Properly applying discount chiropractic services, Part I

Your discount chiropractic services needs to be documented, consistent, and reasonable to avoid putting your practice at risk

If you’ve thought about discount chiropractic services, you need to be sure that you’re doing it in a way that keeps you compliant. And if you agree to accept discounted services, you have to live up to your agreement — or you and your practice could be at risk.

Jeff Langmaid, DC, co-founder of The Smart Chiropractor and The Smart Chiropractor podcast as well as author of the book Marketing Chiropractic to Medical Doctors, took time to answer our questions about discounting services and staying compliant.

What follows is part I of the interview, which has been edited for length and clarity.

What are the primary ways that DCs can apply discount chiropractic services while still being compliant?

Chiropractors are caregivers. We take pride in trying to help as many people as possible live a naturally healthy life. However, as a business owner, you need to be mindful that discounting your services must be done in a compliant way. Suppose you provide discount chiropractic services in a way that is not compliant? In that case, you may be up against legal fees, monetary penalties, payor contracts issues, board reprimands, and in extreme cases, criminal charges and a revocation of your license. This shouldn’t scare you; it just means that you need to take proper action steps to ensure that you stay compliant when offering discounts to your patients.

Suppose you accept payment from a third party (Medicare/Medicaid, private insurance, etc.). In that case, you need to be aware that you are contractually obligated to charge the agreed-upon fee schedule based on your patient’s insurance. Discounting services for patients with Medicare/Medicaid or private insurance is a big no-no and can end up causing you a lot of trouble. The fee schedule and patient responsibility for Medicare/Medicaid and third-party payors is not merely a suggestion, it’s the law, and non-compliance could put your practice and your license in peril.

What about underinsured or non-insured patients?

For underinsured or non-insured patients, using a discount medical plan organization (DMPO) is one of the most time-tested, and compliant ways to offer discounted services. A DMPO is a membership organization that allows you to offer discounted services to patients without the compliance issues of a dual fee schedule. Before using a DMPO, check with your state board to ensure that they are recognized as an acceptable legal entity in your state.

Generally speaking, it’s acceptable to offer a hardship or cash pay discount. The key is to offer a discount that is within reasonably acceptable parameters and documenting each use. In other words, if you are going to offer a hardship discount, then you need to have internal documentation on what qualifies as a hardship case. In addition, it would be advisable to have every hardship patient fill out a supplement form attesting to the fact that they meet the criteria.

Next, you’ll want to ensure that your discount is reasonable. Discounting services more than 20% starts to appear more like a dual fee schedule than a hardship case, and the same applies for time of service or cash pay discounts. The OIG has previously issued an opinion for a hospital system that indicated 5-15% would be considered a reasonable time of service discount.

And one final word on hardship and time of service discounts — they can be different amounts for every person. Your discount chiropractic services needs to be documented, consistent, and reasonable. Often, patients with government insurance or third-party coverage will be exempt from taking advantage of these types of discounts. Before offering any discounts in your practice, be sure to consult with your state board or a health care attorney to ensure that you are compliant with local, state, and federal laws.

The two biggest areas where chiropractors get into trouble with discounts are with the Stark and Anti-Kickback laws. Stark laws prevent Medicare and Medicaid patient referrals to health services where the referring doctor has a financial interest. Discounting of services does not make these referrals compliant. The Anti-Kickback Statute prohibits medical providers from paying or receiving kickbacks, remuneration, or anything of value in exchange for referrals of patients. Again, reducing fees or offering discounts does not change the law — all of your discounting needs to remain compliant with these federal mandates.

What do chiropractors have to do correctly when providing discounts to stay compliant?

All chiropractors should consult with a health care attorney before providing discounts for their patients. It’s important to never put your license at risk, and staying compliant with local, state, and federal laws can be challenging. Working with a health care attorney will help you mitigate any risk and ensure that your policies, procedures, and systems are compliant. They say the devil is in the details, and the details associated with offering discounts are super important. For example, a chiropractor may provide a compliant discount, but not have their policy and procedure adequately documented, reviewed, and updated within the practice standard operating procedures manual. This could create issues, and many health care providers don’t have adequate documentation of their systems. A health care attorney can help you tidy up those loose ends ensuring that you stay compliant.

Using Discount Medical Plans (DMPO) is a great way to offer compliant discounts to services. A DMPO that, in exchange for fees or membership, provides access to services at a discount for patients with limited or no insurance.

If you have specific questions about providing discounts, it is also a smart idea to reach out to your local chiropractic organization or state board. They can provide additional information and resources to ensure you stay compliant.

The above is meant as general advice. Always consult a health care attorney about your particular situation.


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