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Pricing & Packaging: Defining the Value Exchange
Approaches to pricing will vary based on practice revenue models, however, when possible, you should strongly consider bundling the COVID-19 Care and Prevention episodes into defined packages for patients rather than charging patients by the encounter or unit of time or service.
There has never been a better circumstance in which to apply this pricing structure – especially for practices that do not contract with or bill third-party payers. In the effort to minimize the financial impact of COVID-19 on consumers, an important accommodation has been made that is relevant to functional medicine practitioners. Section 3701 of the CARES Act allows a high-deductible health plan (HDHP) with an HSA to cover telehealth services prior to a patient reaching the deductible. (You may find a thorough listing of the key telehealth provision of the CARES Act from the American Telemedicine Association.)
With this change in effect, along with a host of others from health insurance providers in response to COVID-19, many patients, if given the proper documentation, can submit their own out-of-network claims and receive reimbursement for virtual care.
This enables physicians providing a bundled, COVID-19 related episode of care to deconstruct the bundle into its reimbursable components and equip patients with the documentation to reimburse themselves in full, or in part for whatever they pay the practice for covered features of the care package. This does not restrict practices from setting their own bundle pricing.
If your practice is contracted with payers, you may take a different approach to bundled pricing. As you are obligated to bill payers for covered services, your bundled price should be documented and account strictly for non-covered services included in the bundle. This is a well-tested approach to compliantly capturing the fair value of high-touch health services used for nearly 20 years by concierge physicians in the “fee for non-covered service” model.
Tool: The Pricing & Encounter Form Workbook
To make this process as easy and efficient as possible, we have created an Excel document to assist you in defining your pricing and quickly producing encounter forms to provide to patients.
Each encounter form is mapped to the COVID Care episode and formatted to fit on a single page and should be easy to print and hand to patients.
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