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 to adhere to ethical and legal standards to avoid dual fee schedule violations. Some examples of potential violations include:

1.  Price Discrimination: Charging different fees for the same service based on whether the patient has insurance coverage or is paying out-of-pocket may be considered price discrimination and could be a violation of healthcare laws and regulations.

2. Overbilling or Upcoding: Intentionally inflating fees for services rendered, billing for more expensive procedures than were performed (upcoding), or billing for services that were not provided can lead to dual fee schedule violations and insurance fraud.

3. Fee Waivers: Waiving or reducing fees for certain patients as an inducement to receive medical services can be problematic, particularly if it violates contractual agreements with insurance companies.

4. False Claims: Submitting claims to insurance companies with incorrect or misleading information, such as inaccurate procedure codes or diagnosis codes, can constitute a violation.

5. Unbundling Services: Unbundling involves billing for individual components of a bundled service separately, resulting in higher total fees. This practice is considered fraudulent if it’s done to increase reimbursement amounts.

6. Balance Billing: In some cases, balance billing a patient for the difference between the provider’s charge and the allowed amount by the insurance company may be considered a violation, especially in network agreements with the insurance company.

7. Failure to Disclose Fees: Not disclosing the self-pay fees or insurance fee schedules to patients upfront and transparently may lead to ethical and legal issues.

When it comes down to it, there is a lower administrative burden with providing care to self-paying patients. That is one of the many reasons having a compliant self-pay option for patients is vital for any thriving practice.

Patient Options provides a simplified solution to dual-fee schedule issues for its physicians, allowing access to more affordable care to patients in a compliant manner. It is also 100% free for the patients. No longer is there a need for patients to pay a fee to get access to more affordible care. To find out more about Patient Options, click here. If you join now, your first month is just $1!