Cash Patients And Dual Fee Schedules

If your website says “$20 for massage” and you charge insurance companies $40 then you have a DUAL FEE SCHEDULE!

If you tell cash patients “electric stimulation is $20” and you charge insurance companies $30 then you have a DUAL FEE SCHEDULE!

If anyone who calls your office and asks how much you charge for an adjustment and your staff tells them “we charge $40 for an adjustment” and you charge insurance companies $55 then you have a DUAL FEE SCHEDULE!

The above scenarios happen every day at chiropractic offices. I know because I represent chiropractors all over Florida. Please make sure that you know the laws to avoid getting into trouble with your license.

Here Is The Law:

You must bill everyone the same amount. BUT you can accept less money in payment.For example, let’s say you sent a bill for an adjustment to Medicare, to Health, and to PIP. Your CMS 1500 form (your bill) will show the same charge. Medicare, Health, and PIP will all send you a check for different amounts. THAT IS OK! That is not a dual fee schedule.

The dual fee schedule only affects how much you charge…not what you accept as payment!

Similarly, when you have a cash patient you need to hand them a bill for the same amount as you would bill Medicare, Health, and PIP. But you can tell the cash patient that you will accept less money as payment. Never tell someone over the phone that you will “charge” them “X” when you normally bill “Y”! You never know who is on the other end of that phone! That could cause trouble for your license!

True Story

A PIP insurance adjuster called my client and asked them how much they normally charge for an adjustment, electric stimulation, and a hot pack. The front desk person told the adjuster (who didn’t identify herself as an adjuster) that it was $40 total for cash patients! The PIP adjuster then reduced every single date of service (normally about $130 per visit) down to $40. The PIP adjuster used that phone call as black mail and said if the chiropractor disputed the reductions (which amounted to several thousand dollars) then the adjuster would report the chiropractor to the Board.
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