Establishing a Fee Schedule

Establishing a fee schedule takes research to determine what third-party payers will cover, as well as what the market will bear. If you're considering a cash-only practice, you should also understand the implications for Medicare and Medicaid patients.

From a budgeting perspective, it’s important to know what portion of the practice income will come from indemnity, copayments, deductibles or cash.

The schedule and written policy must accommodate fees that are reasonable and customary and reimbursable under indemnity plans, HMOs, PPOs, etc.

Make sure you understand what is covered under the insurance plans you participate in.

Make Sure the Patient Understands!

Additionally, it's important to have a payment policy so patients know when payment is due for services. They should know that fees will be enforced and collected.

No one likes to ask for money, but money must be collected for services if the practice is to succeed.

Collecting payment may be easiest if it’s handled at the time of service. Consider offering patients the convenience of paying with their credit or debit card. Individuals who have a flex spending account (and a debit card associated with it) may find it easiest to pay with the card at the time of care.

There is some anecdotal evidence of a correlation between a patient suing a doctor for malpractice because they feel they are being pressured for collection. There are also legal ramifications regarding professional discounts in different government regulations and also the effort that must be made to collect amounts due from patients to avoid a perception of discounting or rebating fees.

Discounted Fees

Many D.C.s like to take advantage of inexpensive opportunities to advertise their practice. If you are considering a discount program like Groupon, Living Social, etc., you may need to reconsider.

If the discounter (Groupon, etc.) keeps a portion of the fee for the service they provided, many states consider that fee-splitting (which is illegal in most states).

Advertising Your Fees

If you create an ad that references your fees – especially a discount you may be offering – you MUST include a disclaimer for Medicare and Medicaid patients. Any discount you offer cannot be given to Medicare or Medicaid patients.

Cash Practices

If you are considering a cash-only practice:

  • Make sure your demographics support a cash only practice. If a neighboring D.C. accepts insurance and most of your patients have insurance, they may be less likely to visit you.
  • When patients have insurance, they tend to stay within the parameters of their plan to maximize their benefits.
  • You cannot treat Medicare or Medicaid patients without submitting a claim to Medicare. And, it is illegal for chiropractors to opt out of Medicare. Even if you do not participate in Medicare, you must still submit a claim (however you will be reimbursed at a lower rate than a participating doctor).
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