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Sliding Scale - Good Idea or Bad?

As nurses, we inherently try to do what is best for our patients. Everyone experiences financial hardships at some point in their lives, and as providers you may want to help them out. I get questions from providers all the time about sliding scales and waiving fees. You have your own practice and you should be able to charge what you want to, right? Yes and no. If you are a cash pay practice you have a fee schedule and you can freely make the decision to have a sliding scale or offer discounts, BUT you have to offer those discounts to everyone equally based on guidelines and a clear policy. You can't privately offer a discount to Mary, and not offer it to Suzy. You need to have a policy that outlines guidelines and who qualifies for sliding scale or discounted prices. These guidelines are usually set on the national poverty guidelines (2020 Poverty Guidelines by State). Providing discounts to those in need sounds like you are doing a good deed, however, you are still trying to run a business and pay overhead costs and make a living. If you start offering low priced care, you are going to get more and more patients looking for the same. Again, you are running a business. Carefully, do your research and see if you can afford to do this and keep your business afloat, and then make an informed decision. A good article to read that walks you through the steps of creating a sliding scale for your practice.

If you take insurances, this is an entirely different story. You are required by most insurance contractual agreements to collect copays, coinsurances and deductibles not met. You can not randomly waive these payments to help your patient out if the terms in your contract prohibit you from doing so. You can get yourself into hot water with your insurers (including Medicaid/Medicare) and you can be charged with insurance fraud! Remember that you have to make the playing field even for everyone, if it is not prohibited by your contractual agreement with your insurer.

I recommend that you get legal consult on what your insurance contract limitations are, watch your Medicare and Medicaid guidelines (because they can change) and have a solid policy with guidelines on how your sliding scale program works. This is a good article and gives you some advice on what to do and what to avoid.


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