tag:blogger.com,1999:blog-2760353953251845523.post6681513135176448225..comments2024-02-10T02:14:39.898-05:00Comments on Buckeye Surgeon: The Chargemaster and Non-Profit Charity CareJeffrey Parks MD FACShttp://www.blogger.com/profile/15650563299849196122noreply@blogger.comBlogger1125tag:blogger.com,1999:blog-2760353953251845523.post-45955671319817913832013-03-06T12:35:24.250-05:002013-03-06T12:35:24.250-05:00One reason for this problem of overcharging for se...One reason for this problem of overcharging for services, at least at outpatient offices, is the problem which occurs when you undercharge. Most insurance plans have contractual language that states that practices accept “preferred” or discounted rates to that insurance. Those “preferred” rates are not the rates that you bill for, but what you actually receive. Those “preferred” rates are not the same for each insurance. Furthermore, by law and contractual arrangements, practices cannot charge Medicare more than they charge any other patient, insured or otherwise, nor balance bill the patients (i.e. asking patients for the balance between charged and actual monies received). These factors lead to practices charging higher than those “preferred” rates and Medicare rates to keep them out of danger from insurances coming back and stating that offices offered lower rates to other insurances. Charge high, accept lower payments, and no one can say you are not accepting preferred rates, and ask for money back (which for Medicare can be seven years back). In fact, because the contracts between insurances and offices are private, it is hard to know what that preferred rate is before a service is billed for and monies received. For patients who are self-pay, offices cannot “offer” lower rates, but may well “negotiate” a discounted rate based on financial need if the patient asks for it—this keeps offices out of danger of offering lower rates. This is a result of the third party payer system in this country, leading to lack or price transparency.-- from a rheum in private practiceAnonymousnoreply@blogger.com