Dual fee schedules are a thing of the past. We now have multiple fee schedules because of managed care, Medicare, Worker’s Compensation and other contractual agreements.
Despite the various types of insurance and the individual fee schedules with which we must comply, it is still important to establish a regular or standard fee schedule in your office. You will normally bill your standard fee schedule to all types of insurance and then take the appropriate contractual write-offs from the “explanation of benefits”. It is also from this standard fee schedule that you will determine your TIME OF SERVICE DISCOUNT. Please note that this is NOT referred to as a CASH DISCOUNT. It is merely a way for you to provide a way to share the reduction of overhead you receive by not having to bill insurance or patients and by not having to wait for payment. The offer you will make on your time of service discount program is non-discriminatory. Integrity Doctors recommends that you check with your state chiropractic association or state licensing board as to the acceptability of such a plan in your state, but across the country, time of service discount is an acceptable means of reducing costs for all parties.

Use these guidelines when establishing your Time of Service Discount Plan:

1. Establish a “standard” fee schedule.
2. Establish a Time of Service Fee Schedule. This schedule is the lowest schedule for those who prepay or pay at the time of service. It is intended to save your office the cost of collecting the amount either from the insurance company, or other payer and avoids the costs associated with unpaid billing and bad accounts. The TOS fee passes these savings on to patients and insurance companies.
3. Consider and position your TOS fee schedule to be NO lower than your local Medicare Fee Schedule. Use the limiting charge for any service if you are non-participating in Medicare. Use the allowed amount if you are participating in Medicare. This is a safe harbor. It avoids the risks for Medicare fraud and abuse. Typically, your TOS discount should run about 20 – 25% less than your standard fee schedule. However under no circumstance should the discount exceed your costs to collect the payment.
4. Make your TOS discount available to all. Treat patients and insurance companies alike. IF YOU OFFER THE TOS DISCOUNT TO AN INSURANCE PATIENT, REMEMBER THAT YOU MUST NOT INCUR ADMINISTRATIVE COSTS. THAT MEANS THE PATIENT IS RESPONSIBLE FOR FILING THEIR OWN INSURANCE. All have an equal opportunity to participate in reducing health care costs and to share in the savings. Payments can be in any form: check, cash, credit card, debit card, etc. HOWEVER, REMEMBER THAT THE CRITERIA FOR THE DISCOUNT IS THAT PAYMENT BE MADE AT THE TIME OF SERVICE AND THAT NO INSURANCE WILL BE FILED FROM YOUR OFFICE.