Charging Less Than Medicare

October 1, 2007

Can we legally charge our self-pay patients less than what the Medicare fee schedule allows?

Question: Can we legally charge our self-pay patients less than what the Medicare fee schedule allows?

Answer: Ask 10 managers this question, and you’ll get 10 answers. It’s a gray area. Here’s my answer: Yes, you can charge self-pay patients less than Medicare, but you want to make it clear that this lower charge is not your “usual and customary fee” (lest Medicare decides to pay you that much, too). So, you might offer it only to self-pay patients who pay in full at the time of service since there are obvious cost savings to you. Or you might reconsider the lower fee if self-pay patients make up a sizeable portion of your patient base. If you do it, do it judiciously.