Just to reiterate the actual ruling summary is below… There’s so much speculation in our profession about what is legal and illegal. Everybody take 5 seconds and read the rule summary below. If you’re confused, download the actual rule. Put it into your patient agreement and be done with the speculation 🙂
1. The actual rule: http://oig.hhs.gov/fraud/
2. A summary of the actual rule: http://www.lexology.com/
OIG Advisory Opinion OKs prompt pay discounts
Baker & Hostetler LLP
Susan Feigin Harris, Summer Rohde
February 21 2008
The OIG recently issued an Advisory Opinion (No. 08-03) addressing a provider’s proposed arrangement by which it would offer prompt pay discounts in connection with both inpatient and outpatient services to insured patients, including those covered by Medicare and Medicaid. The prompt pay discounts would range from 5% to 15% depending upon the time payment is made, which may include the time of discharge or within 30 days of discharge. The OIG determined that although the prompt pay discounts could generate prohibited remuneration under the anti-kickback statute, the OIG would not impose administrative sanctions or civil monetary penalties, concluding that several factors were present that constitute a legitimate prompt pay incentive and not a means to induce patients to self-refer.
Such factors include: (1) any amounts forgone would not be claimed as debt; (2) the discount would be offered without regard to the reason for the patient’s admission, length of stay, diagnostic-related group, or ambulatory payment classification; and(3) the discount would not be part of a price-reduction agreement between the provider and any third-party payor.
In addition, the fact that (1) the provider would not advertise the discounts; (2) third-party payors would be notified of the discounts (if applicable); (3) all costs associated with the proposed arrangement would be borne by the provider and not be written off to bad debt; and (4) the discounts were certified by the provider to be reasonably related to the amount of collection cost that would be avoided were critical to the OIG’s analysis. copy of the advisory opinion is available online.