Time of service reduction ("TOSR") is a method of discounting services that does not discriminate against any person or responsible party in a healthcare provider office.
If services are paid at the time of service, a discount is appropriate since there will not be the administrative costs of billing and collecting the services, or the losses incurred through insurance (or discount plan) denials that, although candidates for administrative appeal with merit, the administrative costs outweigh appealing most services that are denied.
Accordingly, if a patient pays at time of service, it is fair to offer them a reasonable discount, proportional to your administrative collection fees, plus an incentive for a patient to pay at time of service.
This is non-discriminatory, because if an insurance adjuster was at the office with the company checkbook as their insured party checked-out, you would offer them the same TOSR discount. (Don't count on this.)
EMR Datacenter supports TOSR through the Tools->Procedure Catalog. For each service or product entry, the TOSR amount is the reduction. For example, if you charge $45 for an adjustment, but fairly assess your administrative payroll and other costs to collect the $45 as $8, then it is fair to implement the $8 TOSR discount. Similarly, if hot packs are $20, but the patient is willing to pay at the time of service, a fair TOSR discount may be $6.
The rule is that your TOSR discount is reasonable and prudent. The TOSR discounting method is not intended for hardship or charity cases, but the norm of your healthcare transactions.
Once you have decided your TOSR discount amounts and set them in Tools->Catalogs->Procedures, the TOSR discounts are ready to be implemented. On the New Transaction window, if the front desk person asks if the patient will be paying in full today, their "time of service discount" applies, so the TOSR button on the New Transaction window is pressed which applies the *TOSR discount to each transaction. (If a patient is able to pay some but not services at the time of service, the *TOSR must be deleted for transactions that will be billed – this is the "spirit" and also the legal argument of the TOSR discount.)
In real world situations, where insurance assignment is being accepted, the insurance companies will never receive the TOSR discount, because the insurance responsibility is assigned and billed. But if a patient has an insurance policy and you are not accepting assignment on the insurance, you do not have the administrative costs of billing so the patient should be able to qualify for the discount. You should seek legal advice in your state regarding the patient receiving a discount and their ability to receive proportional reimbursement when filing their own insurance.
Prepayment escrow plans are great for office, with emphasis that the legal agreement be construed such that the healthcare provider is not practicing insurance without a license.
Once again, since there is not the administrative cost of collecting the payment, this substantiates a reduced amount for the term of the escrow pre-payment, pursuant to a well constructed legal agreement. Before constructing any pre-payment escrow plan, you should check with a legal advisor who specializes in Healthcare Law in your state, or with your state's chiropractic association.
Group discount plans aren't themselves insurance companies, but rather are constructed to offer discounts for chiropractic, dental and other heathcare services. These patients are essentially cash patients who qualify for a discount negotiated by the group discount plan. These discounts should be entered as simple patient credit memos, or new patient credit memo entries can be created so that practice statistics can total the amount for each group discount plan.