Patients who pay up front occasionally expect a cash discount and many dentists are willing to extend that courtesy if the payment is made by cash or personal check. Carefully consider the loss of income that results from extending a courtesy for payments made by debit or charge card since the practice pays a processing fee to a third party.
Dental practices that offer different discounts to different patients put themselves at higher risk for theft, fraud and embezzlement. This is because fraud can easily occur when the same person accepts and processes payments; it can be tempting for a dishonest employee to “skim” a little off the top and claim that the patient received a greater discount than was actually provided while pocketing the difference. More information on this can be found in the GPSTM module that discusses Risk Management.
The important thing to remember is that, if you decide to extend cash discounts, be careful, be consistent and have the appropriate systems of checks and balances in place in order to be properly protected.
A good rule of thumb is to limit discounts, also known as accounting reductions. Dentists who offer discounts as an enticement so patients will accept and complete a treatment plan should be certain to outline all of the specific conditions for any discount in their financial policy. That written policy should include a detailed list of agreed upon accounting reductions, which often are limited to situations when the patient pays in full by cash or check on the day treatment starts. Review your accounting reductions as they occur by reviewing the end of day reports; reevaluate your accounting reduction policy regularly, preferably at least quarterly.
Every member of your staff should be aware of the practice’s written financial policy regarding accounting reductions.
It’s a good idea to have all employees sign a statement that they’ve read, understand and agree to comply with the policy. Place a copy of that statement in each staff member’s personnel file. While it may seem tedious or unnecessary, this important precaution could protect you in the event that embezzlement occurs in your practice; having a signed document acknowledging awareness of the practice’s financial policy prevents employees from claiming that they “didn’t know” they were acting in a way that was not allowed.
Keep in mind that the patient’s dental benefit plan should be informed of any fee adjustment through a separate paper claim or as an attachment to a reimbursement submission. Failure to notify the plan of any accounting reduction could be considered fraud, even though it may be no more than a simple oversight.
Some insurance contracts require the dentist to avail their enrollees of the lowest service fees provided in the office. Repeated fee reductions may qualify as such an occurrence and the practice may be required to extend the discount to all members in a particular insurance plan.
Also, remember that different states have different laws regarding discounts. Check with a knowledgeable attorney in your jurisdiction or consult your state dental association for information about laws relating to discounts that might apply to your practice.
- Preventing fraud and abuse
- Responsibility for Billing, Records and Accounting
- Guidelines for Practice Success | Resources for Managing Professional Risks
- Guidelines for Practice Success | Resources for Managing Finances
- Guidelines for Practice Success | Managing Finances | Risk Management and Fraud Prevention
- Financial Policy Statement [PDF]
- If You Suspect Fraud Checklist [PDF]