A report on the CBS Evening News today may generate more inquiries about the practice. Cash paying patients in the know ask for discounts from the full fees. There have been times when we had a minimal coverage health insurance plan that we paid for. We would routinely ask to make payments for our portion of the bill. These days, we have an MSA account, so it’s a whole lot easier from an administrative perspective to just pay our portion immediately. It’s important to remember that you can’t discount fees to patients who have insurance that will be paying part of the bill. To do so would be insurance fraud, assuming that you billed the carrier at full fee but accepted a lower co-payment from the patient. Since many co-payments are a percentage of the fee, by lowering the co-payment, you are implying that the fee was – or should be – less. The real challenge comes with self-paying patients who may have a high deductible plan and want a discount for paying cash that day. Now, you should be collecting co-payments when the patient presents for their appointment, and certainly before they leave. Whether the service is covered or no, or the deductible has been met, the patient will be paying this amount out of pocket. Patients, knowing that physicians routinely accepts fees that are discounted by up to 50% (or more!), are getting savier about asking for a discount. OK – so what will your policy be? Granting a standard discount for cash paying patients is a fair and reasonable business practice. You get your money immediately, without the cost and time of trying to collect through the billing process. You can grant further discounts based upon the patient’s financial situation. SImply allowing for a payment plan with a minimum payment (say, $50 per month), also relieves some of the financial pressure on the patient. Some practices will offer a 10% discount. For small fee balances – less than, say, $200 – this seems reasonable. As the fees climb, and you have an uninsured patient without a lot of resources, higher discounts are in order. Most importantly, your staff must be respectful and helpful to patients who they know, or suspect, that will have difficulty in paying your fee. It is better to have a loyal, paying patient who will be able to afford to follow your advice than one who pays right away but can’t afford the follow-up plan. Someone who owes you a lot of money is more likely to avoid coming to see you, and avoid the letters and calls from your business office. Digging in your heels about discounting is an illusion – by waiting longer and have to pursue payment, the time value of money and the billing expense reduces your yield on the fee charge anyway. If a patient is having trouble making payments, call them and ask if they need a larger adjustment. Goodwill and a reputation for caring about a patient’s financial situation is very important to many patients. A policy that outlines discounts that staff can routinely grant smooths your operation and promotes a consistent approach. Deviations should also be allowed, either with your consent or that of your manager. Monitor the discounts you grant so you know the scope of what you are doing and plan accordingly. Allowing the line staff to go to a 25% discount is reasonable, You may require the you or the manager approve larger discounts, so insure that a decision is made quickly. In the end, there are no hard and fast rules here – you simply have to do what is right for your patients – your “customers”. A policy is a good management practice and a tool for guidance for your line staff to be able to make good decisions on the spot by themselves, as it should be.