________ schedules are NOT allowed by law or provider contracts?

________ schedules are NOT allowed by law or provider contracts?

• A. Dual Fee
• B. Tiered
• C. Bundled
• D. Flat-Rate

Answer: (A)

Pricing for the same service must be consistent with what you’ve contracted to accept and what laws allow. A dual fee schedule sets one price for some patients or payers and a different price for others for the exact same service. That kind of differential pricing is not allowed because it undermines uniformity, can violate payer contracts, and can be seen as price discrimination or fraudulent if it’s not transparently supported by a legitimate, disclosed policy. In practice, you bill insured patients at the negotiated rate and disclose a cash or other rate for patients without insurance, if applicable, but you don’t casually switch prices based on who is paying. Other pricing approaches are commonly permissible when they’re clear and compliant with contracts: tiered pricing adjusts rates based on objective criteria (like service complexity), bundled pricing offers a single price for a defined set of services, and flat-rate pricing charges a fixed amount for a specific service. These can be legally and contractually acceptable when properly structured and disclosed.

Pricing for the same service must be consistent with what you’ve contracted to accept and what laws allow. A dual fee schedule sets one price for some patients or payers and a different price for others for the exact same service. That kind of differential pricing is not allowed because it undermines uniformity, can violate payer contracts, and can be seen as price discrimination or fraudulent if it’s not transparently supported by a legitimate, disclosed policy. In practice, you bill insured patients at the negotiated rate and disclose a cash or other rate for patients without insurance, if applicable, but you don’t casually switch prices based on who is paying.

Other pricing approaches are commonly permissible when they’re clear and compliant with contracts: tiered pricing adjusts rates based on objective criteria (like service complexity), bundled pricing offers a single price for a defined set of services, and flat-rate pricing charges a fixed amount for a specific service. These can be legally and contractually acceptable when properly structured and disclosed.