Q: What is the proper/legal way of billing cash patients. We went to a seminar recently and were told that according to Ca Business & Professions Coe 657.b) To encourage the prompt payment of health or medical care claims, health care providers are hereby expressly authorized to grant discounts in health or medical care claims when payment is made promptly within time limits prescribed by the health care providers or institutions rendering the service or treatment.


According to the chiropractor at the seminar we can give discounts to cash patients. We have a monthly plan of $230 for 12 visits that month. Our fee schedule is $50 and we discount that after the 12th visit. Should we post each visit at $19.17 each and not post a courtesy discount? Should we post at $50 and post a courtesy discount? Or post a monthly plan of $230 for that first visit and post the rest of the 11 visits at $0? Can we discount at all? Your help and opinion is greatly appreciated. Thank you!


A: I don't think it is as clear cut as that, but I will admit on the face of it that seems to be what the law says. It was passed in 1998 (See below.)


However, I specifically spoke with chiro attorney Keith Carlson about this, and while he intimated there is not a definitive case on this, his recommendation is against providing cash discounts unless they are done under certain circumstances.    For example, you can establish a written policy to discount fees for patients with financial hardship- especially if you ask them to provide some documentation: unemployment check, SSI identification, discount letter from utility etc.


You might want to do some research at ChirohealthUSA.  They have set up a program that does not cost you anything but avoids any legal issues that otherwise might arise. Another option would be to contact Cash Practice and get their advice.


Finally, as someone who does reviews for the BCE, I see docs get themselves in trouble regularly with pre-pay plans, where they offer big discounts for long treatment plans.  When the patient becomes dissatisfied after a few weeks without improvement and want their money back, the doctor charges them full fare for the visits they used, leaving little left to refund.  The patient files a complaint with the BCE, the doctor spends thousands on a lawyer to protect their license, and so on.  


Personally I would post whatever the fee you charged for that visit was (we cannot discuss fees by law) but lets just say for illustration purposes that you were charging $100 for ten visits, but your normal fee was 5 times that.  I would post the $10 per visit.


There are lots of ways to get in trouble with cash discount plans. That is why I don't do them except for financial hardship cases.  To me, they reduce the perceived value of chiro care,and the issue is usually value, not cost.


Anyway, I think you should check out ChirohealthUSA's website; they have a lot of useful information there that might help you make a more informed decision about your discount plans.  Hope that helps.

And don't believe everything you hear at a seminar!  I'm just sayin'!


CODE TEXT

 


BUSINESS AND PROFESSIONS CODE - BPC



DIVISION 2. HEALING ARTS [500 - 4999.129]

   ( DIVISION 2 ENACTED BY STATS. 1937, CH. 399. )


  

CHAPTER 1. GENERAL PROVISIONS [500 - 865.2]

   ( CHAPTER 1 ENACTED BY STATS. 1937, CH. 399. )


  

ARTICLE 6. UNEARNED REBATES, REFUNDS AND DISCOUNTS [650 - 657]

   ( ARTICLE 6 ADDED BY STATS. 1949, CH. 899. )



  657.  

(A) THE LEGISLATURE FINDS AND DECLARES ALL OF THE FOLLOWING:


(1) CALIFORNIANS SPEND MORE THAN ONE HUNDRED BILLION DOLLARS ($100,000,000,000) ANNUALLY ON HEALTH CARE.

(2) IN 1994, AN ESTIMATED 6.6 MILLION OF CALIFORNIA’S 32 MILLION RESIDENTS DID NOT HAVE ANY HEALTH INSURANCE AND WERE INELIGIBLE FOR MEDI-CAL.

(3) MANY OF CALIFORNIA’S UNINSURED CANNOT AFFORD BASIC, PREVENTATIVE HEALTH CARE RESULTING IN THESE RESIDENTS RELYING ON EMERGENCY ROOMS FOR URGENT HEALTH CARE, THUS DRIVING UP HEALTH CARE COSTS.

(4) HEALTH CARE SHOULD BE AFFORDABLE AND ACCESSIBLE TO ALL CALIFORNIANS.

(5) THE PUBLIC INTEREST DICTATES THAT UNINSURED CALIFORNIANS HAVE ACCESS TO BASIC, PREVENTATIVE HEALTH CARE AT AFFORDABLE PRICES.

(B) TO ENCOURAGE THE PROMPT PAYMENT OF HEALTH OR MEDICAL CARE CLAIMS, HEALTH CARE PROVIDERS ARE HEREBY EXPRESSLY AUTHORIZED TO GRANT DISCOUNTS IN HEALTH OR MEDICAL CARE CLAIMS WHEN PAYMENT IS MADE PROMPTLY WITHIN TIME LIMITS PRESCRIBED BY THE HEALTH CARE PROVIDERS OR INSTITUTIONS RENDERING THE SERVICE OR TREATMENT.

(C) NOTWITHSTANDING ANY PROVISION IN ANY HEALTH CARE SERVICE PLAN CONTRACT OR INSURANCE CONTRACT TO THE CONTRARY, HEALTH CARE PROVIDERS ARE HEREBY EXPRESSLY AUTHORIZED TO GRANT DISCOUNTS FOR HEALTH OR MEDICAL CARE PROVIDED TO ANY PATIENT THE HEALTH CARE PROVIDER HAS REASONABLE CAUSE TO BELIEVE IS NOT ELIGIBLE FOR, OR IS NOT ENTITLED TO, INSURANCE REIMBURSEMENT, COVERAGE UNDER THE MEDI-CAL PROGRAM, OR COVERAGE BY A HEALTH CARE SERVICE PLAN FOR THE HEALTH OR MEDICAL CARE PROVIDED. ANY DISCOUNTED FEE GRANTED PURSUANT TO THIS SECTION SHALL NOT BE DEEMED TO BE THE HEALTH CARE PROVIDER’S USUAL, CUSTOMARY, OR REASONABLE FEE FOR ANY OTHER PURPOSES, INCLUDING, BUT NOT LIMITED TO, ANY HEALTH CARE SERVICE PLAN CONTRACT OR INSURANCE CONTRACT.

(D) “HEALTH CARE PROVIDER,” AS USED IN THIS SECTION, MEANS ANY PERSON LICENSED OR CERTIFIED PURSUANT TO DIVISION 2 (COMMENCING WITH SECTION 500) OF THE BUSINESS AND PROFESSIONS CODE, OR LICENSED PURSUANT TO THE OSTEOPATHIC INITIATIVE ACT, OR THE CHIROPRACTIC INITIATIVE ACT, OR LICENSED PURSUANT TO CHAPTER 2.5 (COMMENCING WITH SECTION 1440) OF DIVISION 2 OF THE HEALTH AND SAFETY CODE; AND ANY CLINIC, HEALTH DISPENSARY, OR HEALTH FACILITY, LICENSED PURSUANT TO DIVISION 2 (COMMENCING WITH SECTION 1200) OF THE HEALTH AND SAFETY CODE.

(AMENDED BY STATS. 1998, CH. 20, SEC. 1. EFFECTIVE APRIL 14, 1998.)T


WAYNE M. WHALEN, D.C.