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 charging different fees for the same services, depending on factors such as the patient’s insurance coverage or payment method. Chiropractors must be aware of various laws and regulations, including those related to insurance fraud and anti-kickback statutes, which can be triggered by dual-fee schedules that lead to improper financial incentives or discriminatory practices.
Chiropractors face specific compliance challenges related to dual-fee schedules:
- Insurance Fraud: Charging different fees for the same service based on a patient’s insurance coverage can potentially be considered insurance fraud. This occurs when the chiropractor intentionally overcharges or misrepresents services to insurance providers, thereby violating the law.
- Anti-Kickback Violations: Chiropractors need to be cautious about providing discounts or waiving fees for patients who refer others, as this may be construed as an illegal kickback. Chiropractors must ensure that referral relationships and financial incentives comply with applicable anti-kickback laws.
- Stark Law Compliance: The federal Stark Law prohibits physicians, including chiropractors, from referring patients to entities with which they have financial relationships, creating potential compliance issues when dual-fee schedules affect referral patterns.
DMPOs: An Ally for Chiropractic Compliance
Discount Medical Plan Organizations (DMPOs) offer chiropractors a valuable resource in navigating compliance challenges associated with dual-fee schedules. Here’s how DMPOs can help:
- Fee Schedule Management: DMPOs can assist chiropractors in creating and maintaining fee schedules that are compliant with relevant regulations, ensuring fees are based on services rendered and not influenced by insurance or payment methods.
- Network Support: Chiropractors who are part of a DMPO network may benefit from collective compliance efforts and shared best practices, further reducing the risk of dual-fee schedule-related problems.
Downfalls of Traditional DMPOs
In the past, patients had to pay a fee to get access to the benefits of a DMPO network. There is nothing inherently wrong with this. There are some things to consider from the providers perspective when it comes to DMPOs. One of which is that your patient may not be familiar with the nuances surrounding healthcare compliance. Therefore, on top of educating a new patient on the importance of a treatment plan, you must educate that patient on why they need to pay extra to get access to more affordable care. This is a major complaint for providers that have used DMPOs. It doesn’t have to be that way.
Patient Options offers the same compliance benefits traditional DMPOs provide for chiropractors. A key difference is it is entirely free for patients. Providers no longer have the burden of selling a patient on the idea of a DMPO network. Onboarding and participation for the patient is virtually effortless and allows both the chiropractor and the patient focus on what is truly important…patient care.
Right now, it has never been more affordible to improve your fee schedule compliance. Your 1st month is $1 when you join today! Click here for more details.