Giving patients “cash” discounts patients can be problematic. However, a carefully developed, written  prompt payment discount policy could work for your practice (read the article from TMA below).

One concern is that most of your health care payment plan contracts likely specify that the plan will pay “the lesser of” the provider’s usual charge or the plan allowable. When you give a reduced price to other patients, the plan could possibly claim that that reduced price is your REAL usual charge. If the plan has been paying you more than that, it could try to recoup the difference.

However, a carefully developed prompt payment discount policy such as the following could work for your practice.  Be sure to put the policy in writing.

• Offer the discounts only for services that are paid in full at the time of the service, in advance, or maybe within a certain number of days.
• Make it clear that the discount is available to anyone who meets your terms, unless their insurer’s policies or contracts prohibit it. If an insurer can pay you in full within your terms for the discount, it receives the discount, too.
• Apply the discount s to your standard fees, not to any contractually reduced fees.
• Inform your patients of the availability of the discount as appropriate during the billing process.
• Make efforts to ensure that the amount of fees discounted to patients bears a reasonable relationship to the amount of avoided collection costs. 

For details about the legal issues involved, read TMA’s white paper, “Prompt Payment Discounts for Patients.”  

Also, remember that under Texas law (House Bill 1731), you must post a notice in your waiting room to inform patients they can request a copy of your billing policies.

Need help developing billing and payment policies? TMA Practice Consulting can evaluate these, and other office policies and procedures. An Operations Assessment identifies risks within a practice and shows you how to reduce or eliminate them.  The TMA Education Center has on-demand webinars that can help with billing, prompt payment, and clean claims issues.

Published Aug. 28, 2012

NOTICE: This information is provided as a commentary on legal issues and is not intended to provide advice on any specific legal matter. The Texas Medical Association provides this information with the express understanding that 1) no attorney-client relationship exists, 2) neither TMA nor its attorneys are engaged in providing legal advice and 3) the information is of a general character. This is not a substitute for the advice of an attorney. While every effort is made to ensure that content is complete, accurate and timely, TMA cannot guarantee the accuracy and totality of the information contained in this article and assumes no legal responsibility for loss or damages resulting from the use of this content. You should not rely on this information when dealing with personal legal matters; rather legal advice from retained legal counsel should be sought.

Last Updated On

June 01, 2016

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by Joey Berlin, July 17, 2020

The Texas Medical Association has updated its white paper on Texas’ law for settling out-of-network billing disputes involving state-regulated health plans.

The eight-page white paper, first released last December, covers the ins and outs of Senate Bill 1264, the 2019 legislation now in effect. SB 1264 took patients out of the middle of surprise-billing disputes between certain out-of-network physicians and state-regulated health plans, allowing them to settle those disputes through an arbitration process similar to the one used to settle salary disputes in Major League Baseball.

The white paper update comes after the Texas Department of Insurance  adopted a final rule touching on exceptions to SB 1264’s general ban on balance billing for out-of-network services the law covers. SB 1264 prohibits balance billing except in certain circumstances, which include required notice and disclosure.

The newly amended rules include these changes that TMA requested:

• Legal representatives or guardians of a patient may be the people to agree to an out-of-network physician’s required notice and disclosure of a potential balance bill;
• A physician may delegate the record-keeping of that notice and disclosure statement by allowing a practitioner’s “agent or assignee” to maintain a copy of the statement. Also, the statement only has to be maintained if the practitioner provides the medical service or supply at issue and sends a balance bill.

You can read the complete adopted rule on page 4,204 of the June 19 Texas Register.

To view the TMA updated white paper on Ink, follow this link.

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As our understanding of COVID-19 continues to grow, the steps you should take to test and care for patients safely have evolved. (TMA) 6/8/2020

Check out the entire article here or click on the links below to go straight to the FAQs

• COVID-19 Testing Information Frequently Asked Questions (FAQs
• Quick How-To Testing Guide for Outpatient Clinics
• FAQ on Infection Prevention and Control for Outpatient Clinics
•  TMA’s COVID-19 Resource Center

[embeddoc url=”https://community.poetllc.org/wp-content/uploads/2020/06/Here-Is-the-Latest-on-Testing-Caring-for-COVID-19-Patients-By-David-Doolittle-TMA-06182020.pdf” download=”all” viewer=”google”]

[embeddoc url=”https://community.poetllc.org/wp-content/uploads/2020/06/Delegation-of-Duties-by-a-Physician-to-a-Nonphysician.pdf” download=”all” viewer=”google”]

[embeddoc url=”https://community.poetllc.org/wp-content/uploads/2020/06/Non-physician-provider-guideline-TMA.pdf” download=”all” viewer=”google”]

A Quick Guide to Each Payer’s Coronavirus Changes and Waivers

Throughout the COVID-19 pandemic, commercial and government payers have issued waivers and policy changes to help physicians care for as many patients as possible. 

But each plan has different effective and expiration dates for telemedicine, testing, and treatment changes. And most commercial plans can opt in or out of government-program adjustments such as waiving cost-share for treatment. 

If you’re trying to keep track of each payer’s policies, the Texas Medical Association has created a chart that shows when each change began – and is scheduled to end – for government and commercial plans. 

The chart includes information on Medicaid and Medicare as well as Texas Department of Insurance (TDI)-regulated commercial plans and ERISA (federally regulated) policies. It is based on details posted on each plan’s website and will be updated frequently. TMA recommends you contact each patient’s plan directly. 

The chart is one of several tools TMA has published to help you navigate the constantly changing payer landscape during the pandemic. 

TMA’s Practice Viability Toolkit details multiple ways to keep your practice’s finances healthy. It includes a section on each payer’s policies. 

The webinar, Payer Updates in the Time of COVID-19, offers guidance in sorting through the inconsistent patchwork of varying COVID-19 billing and coding policies. It is accredited for 0.5 AMA PRA Category 1 Credits™. 

You can find the payer chart, toolkit, webinar, and other resources and information on the practice viability section of the TMA COVID-19 Resource Center.

POET Update 8/19/2020: BCBS Expands Telemedicine through 12/31/2020.

Be sure to open this article ( click on title) to be able to access links.

Last Updated On

May 12, 2020

Payers Extend Prior Authorization Windows During COVID-19, follow this link.