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Understanding the Waiver of Co-pays and Deductibles
By Patricia A. Trites; PhD, MPA, CHBC, CMP™ (Hon)
Professional medical courtesy and the waiver of co-pays and deductibles is a very controversial subject to healthcare practitioners.
It appears to most people that it should be up to each physician to decide if he/she wants to waive payment for their services or to discount the service. Unfortunately, this practice may be illegal in most instances.
And, there are only a few instances when this “tradition” is legally allowable, such as in the case of indigence of the patient or when the practitioner provides services to an immediate relative or household member.
DHHS Definition
According to the Department of Health and Human Services [DHHS], the “routine waiver of deductibles and co-payments by charge-based providers, practitioners or suppliers is unlawful because it results in:
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false claims,
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violations of the anti-kickback statutes, and
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excessive utilization of items and services paid for by Medicare.”
When the patient has insurance other than Medicare, waiving the co-payment, deductible or the entire charge is violating both the insured’s contract with their insurance company and the physician’s or other provider’s contract or participation agreement.
Exceptions
Financial or medical indigence is an exception. The provider may reduce or waive his/her fee, if the rules are followed. But, a simple statement by the patient that they are unable to pay their share of the service is not enough.
Medicare requires that the provider ask and document the answers to these specific questions.
Does the patient have any other source that may be legally responsible for his/her medical bills?
Examples: Medicaid or Legal Guardian
Can the patient provide information for the practice to perform an analysis of total resources?
Examples:
Assets (only those convertible to cash and unnecessary for the patient’s daily living), Liabilities, and Income and Expenses.
Assessment
Such patient information should be reviewed annually and documented in the financial file.
Conclusion
And so, have you ever run afoul of the law by granting a patient professional courtesy? Do you still grant PC at all?
More info: http://www.springerpub.com/prod.aspx?prod_id=23759
Institutional: www.HealthcareFinancials.com
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