Charging Less Than Medicare
Can we legally charge our self-pay patients less than what the Medicare fee schedule allows?
Question: Can we legally charge our self-pay patients less than what the Medicare fee schedule allows?
Answer: Ask 10 managers this question, and you’ll get 10 answers. It’s a gray area. Here’s my answer: Yes, you can charge self-pay patients less than Medicare, but you want to make it clear that this lower charge is not your “usual and customary fee” (lest Medicare decides to pay you that much, too). So, you might offer it only to self-pay patients who pay in full at the time of service since there are obvious cost savings to you. Or you might reconsider the lower fee if self-pay patients make up a sizeable portion of your patient base. If you do it, do it judiciously.
HIPAA highlights: 2 disturbing class actions, OCR risk analysis enforcement
April 24th 2025Two class-action lawsuits targeting the University of Maryland Medical Center and the University of Kansas Health System for years-long cyberstalking and unauthorized access to protected health information spotlight massive HIPAA risk-analysis failures and underscore the urgent need for stronger health care cybersecurity safeguards.
