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  • Writer's pictureMuhammad Sair Khan

Standardize your billable rate – it’s the law



With the rise of the opioid epidemic, a huge number of addiction treatment centers opened. However, some of these centers were only out to make a profit and did not provide quality care. Instead, they participated in fraudulent and sometimes illegal practices to recruit patients.


Because of the actions of these centers, insurance companies are always on the look out for possible fraud when it comes to patient payments at mental health facilities. The best way to protect your facility from charges of fraud or even the appearance of fraud is to keep your payment policies and prices transparent and standardized for every patient and every payor.


To keep payors happy and stay on the right side of the law, you should:


Avoid Waiving Co-Pays


Waiving a co-pay for a patient can be seen as incentivizing or bribing them to choose your facility for their treatment. Such bribes are illegal.


f you want to waive co-pays for certain patients, you need to have a written policy in place that applies to all patients. For instance, you may choose to waive co-pays or other payments for people who make below a certain income or for college students. This practice is totally legal, as long as you have it written and available for review and offer the same waiver to all patients who quality.


Don’t Advertise Discounts


Discounts, like co-pay waivers, are seen as a way to bribe patients to choose your facility. Many unscrupulous and predatory addiction treatment centers advertised discounts, drawing patients away from legitimate services. You should not be advertising discounts for any services or even giving discounts.


You should always attempt to collect the full amount of out-of-pocket payments from patients and never take on unpaid amounts to the insurance claim. In some states, this may put your facility at risk of fraud charges or may mean you have to return any reimbursement that the payor sent you because the action would be a breach of contract.


Maintain the Same Cost of Service


The same service should cost the same for every patient. If one day of detox treatment costs $4000, that is how much you must charge every payor and patient. Standardizing your billable rate ensures you don’t participate in any illegal activity. It also makes it easier for patients to understand the cost of their care and what they will owe at the end of their care.


Need help creating your payment policies or navigating payor relationships? Contact the experts at Datapro billing for consultations, billing support, staff training and more

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