In a scenario where you reduce a medical bill by $500 under the Official Medical Fee Schedule and the physician bills the applicant who pays, what is the physician's responsibility?

• A. Bill the applicant and inform you.
• B. Return the $500 to the applicant.
• C. Bill the ER for the $500.
• D. Forgive the $500.

Answer: (B)

When a bill is reduced under the Official Medical Fee Schedule, that reduction is a benefit to the patient and should be passed through to them. If the patient has already paid the higher, unreduced amount, the physician must refund the difference. In this scenario, the physician’s obligation is to return the $500 to the applicant so the patient isn’t charged more than the allowed discounted amount. Billing the applicant for the higher amount or directing funds elsewhere would defeat the purpose of the schedule’s discount, and simply forgiving the $500 doesn’t ensure proper credit to the patient.