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:
- Document the waiver
- Do not routinely waive deductibles, co-pays, or co-insurance
- 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.
- Conduct periodic audits of patient accounts to verify that the policy and procedure is followed.
- 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 in “Head Off Innocent Billing Errors that Result in Legal Headaches.”
Commonly Purchased Online Trainings and Resources
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Negotiate Payer Contracts to Get Paid More of What You’re Due$277.00 – $917.00
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Head Off Innocent Billing Errors that Result in Legal Headaches$247.00 – $257.00
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Stark Law 2020: Stop Audit and Penalty Threats$247.00 – $257.00