had we gone the self pay route our OOP would have been almost $5k. With insurance it was $257.
With Medicare alone we would have owed about $600 after repricing and including the deductible.
- 31,149
I didn't watch the whole thing, but I thought he was being sarcastic about canceling his insurance to get the discount.
Sarcastic, being a jerk, or just plain foolish? Does the label really matter?
- 11,044
That is true everywhere. Cash rate is 50% less than insured rate.
Insurance will pay inflated rates.... because they benefit financially from doing so...
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