Realizing a patient might have problem paying his bills owing to financial difficulty is a discouraging aspect of the modern economic zone. While you certainly remain concerned for your patient’s well-being, your practice also needs to stay financially healthy.
Resist the temptation: When a financial hardship affects a patient, you might want to help by waiving a co-pay or deductible – or possibly even writing off the balance.
The problem: Regularly waiving deductibles and copayments can violate several federal laws and regulations, including the federal False Claims Act, anti-kickback statues, and compliance guidelines for individuals and small group physician practices.
When you do so, you may also violate payer contracts and could result in your removal from a health plan’s provider panel.
Know when you cannot waive
The OIG has issued guidance about waiving co-pays and deductibles. In the FCA, the OIG identifies three criteria that can result in a violation:
The waivers are routine The waiver is given without regard to the individual’s financial hardship The provider fails to pass on to the payer its proportional share of the discount Watch out: OIG regulations are not your only concern when it comes to collecting co-pays. See to it that you check your payer contracts as well. Many contracts require that co-pays are collected at the time of service. A provider can lose participating status if they fail to follow the guidelines. Alternative: There are a number of circumstances when it’s right to write off a patient’s payment. One reason you may be able to write off a patient’s co-pay, deductible or balance is if the patient meets financial hardship criteria. In order for your practice to accept financial hardship as terms for a debt write-off, the patient needs to be able to prove he’s unable to pay. For further details on this and other medical billing know how, sign up for a medical coding guide like Supercoder.