[Mikec041]

Originally Posted by blueash

There is absolutely nothing unethical about it. The doctor is REQUIRED to bill the same charge to all patients for an identical service whether the patient is self pay, commercial insurance or government insurance. So the 5000 in the OP's post is the charge to every patient. Medicare might only pay 3000, but United Airlines insurance might pay 4999. Medicaid might pay 2000, BCBS of NY might pay 4200. The doctor tries to keep the billed charge higher than the maximum payment of any carrier and eats the write off of the poor payers. But everybody is billed the same "usual and customary"

That's not exactly accurate. Doctors can "discount" for cash paying patients. Which may or may not be lower than what insurance companies pay.

[jimhoward]

Originally Posted by SHIBUMI

Dodgy Doctors or Not..........

Lets say a Doctor charges you (bills insurance) $5,000 for a 1 mg medication shot.

Medicare will only cover $3,000 for that shot.

Does the doctor have a $2,000 loss that he can deduct on his tax return???

If so, we talking about a half million dollars or more of tax deductions--based on trumped up charges.

Thanks for your expertise..........

If your rack rate for golf lessons was $200/hour, and you gave your favorite student a rate of $100/hr, would you still recognize $200/hour as income and record a $100/hour expense on your tax return? Neither would a doctor on his invoices.

[Pugchief]

Originally Posted by CoachKandSportsguy

A medical office, doctor, can not remain in business if the only rate accepted is the medicare rate. most hospitals and doctors office need non medicare higher rates and patients to survive to stay in business. Otherwise they must rely on CMS annual reimbursements for improvements to stay in business. Small hospitals and medical practices going out of business is very common, because they can't get sufficient revenue mixes to overcome their fixed expenses. hospitals also have different CMS designations, based upon size and area for reimbursements.

And this, in a nutshell is why Medicare for All will be a disaster.

[Pugchief]

Originally Posted by blueash

There is absolutely nothing unethical about it. The doctor is REQUIRED to bill the same charge to all patients for an identical service whether the patient is self pay, commercial insurance or government insurance. So the 5000 in the OP's post is the charge to every patient. Medicare might only pay 3000, but United Airlines insurance might pay 4999. Medicaid might pay 2000, BCBS of NY might pay 4200. The doctor tries to keep the billed charge higher than the maximum payment of any carrier and eats the write off of the poor payers. But everybody is billed the same "usual and customary"

Originally Posted by Gigglesmom

I have been managing hospital-based physician professional component medical billing for 40 years. Practices/physicians (in and out of hospitals) usually will set fees slightly above the highest allowed amount from any of their managed care contracts. They are required to accept no more than the allowed amount from any carrier (in or out of network). The difference between the fee and allowed amount is adjusted off and called a disallowance. It is not tax deductible. The remainder is the patient’s deductible or co-pay. As for uninsured patients, groups will heavily discount their base/full fees. Hospitals often discount 80% or more, often accepting less than they would be paid by Medicaid. Physicians who are contracted to perform services in hospitals, but are independent practices (radiologists, pathologists, ER providers, anesthesiologists and others) often have contractual obligations to the facility to match their discount rates for uninsured patients. There are no rules governing their fee structures at all.

These two are in direct opposition.....

[Salty Dog]

When I didn't have dental insurance, I had a higher rate than if insurance has paid it. I just asked the dentist to give me the same rate. After all, he didn't have to file paperwork for billing and then wait for the payment. He got the payment right then and there. He was fine with this arrangement.

[Pugchief]

Originally Posted by DAVES

Having been in my own business, you are right. A rude shock someone owes you money and they go out of business, you cannot even take the income NOT PAID as a tax deduction.

That depends on whether you are using cash or accrual accounting. That is correct for cash, but not for accrual.

In a cash system, you never received the income in the first place, so there is nothing to deduct.

[SHIBUMI]

don't discount at all because it affects the students retention rate.......the student learns better at 200$ because the info is more valuable.......to him....

Originally Posted by jimhoward

If your rack rate for golf lessons was $200/hour, and you gave your favorite student a rate of $100/hr, would you still recognize $200/hour as income and record a $100/hour expense on your tax return? Neither would a doctor on his invoices.