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Chiropractic Doctor


Risk 119

Understanding the Legalities of Fee Discounts, Particularly Time-of-Service Discounts and Hardship Discounts - 6 Hour


6.0

  • Assess state, federal and board rulings regarding fee discounts, particularly time-of-service discounts and hardship discounts, and the extent to which they may be impacted by anti-kickback legislation, insurance regulations, self-referral laws, marketing restrictions, and the tenets of unprofessional conduct..
  • Identify potential problems associated with routine approval of hardship discounts and the requirement for inquiry and documentation regarding qualifying for same.
  • Distinguish between appropriate and inappropriate/illegal marketing relating to fees and professional services.
  • Demonstrate how these discounts are regarded by relevant professional boards, and state and federal enforcement agencies.
  • Explain terms associated with time of service discounts and relevant factors associated in calculating an appropriate reduction in fees.
  • Identify specific conduct and activities within the practice of healthcare that violate a host of regulatory and statutory proscriptions relating to pre-paid fee arrangements.
  • Explain the development of current fee discounting legislation, rules and holdings.
  • Distinguish between appropriate and inappropriate/illegal marketing relating to fees and professional services.
  • Demonstrate a working knowledge regarding the roles played by the various state and federal enforcement agencies as they related to fee splits and kickbacks.
  • Assess one’s working knowledge regarding the process by which state and federal rulings regarding fees impact a healthcare provider’s practice in light of marketing, fee-splitting and anti-kickback legislation, insurance regulations, self-referrals, and the tenets of unprofessional conduct generally.
  • Verify how certain discount practices may be legally actionable as “improper inducements.”
  • Evaluate federal Stark legislation and the discouragement of corruption in sound professional healthcare decision-making.
  • Identify distinctions between federal anti-kickback and the federal Stark legislation.
  • Critique state anti-kickback laws.
  • Recognize the role the FTC played, and continues to play, in discouraging the fraudulent marketing of discount health care programs.
  • Draw associations between co-pay requirements, consumer habits and federal healthcare expenditures.
  • Assess how "professional courtesy" discounts may raise enforcers' concerns under the federal anti-kickback statute.
  • Diagram how prepaid fee arrangements often resemble health insurance to unwitting patients.
  • Illustrate pitfalls that advertising discounts visit on the practitioner.

Peter Van Tyle, Esq

Downloadable Course in PDF
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$120.00 USD


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