Cash for Treatment (Full Version)

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tnt -> Cash for Treatment (January 26, 2006 8:18:00 AM)

A recurring theme on this site seems to be suggestions to turn a private practice into "cash only" treatment, which chiropractic has been doing successfully for many years. While I think this is an excellent idea, I also believe it to be a bit idealistic, at least in the regions where I have practiced. Now maybe my views are a bit naive, having never tried it, so I will always consider exploring further.
In doing so, at risk of my ignorance showing, one question always comes up: If I do charge patients cash for treatment, can they then apply or submit the bills to their insurance to be reimbursed for the P.T. according to the coverage of their plan? If this is an option, and insurance will reimburse in this manner, I think the cash business becomes a much more feasible model, with pts knowing that they will be reimbursed at some point.
I am very interested to hear from those of you currently practicing on a cash basis, and from those of you considering this option.

TNT -- PT



tc -> Re: Cash for Treatment (January 26, 2006 9:29:00 AM)

At least in CA, yes. I and other other PTs will see patients (with an RX and referral in hand) for cash payment, then provide patient with an invoice of payment with all required documentation and CPT codes, etc. THen the patient can submit this with a copy of Rx to insurance company for reimbursement. Patient is responsible for finding out what coverage is and there may be a difference between what they pay me and what they are reimbursed. This is discussed in advance and patient signs a form stating as such.
I think the reason this doesn't happen more often is that most people have difficulty coming up with that much cash up front and waiting the months it takes for reimbursement. It is much easier as a patient to go somewhere where you can pay your co-pay only and not deal with paperwork or more out of pocket cash.



Randy Dixon -> Re: Cash for Treatment (January 26, 2006 7:26:00 PM)

Isn't that the way insurance used to be done, patients pay up front then get reimbursed by insurance. This was replaced by "courtesy" billing of insurance, and now it seems to be a major part of a private practice.

I'm wondering how flexiaccounts and Medical Savings Accounts will impact this.



SJBird55 -> Re: Cash for Treatment (January 27, 2006 12:15:00 AM)

Randy, I think that as those kinds of accounts become more prominent, there will be more and more "cash only" patients.

tc, my biller submits claims electronically. I'd like to head to a higher percentage of cash only practice as soon as I build the practice and have a high steady flow. I would plan on continuing to use my biller in that situation. The electronic billing does result in quicker payments - it seems like 14-21 days. It really isn't "months" of waiting, generally. (Which would be a nice option to offer patients so they don't have to wait long periods of time via paper claim submissions.) I still need to do some thinking on how a contract between the biller and I would be set up... I don't forsee that I would be "cash only" because I'll still participate with Medicare and technically the patient isn't to pay anything until Medicare says what they pay.



drbuddy -> Re: Cash for Treatment (January 27, 2006 1:28:00 PM)

Also, keep in mind, as long as you treat patients with medicare, you will never be a completely all cash practice. It is my understanding that you must abide by the documentation rules and submit all claims for these patients. You can choose not to accept assignment, then the patient pays up front, but you still have to submit and abide by their fee schedule (for covered services).



Soleman -> Re: Cash for Treatment (February 1, 2006 4:11:00 AM)

Re the Medicare issue, you may choose to not accept assignment, have the pt pay cash, and they submit to Medicare for reimbursement, however the Medicare rules state that you can only require the pt to pay 115% of the allowed Medicare fee schedule. Now, I don't know how they enforce that or if it is technically a law, therefore I chose to go ahead and accept assignment and the headaches it involves.



TLB -> Re: Cash for Treatment (February 1, 2006 7:40:00 AM)

[QUOTE] Also, keep in mind, as long as you treat patients with medicare, you will never be a completely all cash practice. It is my understanding that you must abide by the documentation rules and submit all claims for these patients. You can choose not to accept assignment, then the patient pays up front, but you still have to submit and abide by their fee schedule [/QUOTE]Buddy T, do you have a link to this. If I'm in a direct access state and have nothing to do with Medicare how can they have any say in the matter, whether it be as a personal trainer, LMT, PT or whatever. You saying just because the are covered through Medicare that they can't be treated by anyone even if they pay out of pocket, is this correct? Thanks for the help.



drbuddy -> Re: Cash for Treatment (February 1, 2006 11:19:00 AM)

Sorry, Soleman is right. You can collect at the time of service and have them submit the claim. I dont know what I was thinking when I wrote that.

As far as I know, you can only charge them the limiting charge for covered services.

LMT and Personal trainers would not be providing covered services, so it wouldnt apply to them. If I provide anything other than CMT, then they are considered non covered services for me, thus I can charge what I want.

All of this is covered in the medicare manual. Not exactly fun reading, so good luck.



grizfb75 -> Re: Cash for Treatment (February 11, 2006 8:51:00 AM)

I have been reading through this forum and gathering lots of information. I was also wondering if there were any articles or other information on the web about accepting cash for treatment exclusively.



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