Billing the Uninsured

November 1, 2007

I need help with the rules for billing patients without insurance. It is my understanding that self-pays must be billed the same amount as non-Medicare payers. Is that correct? Outside of paying their bill in full at the time of service, is it ever compliant to automatically discount self-pays before the self-pays are billed? If so, in what circumstances?

Question: I need help with the rules for billing patients without insurance. It is my understanding that self-pays must be billed the same amount as non-Medicare payers. Is that correct? Outside of paying their bill in full at the time of service, is it ever compliant to automatically discount self-pays before the self-pays are billed? If so, in what circumstances?

Answer: You can charge the uninsured a discounted fee, sure. Most practices do. You just don’t want that discount to ever be lower than Medicare or your lowest discounted rate, lest that rate be seen as your “usual and customary” rate. Don’t offer discounts to more than half of your patients, and start paying attention when your discounted business gets to about 40 percent of your practice. Otherwise, the discounted fee schedule will much more likely be considered your customary fee schedule.

Don’t balk right away, either, at discounts for payment at time of service. While charges might be high in your specialty, you can sure ask for 30 percent at time of service with the rest to be mailed within 15 to 30 days in an addressed, stamped envelope the patient leaves the practice with. Some practices also encourage self-pay patients to get loans, so they pay the practice in full and make monthly payments to the lender instead.

You should have a written policy about all the sorts of discounts you offer and follow it to the letter, lest a patient accuse you of acting in a discriminatory manner.