Ask the Experts Answer: Billing for Urgent Care Center

Q: We are opening an urgent care center that will be hospital-based. This is a new venture for our hospital. The consulting team that is setting-up the billing suggests that we have two different charge slips and two different prices — one for self pay and one for insurance patients. I am not comfortable with this recommendation and would like guidance on charging two different prices.

A: If the urgent care center is a Medicare participating provider, then all patients must be charged the same price for all services. The center cannot have separate prices based on who will be paying the fees. It can offer self pay discounts, but the discount must be applied to the same base charge that every patient receives for the same service.

Suzanne Lestina, HFMA Technical Director, answered this question.