An article in ENT Journal is a good reminder that every practice should have basic financial policies, bother as a matter of sound business practices and to comply with the law. While the “typical” patient has a third party payer that will pay most of your fee, there are many who do not have coverage, or your services are not covered by the plan. When that patient is covered by Medicare, a new set of concerns arise. As a matter of practice efficiency and simplicity, a standardized procedure works best. Discounts for payment in cash (with no insurance payment coming) is allowable. Using the federal income guidellines for poverty, you can set up a discount schedule that your staff can use. Exceptions can be referred to the office manager or you. Any such discounts or waivers should be documented, so that there is no question later as to what you did and why you did it. The guiding principal is this: the giving of something of value (tangible or intangible) that induces the use of a service covered by the Medicare or Medicaid program is suspect. A standardizied policy that allows for financial need or other special circumstances is permissable – just have your staff document what was done and why.
For services to Medicare patients which will not be covered, there is the ABN – Advance Beneficiary Notice. You can download the form from the CMS website (it’s a PDF file).
This summer, after your tax returns are in and your accountant has had a vacation, plan a meeting with them to review policies and procedures, and items they may have noticed when completing your tax return. It’s an effective use of your time and helps you to be attune to improving your practice operations.