Guest guest Posted August 19, 2008 Report Share Posted August 19, 2008 I had an interesting conversation with Robert Kientz who teaches the NCCAOM Ethics class about giving discounts. (Robert Keintz, btw, is the former pres & dean of curriculum at the phoenix college of acu. he was also an instrumental player in writing the practice act when AZ obtained licensure). On the issue of giving patients discounts: basically we cannot do this. commonly discounts are offered to a select group of people: eg. medicaid patients, seniors, students, your favorite club, blue cross patients, sliding scale. the reason we can't do this is that it's considered discriminatory against those who don't fall into the select group (regardless of whether or not it's offered for altruist reasons). this is a mestemeaner (sp?) offense. if insurance is involved so that insurance patients don't qualify for the discount (thus billing the insur co a higher rate than the cash patient), it becomes a felony. (a time of service discount would be ok, so long as everyone who pay at the time of service gets it, and its a reasonable discount: 25%). this means that the sliding scale fees offered by community acupuncture clinics and others are illegal. you have to set one flat rate that applies to everyone. you can offer a coupon for x amount off, so long as everyone is informed about the offer so that they may all take advantage of the discount. ($10 off the initial visit in September. you have to offer it to all new patients). you can offer a discount on a particular day or time: monday mornings are 10% off. again, you have to offer it to all your patients. if you want to offer a lower price to a particular population, you need a separate location: $45tx at x,y, z clinic. again, anyone who comes to that location gets the $45 tx. you would need to be able to show that the lower overhead at location B enables you to offer the tx at the lower rate: the location across town is a bare bones setting in a low rent district, with fewer amenities and staffing needs. another commonly used but illegal practice is pkg tx: get 10 tx for $500, this would normally be $700, and paid in adv gift certificates. the reason is accepting payment in adv of service constitutes insurance, and only insurance cos are licensed to do this. so a patient cannot pay on monday for the tx s/he will receive on friday. payment must be made after the tx is received, not prior to. complaints about these practices would be directed to the state atty generals office, the lic. boards, state orgs and nccaom. -- Oriental Medicine Experienced, Dedicated, Effective Flying Dragon Liniment: Effective pain relief for muscles & joints Formulated by Kath Bartlett, Traditional Chinese Herbalist Available at Asheville Center for , or web order at: Kamwo Herbal Pharmacy: NY - Chinatown https://www.kamwo.com/shop/product.php?productid=17442 & cat=0 & page=1 Golden Needle Acupuncture, Herbal & Medical Supply - Candler, NC http://www.goldenneedleonline.com/index.php?page=categories & category=14 & vendor= & \ product=5554 & pg= Asheville Center For 70 Woodfin Place, Suite West Wing Two Asheville, NC 28801 828.258.2777 kbartlett www.AcupunctureAsheville.com <http://www.acupunctureasheville.com/> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 19, 2008 Report Share Posted August 19, 2008 I've heard all this before, yet I have never seen any independent documentation to back it up. To my knowledge there is nothing in the State practice act of Arizona regarding this. Perhaps you could ask Robert to back these statements up with legal documents or statute. It may be that he is speaking from an ethical perspective as opposed to a legal one or just his interpretation of laws that apply only to MD's. Has anyone (MD's ND's, Chiropractors, Psychologists, ANY health practitioner), ever, been prosecuted for providing discounts or a sliding scale? I also think that this would vary widely from State to State making these blanket sweeping statements not applicable to someone treating in Montana vs. California for example. My daughters pediatrician gives us discounts each time we ask for them as we have not had insurance until recently. Is he breaking the law? If you are providing spa like acupuncture, or cosmetic acupuncture how is selling 10 treatments any different than what other spas do with there services? If you provide a prorated refund on any unused treatments from a package sale, how is that acting like insurance? I give my students and select others 20% off my fee. I also sell gift certificates. As a business owner I can't imagine these being a problem. As a private business owner that does not take insurance, I can charge what I want. If you, or anyone else out there knows the bottom line truth regarding these issues, I would love to know them as all I have is hearsay myself. Chris Vedeler L.Ac. wrote: > I had an interesting conversation with Robert Kientz who teaches the NCCAOM > Ethics class about giving discounts. (Robert Keintz, btw, is the former > pres & dean of curriculum at the phoenix college of acu. he was also an > instrumental player in writing the practice act when AZ obtained licensure). > > On the issue of giving patients discounts: basically we cannot do this. > commonly discounts are offered to a select group of people: eg. medicaid > patients, seniors, students, your favorite club, blue cross patients, > sliding scale. the reason we can't do this is that it's considered > discriminatory against those who don't fall into the select group > (regardless of whether or not it's offered for altruist reasons). this is a > mestemeaner (sp?) offense. if insurance is involved so that insurance > patients don't qualify for the discount (thus billing the insur co a higher > rate than the cash patient), it becomes a felony. (a time of service > discount would be ok, so long as everyone who pay at the time of service > gets it, and its a reasonable discount: 25%). > > this means that the sliding scale fees offered by community acupuncture > clinics and others are illegal. you have to set one flat rate that applies > to everyone. > > you can offer a coupon for x amount off, so long as everyone is informed > about the offer so that they may all take advantage of the discount. ($10 > off the initial visit in September. you have to offer it to all new > patients). you can offer a discount on a particular day or time: monday > mornings are 10% off. again, you have to offer it to all your patients. if > you want to offer a lower price to a particular population, you need a > separate location: $45tx at x,y, z clinic. again, anyone who comes to that > location gets the $45 tx. you would need to be able to show that the lower > overhead at location B enables you to offer the tx at the lower rate: the > location across town is a bare bones setting in a low rent district, > with fewer amenities and staffing needs. > > another commonly used but illegal practice is pkg tx: get 10 tx for $500, > this would normally be $700, and paid in adv gift certificates. the reason > is accepting payment in adv of service constitutes insurance, and only > insurance cos are licensed to do this. so a patient cannot pay on monday > for the tx s/he will receive on friday. payment must be made after the tx > is received, not prior to. > > complaints about these practices would be directed to the state atty > generals office, the lic. boards, state orgs and nccaom. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 19, 2008 Report Share Posted August 19, 2008 Wow Kath why are you suggesting everyone who offers anything other than astronomical prices be tossed up for judging? You have brought this up a few times and it gets nowhere. The only one I can comment on is community acupuncture. As long as you are not accepting insurance and you are offering it to everyone you can do sliding scale, so please take community acupuncture off your firing line or offer up some proof. I don't get why people keep pursuing this or really care that much. What happened to making things acceptable for others stop being a good thing??? Julie On Mon, Aug 18, 2008 at 8:53 PM, Christopher Vedeler <vedelerwrote: > I've heard all this before, yet I have never seen any independent > documentation to back it up. To my knowledge there is nothing in the > State practice act of Arizona regarding this. Perhaps you could ask > Robert to back these statements up with legal documents or statute. It > may be that he is speaking from an ethical perspective as opposed to a > legal one or just his interpretation of laws that apply only to MD's. > Has anyone (MD's ND's, Chiropractors, Psychologists, ANY health > practitioner), ever, been prosecuted for providing discounts or a > sliding scale? I also think that this would vary widely from State to > State making these blanket sweeping statements not applicable to someone > treating in Montana vs. California for example. > > My daughters pediatrician gives us discounts each time we ask for them > as we have not had insurance until recently. Is he breaking the law? > If you are providing spa like acupuncture, or cosmetic acupuncture how > is selling 10 treatments any different than what other spas do with > there services? If you provide a prorated refund on any unused > treatments from a package sale, how is that acting like insurance? > > I give my students and select others 20% off my fee. I also sell gift > certificates. As a business owner I can't imagine these being a > problem. As a private business owner that does not take insurance, I > can charge what I want. > > If you, or anyone else out there knows the bottom line truth regarding > these issues, I would love to know them as all I have is hearsay myself. > > Chris Vedeler L.Ac. > > > wrote: > > I had an interesting conversation with Robert Kientz who teaches the > NCCAOM > > Ethics class about giving discounts. (Robert Keintz, btw, is the former > > pres & dean of curriculum at the phoenix college of acu. he was also an > > instrumental player in writing the practice act when AZ obtained > licensure). > > > > On the issue of giving patients discounts: basically we cannot do this. > > commonly discounts are offered to a select group of people: eg. medicaid > > patients, seniors, students, your favorite club, blue cross patients, > > sliding scale. the reason we can't do this is that it's considered > > discriminatory against those who don't fall into the select group > > (regardless of whether or not it's offered for altruist reasons). this is > a > > mestemeaner (sp?) offense. if insurance is involved so that insurance > > patients don't qualify for the discount (thus billing the insur co a > higher > > rate than the cash patient), it becomes a felony. (a time of service > > discount would be ok, so long as everyone who pay at the time of service > > gets it, and its a reasonable discount: 25%). > > > > this means that the sliding scale fees offered by community acupuncture > > clinics and others are illegal. you have to set one flat rate that > applies > > to everyone. > > > > you can offer a coupon for x amount off, so long as everyone is informed > > about the offer so that they may all take advantage of the discount. ($10 > > off the initial visit in September. you have to offer it to all new > > patients). you can offer a discount on a particular day or time: monday > > mornings are 10% off. again, you have to offer it to all your patients. > if > > you want to offer a lower price to a particular population, you need a > > separate location: $45tx at x,y, z clinic. again, anyone who comes to > that > > location gets the $45 tx. you would need to be able to show that the > lower > > overhead at location B enables you to offer the tx at the lower rate: the > > location across town is a bare bones setting in a low rent district, > > with fewer amenities and staffing needs. > > > > another commonly used but illegal practice is pkg tx: get 10 tx for $500, > > this would normally be $700, and paid in adv gift certificates. the > reason > > is accepting payment in adv of service constitutes insurance, and only > > insurance cos are licensed to do this. so a patient cannot pay on monday > > for the tx s/he will receive on friday. payment must be made after the tx > > is received, not prior to. > > > > complaints about these practices would be directed to the state atty > > generals office, the lic. boards, state orgs and nccaom. > > > > > > > -- Julie Ormonde, L.Ac. Rowan Clinic for Women 1524 W. Hays, Suite 102 Boise, Idaho 83702 www.rowanclinicforwomen.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 19, 2008 Report Share Posted August 19, 2008 Kath, The issues of discounting, treatment packages, gift certificates, etc are all regulated at the state level. So that particulars will vary state by state, and it isn't possible to issue a blanket statement that applies in all states. In California, for example, discounting is absolutely legal under certain circumstances. Specifically, if there is " reasonable cause " to believe that the patient is not eligible for insurance reimbursement for a given health care service, the practitioner is explicitly authorized to provide a discount in accord with any criteria that they establish (including sliding scale). Additionally, practitioners may also establish policies for " prompt payment " discounts. If payment is made (by any payer) within a time period established by the practitioner, the practitioner is authorized to provide a discount. If the practitioner's policy is to provide a discount if payment is made at the time of service then this amounts to a cash payment discount. California does, however, have a law that prohibits prepayment for health care services. Some practitioners structure their " packages " as rewards programs in which a patient will pay for x number of visits at the time of service and receive the (x + 1)th visit free. This avoids prepayment. Finally, there are a whole series of restrictions on issuance of gift certificates in California that I won't even get into here. Of course, the particulars will vary state by state, so each practitioner should become familiar with the laws and reg of his/her state. --Bill. On Aug 18, 2008, at 6:50 PM, wrote: > On the issue of giving patients discounts: basically we cannot do > this. > commonly discounts are offered to a select group of people: eg. > medicaid > patients, seniors, students, your favorite club, blue cross patients, > sliding scale. the reason we can't do this is that it's considered > discriminatory against those who don't fall into the select group > (regardless of whether or not it's offered for altruist reasons). > this is a > mestemeaner (sp?) offense. if insurance is involved so that insurance > patients don't qualify for the discount (thus billing the insur co a > higher > rate than the cash patient), it becomes a felony. (a time of service > discount would be ok, so long as everyone who pay at the time of > service > gets it, and its a reasonable discount: 25%). > > this means that the sliding scale fees offered by community > acupuncture > clinics and others are illegal. you have to set one flat rate that > applies > to everyone. > > you can offer a coupon for x amount off, so long as everyone is > informed > about the offer so that they may all take advantage of the discount. > ($10 > off the initial visit in September. you have to offer it to all new > patients). you can offer a discount on a particular day or time: > monday > mornings are 10% off. again, you have to offer it to all your > patients. if > you want to offer a lower price to a particular population, you need a > separate location: $45tx at x,y, z clinic. again, anyone who comes > to that > location gets the $45 tx. you would need to be able to show that > the lower > overhead at location B enables you to offer the tx at the lower > rate: the > location across town is a bare bones setting in a low rent district, > with fewer amenities and staffing needs. > > another commonly used but illegal practice is pkg tx: get 10 tx for > $500, > this would normally be $700, and paid in adv gift certificates. the > reason > is accepting payment in adv of service constitutes insurance, and only > insurance cos are licensed to do this. so a patient cannot pay on > monday > for the tx s/he will receive on friday. payment must be made after > the tx > is received, not prior to. > > complaints about these practices would be directed to the state atty > generals office, the lic. boards, state orgs and nccaom. > > -- > > Oriental Medicine > Experienced, Dedicated, Effective > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 19, 2008 Report Share Posted August 19, 2008 Discounting, prepayment, etc may not be written into the practice act in a given state. In California, the Acupuncture Act doesn't mention a thing on these topics, but the generic parts of our Business & Professions Code that apply to all health care providers addresses discounting. The question of prepayment is addressed in our Health & Safety Code. Gift certificates are addressed in our Civil Code. So one will probably need to look outside of the acupuncture practice act of a given state for answers. --Bill. On Aug 18, 2008, at 8:53 PM, Christopher Vedeler wrote: > To my knowledge there is nothing in the > State practice act of Arizona regarding this. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 19, 2008 Report Share Posted August 19, 2008 I think this is a very valid topic and documentation supporting a position is important. Just because a business has a procedure that is never questioned, that doesn't make it ethical or legal. For example, working at a hospital that violates all its human resource policies on time worked and salary paid, by overtly encouraging its employees to punch in and out differently that actual work time, or having a supervisor edit the punched in/out work hours to reduce the amount of pay, doesn't make it OK - it is still illegal. This is not a made-up example and the practice continues to this day because no one seems to have the courage to stand up to the bullies. I find having a widely acceptable standard to follow makes some business decisions easier. For example, if we discover clear documentation that states prepaying for procedures (and thereby giving the patient a discount), is an option only legally available to insurance companies, then I won't institute a prepayed discount in my practice - and I will not be putting my license or practice in jeopardy. Following the law is a standard I will choose to apply to my business, plain and simple. There are many fraudulent billing practices going on in health care that aren't prosecuted, because many people aren't aware of the facts - or have the nerve to report them. But, if you look up a few of those who do get reported and caught - you can bet it wasn't worth it. It only takes one disgruntled competitor or savvy patient to blow it all out of the water. I do not want to be a practitioner who uses ignorance as an excuse to break the law and ruin my practice. I don't think this topic is about charging exorbitant rates for acupuncture or judging those who don't. It is about practicing your trade ethically and within the legal structure that protects it from being shut down. Best regards, Janis Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 19, 2008 Report Share Posted August 19, 2008 Hi Kath, The issue as you have stated it (or interpreted it from Robert K.) may be factual to some degree as it relates to corporate insurance and the healthcare insurance setting. If in fact you were working exclusively in that setting, you would not be able to see patients from outside that setting nor could you refer patients to anyone outside that setting. However, even MD orthopedic surgeons here in the San Francisco Bay area are generally outside of this configuration unless they are employed by Kaiser. For instance the orthopedic surgeons at Alta Bates Hospital on Ashby in Berkeley may decline patients who do not have insurance or do not qualify for Medi-Cal. Alternatively they can accept such patients and perform procedures inside their own office or outside of Alta Bates Hospital campus at a private surgery on Telegraph Avenue. The costs can be profoundly different. There are some very altruistic practitioners around here. The healthcare providers can not buck the pricing system within the insurance framework when doing work inside that framework. The administration at the hospital has mechanisms for waiving fees, but this is not in the hands of the individual practitioner who is working in essence as an independent contractor and receiving payment via a 3rd party. So you only get into trouble if you treat and charge patients with healthcare insurance in a manner that is out of line with the policies of the insurer, and then file an insurance claim for your own or for their compensation. Don't confuse this with performing services completely outside of the corporate insurance framework. You are then only subject to the laws of your own profession and the professional practices within the jurisdiction of your license. You would not then be engaged in corporate 3rd party payment practices or the rules that regulate such practices. You could charge as much or as little as you decide if you acted outside of the insurance setting. Likewise you could get your car fixed for a reasonable price from a private licensed mechanic. However, if you then file an insurance claim and get an insurance settlement that's larger than what you paid, you may be engaged in fraud. So you have to decide whether to act within the insurance system or completely outside of it. Respectfully, Emmanuel Segmen ___________________ Kath Bartlett wrote: Mon Aug 18, 2008 6:50 pm (PDT) I had an interesting conversation with Robert Kientz who teaches the NCCAOM Ethics class about giving discounts. (Robert Keintz, btw, is the former pres & dean of curriculum at the phoenix college of acu. he was also an instrumental player in writing the practice act when AZ obtained licensure). On the issue of giving patients discounts: basically we cannot do this. commonly discounts are offered to a select group of people: eg. medicaid patients, seniors, students, your favorite club, blue cross patients, sliding scale. the reason we can't do this is that it's considered discriminatory against those who don't fall into the select group (regardless of whether or not it's offered for altruist reasons). this is a mestemeaner (sp?) offense. if insurance is involved so that insurance patients don't qualify for the discount (thus billing the insur co a higher rate than the cash patient), it becomes a felony. (a time of service discount would be ok, so long as everyone who pay at the time of service gets it, and its a reasonable discount: 25%). this means that the sliding scale fees offered by community acupuncture clinics and others are illegal. you have to set one flat rate that applies to everyone. you can offer a coupon for x amount off, so long as everyone is informed about the offer so that they may all take advantage of the discount. ($10 off the initial visit in September. you have to offer it to all new patients). you can offer a discount on a particular day or time: monday mornings are 10% off. again, you have to offer it to all your patients. if you want to offer a lower price to a particular population, you need a separate location: $45tx at x,y, z clinic. again, anyone who comes to that location gets the $45 tx. you would need to be able to show that the lower overhead at location B enables you to offer the tx at the lower rate: the location across town is a bare bones setting in a low rent district, with fewer amenities and staffing needs. another commonly used but illegal practice is pkg tx: get 10 tx for $500, this would normally be $700, and paid in adv gift certificates. the reason is accepting payment in adv of service constitutes insurance, and only insurance cos are licensed to do this. so a patient cannot pay on monday for the tx s/he will receive on friday. payment must be made after the tx is received, not prior to. complaints about these practices would be directed to the state atty generals office, the lic. boards, state orgs and nccaom. -- Oriental Medicine Experienced, Dedicated, Effective Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 20, 2008 Report Share Posted August 20, 2008 Kath, Someone offlist asked me to address this as an issue of legal ethics rather than insurance policy or insurance fraud. Consider the notion of charging a practitioner fee that is purely a calculation of your patient's own hourly, weekly, monthly or annual income. This could be one of multiple criteria to be negotiated at the outset of treatment. This overcomes the subjective considerations of a sliding scale. This would also overcome the objections of acting in a subjectively prejudiced manner. Another legal-ethics issue of discounts in any business setting has to do with unfair competition between corporate and small business. I'm guessing that is not what Robert. K. was addressing. Respectfully, Emmanuel Segmen - Hi Kath, The issue as you have stated it (or interpreted it from Robert K.) may be factual to some degree as it relates to corporate insurance and the healthcare insurance setting. If in fact you were working exclusively in that setting, you would not be able to see patients from outside that setting nor could you refer patients to anyone outside that setting. However, even MD orthopedic surgeons here in the San Francisco Bay area are generally outside of this configuration unless they are employed by Kaiser. For instance the orthopedic surgeons at Alta Bates Hospital on Ashby in Berkeley may decline patients who do not have insurance or do not qualify for Medi-Cal. Alternatively they can accept such patients and perform procedures inside their own office or outside of Alta Bates Hospital campus at a private surgery on Telegraph Avenue. The costs can be profoundly different. There are some very altruistic practitioners around here. The healthcare providers can not buck the pricing system within the insurance framework when doing work inside that framework. The administration at the hospital has mechanisms for waiving fees, but this is not in the hands of the individual practitioner who is working in essence as an independent contractor and receiving payment via a 3rd party. So you only get into trouble if you treat and charge patients with healthcare insurance in a manner that is out of line with the policies of the insurer, and then file an insurance claim for your own or for their compensation. Don't confuse this with performing services completely outside of the corporate insurance framework. You are then only subject to the laws of your own profession and the professional practices within the jurisdiction of your license. You would not then be engaged in corporate 3rd party payment practices or the rules that regulate such practices. You could charge as much or as little as you decide if you acted outside of the insurance setting. Likewise you could get your car fixed for a reasonable price from a private licensed mechanic. However, if you then file an insurance claim and get an insurance settlement that's larger than what you paid, you may be engaged in fraud. So you have to decide whether to act within the insurance system or completely outside of it. Respectfully, Emmanuel Segmen ___________________ Kath Bartlett wrote: Mon Aug 18, 2008 6:50 pm (PDT) I had an interesting conversation with Robert Kientz who teaches the NCCAOM Ethics class about giving discounts. (Robert Keintz, btw, is the former pres & dean of curriculum at the phoenix college of acu. he was also an instrumental player in writing the practice act when AZ obtained licensure). On the issue of giving patients discounts: basically we cannot do this. commonly discounts are offered to a select group of people: eg. medicaid patients, seniors, students, your favorite club, blue cross patients, sliding scale. the reason we can't do this is that it's considered discriminatory against those who don't fall into the select group (regardless of whether or not it's offered for altruist reasons). this is a mestemeaner (sp?) offense. if insurance is involved so that insurance patients don't qualify for the discount (thus billing the insur co a higher rate than the cash patient), it becomes a felony. (a time of service discount would be ok, so long as everyone who pay at the time of service gets it, and its a reasonable discount: 25%). this means that the sliding scale fees offered by community acupuncture clinics and others are illegal. you have to set one flat rate that applies to everyone. you can offer a coupon for x amount off, so long as everyone is informed about the offer so that they may all take advantage of the discount. ($10 off the initial visit in September. you have to offer it to all new patients). you can offer a discount on a particular day or time: monday mornings are 10% off. again, you have to offer it to all your patients. if you want to offer a lower price to a particular population, you need a separate location: $45tx at x,y, z clinic. again, anyone who comes to that location gets the $45 tx. you would need to be able to show that the lower overhead at location B enables you to offer the tx at the lower rate: the location across town is a bare bones setting in a low rent district, with fewer amenities and staffing needs. another commonly used but illegal practice is pkg tx: get 10 tx for $500, this would normally be $700, and paid in adv gift certificates. the reason is accepting payment in adv of service constitutes insurance, and only insurance cos are licensed to do this. so a patient cannot pay on monday for the tx s/he will receive on friday. payment must be made after the tx is received, not prior to. complaints about these practices would be directed to the state atty generals office, the lic. boards, state orgs and nccaom. -- Oriental Medicine Experienced, Dedicated, Effective Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 20, 2008 Report Share Posted August 20, 2008 Bill, thanks for that info for CA practitioners. It's very helpful. Does CSOMA provide an info booklet about these questions? K. On Tue, Aug 19, 2008 at 1:37 PM, Bill Mosca <mosca wrote: > Kath, > > The issues of discounting, treatment packages, gift certificates, etc > are all regulated at the state level. So that particulars will vary > state by state, and it isn't possible to issue a blanket statement > that applies in all states. > > In California, for example, discounting is absolutely legal under > certain circumstances. > > Specifically, if there is " reasonable cause " to believe that the > patient is not eligible for insurance reimbursement for a given health > care service, the practitioner is explicitly authorized to provide a > discount in accord with any criteria that they establish (including > sliding scale). > > Additionally, practitioners may also establish policies for " prompt > payment " discounts. If payment is made (by any payer) within a time > period established by the practitioner, the practitioner is authorized > to provide a discount. If the practitioner's policy is to provide a > discount if payment is made at the time of service then this amounts > to a cash payment discount. > > California does, however, have a law that prohibits prepayment for > health care services. Some practitioners structure their " packages " > as rewards programs in which a patient will pay for x number of visits > at the time of service and receive the (x + 1)th visit free. This > avoids prepayment. > > Finally, there are a whole series of restrictions on issuance of gift > certificates in California that I won't even get into here. > > Of course, the particulars will vary state by state, so each > practitioner should become familiar with the laws and reg of his/her > state. > > --Bill. > > > On Aug 18, 2008, at 6:50 PM, wrote: > > > On the issue of giving patients discounts: basically we cannot do > > this. > > commonly discounts are offered to a select group of people: eg. > > medicaid > > patients, seniors, students, your favorite club, blue cross patients, > > sliding scale. the reason we can't do this is that it's considered > > discriminatory against those who don't fall into the select group > > (regardless of whether or not it's offered for altruist reasons). > > this is a > > mestemeaner (sp?) offense. if insurance is involved so that insurance > > patients don't qualify for the discount (thus billing the insur co a > > higher > > rate than the cash patient), it becomes a felony. (a time of service > > discount would be ok, so long as everyone who pay at the time of > > service > > gets it, and its a reasonable discount: 25%). > > > > this means that the sliding scale fees offered by community > > acupuncture > > clinics and others are illegal. you have to set one flat rate that > > applies > > to everyone. > > > > you can offer a coupon for x amount off, so long as everyone is > > informed > > about the offer so that they may all take advantage of the discount. > > ($10 > > off the initial visit in September. you have to offer it to all new > > patients). you can offer a discount on a particular day or time: > > monday > > mornings are 10% off. again, you have to offer it to all your > > patients. if > > you want to offer a lower price to a particular population, you need a > > separate location: $45tx at x,y, z clinic. again, anyone who comes > > to that > > location gets the $45 tx. you would need to be able to show that > > the lower > > overhead at location B enables you to offer the tx at the lower > > rate: the > > location across town is a bare bones setting in a low rent district, > > with fewer amenities and staffing needs. > > > > another commonly used but illegal practice is pkg tx: get 10 tx for > > $500, > > this would normally be $700, and paid in adv gift certificates. the > > reason > > is accepting payment in adv of service constitutes insurance, and only > > insurance cos are licensed to do this. so a patient cannot pay on > > monday > > for the tx s/he will receive on friday. payment must be made after > > the tx > > is received, not prior to. > > > > complaints about these practices would be directed to the state atty > > generals office, the lic. boards, state orgs and nccaom. > > > > -- > > > > Oriental Medicine > > Experienced, Dedicated, Effective > > > > > -- aka Mu bong Lim Father of Bhakti The Four Reliances: Do not rely upon the individual, but rely upon the teaching. As far as teachings go, do not rely upon the words alone, but rely upon the meaning that underlies them. Regarding the meaning, do not rely upon the provisional meaning alone, but rely upon the definitive meaning. And regarding the definitive meaning, do not rely upon ordinary consciousness, but rely upon wisdom awareness. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 20, 2008 Report Share Posted August 20, 2008 Hi All - I would like to just address one specific issue here, the one concerning Community Acupuncture clinics: true Community Acupuncture clinics are in no way offering discounts or breaking any laws that I am aware of. First of all, there is only one fee schedule - the sliding scale - and it is applied to all patients across the board and couldn't be more egalitarian. All patients may choose the amount they pay for each treatment within the sliding scale and there is no income verification, etc. Secondly, CA clinics do not accept insurance. Thanks. Kim Blankenship, L.Ac. On Mon, Aug 18, 2008 at 6:50 PM, wrote: > I had an interesting conversation with Robert Kientz who teaches the > NCCAOM > Ethics class about giving discounts. (Robert Keintz, btw, is the former > pres & dean of curriculum at the phoenix college of acu. he was also an > instrumental player in writing the practice act when AZ obtained > licensure). > > On the issue of giving patients discounts: basically we cannot do this. > commonly discounts are offered to a select group of people: eg. medicaid > patients, seniors, students, your favorite club, blue cross patients, > sliding scale. the reason we can't do this is that it's considered > discriminatory against those who don't fall into the select group > (regardless of whether or not it's offered for altruist reasons). this is a > mestemeaner (sp?) offense. if insurance is involved so that insurance > patients don't qualify for the discount (thus billing the insur co a higher > rate than the cash patient), it becomes a felony. (a time of service > discount would be ok, so long as everyone who pay at the time of service > gets it, and its a reasonable discount: 25%). > > this means that the sliding scale fees offered by community acupuncture > clinics and others are illegal. you have to set one flat rate that applies > to everyone. > > you can offer a coupon for x amount off, so long as everyone is informed > about the offer so that they may all take advantage of the discount. ($10 > off the initial visit in September. you have to offer it to all new > patients). you can offer a discount on a particular day or time: monday > mornings are 10% off. again, you have to offer it to all your patients. if > you want to offer a lower price to a particular population, you need a > separate location: $45tx at x,y, z clinic. again, anyone who comes to that > location gets the $45 tx. you would need to be able to show that the lower > overhead at location B enables you to offer the tx at the lower rate: the > location across town is a bare bones setting in a low rent district, > with fewer amenities and staffing needs. > > another commonly used but illegal practice is pkg tx: get 10 tx for $500, > this would normally be $700, and paid in adv gift certificates. the reason > is accepting payment in adv of service constitutes insurance, and only > insurance cos are licensed to do this. so a patient cannot pay on monday > for the tx s/he will receive on friday. payment must be made after the tx > is received, not prior to. > > complaints about these practices would be directed to the state atty > generals office, the lic. boards, state orgs and nccaom. > > -- > > Oriental Medicine > Experienced, Dedicated, Effective > > Flying Dragon Liniment: > Effective pain relief for muscles & joints > Formulated by Kath Bartlett, Traditional Chinese Herbalist > Available at Asheville Center for , or web order at: > > Kamwo Herbal Pharmacy: NY - Chinatown > https://www.kamwo.com/shop/product.php?productid=17442 & cat=0 & page=1 > > Golden Needle Acupuncture, Herbal & Medical Supply - Candler, NC > > http://www.goldenneedleonline.com/index.php?page=categories & category=14 & vendor= & \ product=5554 & pg= > > Asheville Center For > 70 Woodfin Place, Suite West Wing Two > Asheville, NC 28801 828.258.2777 > kbartlett <kbartlett%40AcupunctureAsheville.com> > www.AcupunctureAsheville.com <http://www.acupunctureasheville.com/> > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 20, 2008 Report Share Posted August 20, 2008 janis: thank you for this post. you are correct, as individuals we need to police ourselves. we don't want to live in a police state where the authorities are breathing down our necks and our neighbors are ratting on us. we need take the personal ethical responcibility of being aware of the law and obeying it. sometimes that is not comfortable or easy, but that is what living ethically is about: taking the high road. for more on this, read confucius. btw: some people seemed to misunderstand. robert kientz is no longer practicing in AZ and wasn't speaking to me about the AZ or CA practice act. kath On Tue, Aug 19, 2008 at 4:58 PM, Janis Egan <janis3934 wrote: > I think this is a very valid topic and documentation supporting a > position is important. > > Just because a business has a procedure that is never questioned, that > doesn't make it ethical or legal. For example, working at a hospital that > violates all its human resource policies on time worked and salary paid, by > overtly encouraging its employees to punch in and out differently that > actual work time, or having a supervisor edit the punched in/out work hours > to reduce the amount of pay, doesn't make it OK - it is still illegal. This > is not a made-up example and the practice continues to this day because no > one seems to have the courage to stand up to the bullies. > > I find having a widely acceptable standard to follow makes some business > decisions easier. > > For example, if we discover clear documentation that states prepaying for > procedures (and thereby giving the patient a discount), is an option only > legally available to insurance companies, then I won't institute a prepayed > discount in my practice - and I will not be putting my license or practice > in jeopardy. Following the law is a standard I will choose to apply to my > business, plain and simple. > > There are many fraudulent billing practices going on in health care that > aren't prosecuted, because many people aren't aware of the facts - or have > the nerve to report them. But, if you look up a few of those who do get > reported and caught - you can bet it wasn't worth it. > > It only takes one disgruntled competitor or savvy patient to blow it all > out of the water. I do not want to be a practitioner who uses ignorance as > an excuse to break the law and ruin my practice. > > I don't think this topic is about charging exorbitant rates for acupuncture > or judging those who don't. It is about practicing your trade ethically and > within the legal structure that protects it from being shut down. > > Best regards, > > Janis > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 20, 2008 Report Share Posted August 20, 2008 emmanuel: actually, you cannot change insurance companies a higher rate than what you charge cash patients. you may offer a reasonable (25%) time of service payment discount. kath On Tue, Aug 19, 2008 at 6:16 PM, Emmanuel Segmen <mrsegmenwrote: > Hi Kath, > > The issue as you have stated it (or interpreted it from Robert K.) may be > factual to some degree as it relates to corporate insurance and the > healthcare insurance setting. If in fact you were working exclusively in > that setting, you would not be able to see patients from outside that > setting nor could you refer patients to anyone outside that setting. > However, even MD orthopedic surgeons here in the San Francisco Bay area are > generally outside of this configuration unless they are employed by Kaiser. > For instance the orthopedic surgeons at Alta Bates Hospital on Ashby in > Berkeley may decline patients who do not have insurance or do not qualify > for Medi-Cal. Alternatively they can accept such patients and perform > procedures inside their own office or outside of Alta Bates Hospital campus > at a private surgery on Telegraph Avenue. The costs can be profoundly > different. There are some very altruistic practitioners around here. > > The healthcare providers can not buck the pricing system within the > insurance framework when doing work inside that framework. The > administration at the hospital has mechanisms for waiving fees, but this is > not in the hands of the individual practitioner who is working in essence as > an independent contractor and receiving payment via a 3rd party. > > So you only get into trouble if you treat and charge patients with > healthcare insurance in a manner that is out of line with the policies of > the insurer, and then file an insurance claim for your own or for their > compensation. Don't confuse this with performing services completely outside > of the corporate insurance framework. You are then only subject to the laws > of your own profession and the professional practices within the > jurisdiction of your license. You would not then be engaged in corporate 3rd > party payment practices or the rules that regulate such practices. You could > charge as much or as little as you decide if you acted outside of the > insurance setting. > > Likewise you could get your car fixed for a reasonable price from a private > licensed mechanic. However, if you then file an insurance claim and get an > insurance settlement that's larger than what you paid, you may be engaged in > fraud. So you have to decide whether to act within the insurance system or > completely outside of it. > > Respectfully, > > Emmanuel Segmen > ___________________ > Kath Bartlett wrote: > Mon Aug 18, 2008 6:50 pm (PDT) > I had an interesting conversation with Robert Kientz who teaches the NCCAOM > Ethics class about giving discounts. (Robert Keintz, btw, is the former > pres & dean of curriculum at the phoenix college of acu. he was also an > instrumental player in writing the practice act when AZ obtained > licensure). > > On the issue of giving patients discounts: basically we cannot do this. > commonly discounts are offered to a select group of people: eg. medicaid > patients, seniors, students, your favorite club, blue cross patients, > sliding scale. the reason we can't do this is that it's considered > discriminatory against those who don't fall into the select group > (regardless of whether or not it's offered for altruist reasons). this is a > mestemeaner (sp?) offense. if insurance is involved so that insurance > patients don't qualify for the discount (thus billing the insur co a higher > rate than the cash patient), it becomes a felony. (a time of service > discount would be ok, so long as everyone who pay at the time of service > gets it, and its a reasonable discount: 25%). > > this means that the sliding scale fees offered by community acupuncture > clinics and others are illegal. you have to set one flat rate that applies > to everyone. > > you can offer a coupon for x amount off, so long as everyone is informed > about the offer so that they may all take advantage of the discount. ($10 > off the initial visit in September. you have to offer it to all new > patients). you can offer a discount on a particular day or time: monday > mornings are 10% off. again, you have to offer it to all your patients. if > you want to offer a lower price to a particular population, you need a > separate location: $45tx at x,y, z clinic. again, anyone who comes to that > location gets the $45 tx. you would need to be able to show that the lower > overhead at location B enables you to offer the tx at the lower rate: the > location across town is a bare bones setting in a low rent district, > with fewer amenities and staffing needs. > > another commonly used but illegal practice is pkg tx: get 10 tx for $500, > this would normally be $700, and paid in adv gift certificates. the reason > is accepting payment in adv of service constitutes insurance, and only > insurance cos are licensed to do this. so a patient cannot pay on monday > for the tx s/he will receive on friday. payment must be made after the tx > is received, not prior to. > > complaints about these practices would be directed to the state atty > generals office, the lic. boards, state orgs and nccaom. > > -- > > Oriental Medicine > Experienced, Dedicated, Effective > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 20, 2008 Report Share Posted August 20, 2008 SF general charges on a sliding scale alon Quote Link to comment Share on other sites More sharing options...
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