Prompt payment discounts are an intriguing option to offer patients to get them to pay up, especially in the midst of high-deductible season. But are they legal?
Many states have laws about how you can bill people for medical services. It's a fertile area for legal analysis. And of course it gets more complicated when Medicare gets involved.
OIG has suggested in the past that routine waivers of co-payments are a form of fraud. On the same principle, might not a reduced bill for prompt payment also be illegal.
DecisionHealth's own Professional Services division explored this subject in a white paper a few years back, and found this:
It looks like the HHS Office of Inspector General’s expanded interpretation of anti-kickback safe harbor rules could lay the foundation for a physician practice to offer its patients prompt payment discounts. While the OIG didn’t directly address their use for physician services, it recently approved a hospital’s prompt pay discount program for the facility’s outpatient services, recognizing it as a way to achieve “more successful bill collection.”
“It is reasonable to expect the OIG to take a similar view of a similarprompt pay discount policy adopted by a physician office,” says veteran health care attorney William Maruca of Fox Rothschild, “but that’s not 100% certain until the OIG formally addresses physician practice discounts in an official interpretation.” (The OIG routinely disclaims that its advisory opinions apply only to the requestor of the opinion and the arrangement described by the requestor.)
Vice President and Chief Compliance Officer of Professional Services Sean Weiss adds that the OIG ruling "does in ways establish precedent,” and doctors can “use opinions rendered by the OIG as documentation to support their claim."
Weiss still cautions, “I always advise readers to seek out legal counsel and request their own legal advisory opinion from the OIG to avoid any sticky situations.” So it's not open and shut -- but at least you have some ammunition to use should your payment practices be challenged.
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