We would like to (if we could actually afford to) charge some of our low-income, unisured patients less, but I think to legally do it I would need to 1) set up a special fee schedule for them, and 2) Ask for alot of personal information (like their income, etc) and then save it in case of some type of audit I can show this is a formal program based on "ability to pay."
Wayne in order to legally do what you are seeking, do something called "date of service payment discount." This is set up in your office as a simple written policy.
For example: 'For 99213, Pay our office on the same date of service and our standard $85 fee is reduced to $50.' This policy applies to all insurers, uninsured, underinsured, etc.
If Medicare and Aetna and Anthem and all the rest would actually pay you at the point of service, you would reduce your charge the same as you would the cash pay/uninsured patient, according to the samply policy above.
HOWEVER, You and I and everyone else knows that the insurance carriers will NOT pay at point of service, so this effectively singles out the uninsured patients and cuts them a deal. The way this benefits you is that you see your money that day, not 3-6 months from now.
AND the $50 charge is equal to the $85 charge because your biller did not have to send out 3 statements to the insurer, did not have to get on the phone to argue w/ the insurer, did not have look at that bill ever again and decide if it is 30, 60, 90, 120 days past due.
In fact, I would argue (as would many who run low fee/cash only practices) that you actually keep more of your money by charging a smaller amount of money that you collect at point of service than by wasting staff time (your money) trying to get your larger fee from the insurer.
Your question also addresses the concept of sliding fee scale, i.e. the ability to pay based upon your income level. I may be wrong, but my understanding is that a private office cannot do this. Some or all hospitals can do this and FQHC's (Federally Qualified Health Clinic's) can do this. I believe we are unable to fix our prices according to a person's or an insurer's ability/willingness to pay. But we can provide point of service discounts.
