5 Steps Make Financial Waivers a Good, Not Risky Deed

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5 Steps Make Financial Waivers a Good, Not Risky Deed

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Billing Waivers

QUESTION: We serve a large volume of underprivileged patients who can barely afford to eat. Our doctors often want to help them by waiving their deductibles and co-pays. Could we get in trouble for doing this “good deed”?

Cookeville, TN Subscriber

ANSWER: Waiving a patient’s co-pay, deductible, or co-insurance can put your practice at risk for not complying with your payer contacts and federal laws. Your payer contracts require you to collect patient cost-sharing amounts. Not doing so can violate your contracts and potentially federal fraud and abuse laws. Further, routinely waiving patient payments could be interpreted as a referral inducement that violates Stark and Anti-Kickback law. Do this: To make sure that you compliantly waive patient amounts, take the following practice-protecting steps:

  1. Document the waiver
  2. Do not routinely waive deductibles, co-pays, or co-insurance
  3. Develop a policy and procedure for determining patients’ financial situations and stick to it. Designate a financial person to approve the waivers. Outline the process steps. Develop objective criteria for waiver approvals such as U.S. poverty guidelines.
  4. Conduct periodic audits of patient accounts to verify that the policy and procedure is followed.
  5. Never allow sales and marketing personnel to discuss this policy with referral sources or patients. Train them to never advertise that you will waive copays or use “insurance-only billing.”

Answer contributed by healthcare attorney Heidi Kocher, BS, MBA, JD, CHC inHead Off Innocent Billing Errors that Result in Legal Headaches.”


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Meet Your Writer

Heidi Kocher
B.S., M.B.A, J.D., CHC

Healthcare Attorney, Liles Parker PLLC

Heidi has 20 years of experience in health care legal and compliance related issues. Her experience includes positions at a large hospital corporation, serving as a compliance officer for a sleep lab/DME company and a compliance director, chief privacy officer and interim chief compliance officer at a medical device manufacturer. In addition, she has represented and advised critical access and long-term care hospitals, physician groups, home health agencies, DME companies, pharmacies (including compounding pharmacies), non-profit organizations, and licensed individuals. As a result, she understands the complexities and challenges that providers large and small face in complying with increasingly varied and complex laws. She is an expert in all aspects of compliance and privacy programs, including developing and deploying policies, procedures and training. Her experience includes implementing the various requirements and aspects of a Corporate Integrity Agreement, responding to and defending audits from Medicare, Medicaid and private insurers up through the ALJ level, guiding clients through voluntary self-disclosures, seeking advisory opinions from the OIG, and defending FDA audits. Heidi developed criteria for and implemented an aggregate spend system, permitting a medical device manufacturer to timely report correct information under the Physician Open Payments Acts (also known as the Physician Payments Sunshine Act). In addition, she is experienced in developing and implementing a compliance program to address Foreign Corrupt Practices Act requirements, including Eucomed guidelines. She also has significant reimbursement experience, addressing coverage policy issues, challenging denials, recoupments, and loss of billing privileges, obtaining HCPCS codes, and other reimbursement related issues.