Posts by Doug Luther

As health insurance premiums rise and coverage decreases physicians everywhere must find ways to provide healthcare in a manner that is accessible. The self-pay model has risen in popularity because of this. That is a good thing. But just because it is good does not mean that there are no negative repercussions. According to Forbes,…

Medical audits can be daunting for healthcare providers due to various reasons. The fear or apprehension associated with audits is valid. We all have heard horror stories of doctors losing their clinic and livelihood to an audit. An entire career or life’s work thrown to the wolves, gone before you even have time to process…

The concept of cash-based healthcare is growing. Health insurance coverage continues to diminish. The demand for self-pay services is more prevalent than ever. With change arises new challenges healthcare providers must address and overcome. Physical therapists are no exception. In some ways PTs have are the hardest. The advent of prior-authorizations on physical therapy cpt…

Medical doctors are transitioning to a cash-based or direct primary care (DPC) model. In a traditional healthcare model, doctors bill insurance companies for their services.  This can be a complex and time-consuming process. In contrast, a cash-based model involves patients paying directly for medical services, often through a subscription or fee-for-service arrangement.  There is a…

Dual fee schedule violations may occur when healthcare providers engage in unethical or illegal practices related to their billing and fee-setting processes. These violations can involve charging different fees for the same services based on the patient’s payment method (insurance vs. self-pay), which can lead to discriminatory practices or fraud. It’s essential for healthcare providers…

Medicare Part C, also known as Medicare Advantage, is a type of health insurance plan offered by private companies approved by Medicare. These plans provide an alternative way to receive Medicare benefits, combining coverage for hospital (Part A) and medical (Part B) services, and often include additional benefits not covered by Original Medicare, such as…

Chiropractors play a crucial role in maintaining the health and well-being of their patients, but like all healthcare professionals, they must navigate a complex landscape of regulations and compliance requirements. One area of concern for chiropractors is the use of dual-fee schedules, which can lead to compliance issues. Dual-fee schedules are pricing structures that involve…