Physicians May Waive Coinsurance During Retroactive Period

After President Barack Obama signed legislation June 25 granting a 2.2 percent update to physicians’ Medicare payments, the Office of Inspector General (OIG) the same day waived a Medicare regulation that would require providers to bill patients for additional coinsurance relative to the rate increase, which is retroactive to June 1.

According to the OIG policy statement, providers will not be subject to OIG administrative sanctions if they choose to waive retroactive beneficiary liability for items and services furnished during the retroactive period (June 1 through June 24).

Participating providers must uniformly offer the waivers to all of their affected beneficiaries (without regard to the types of items and services furnished to a beneficiary or a beneficiary’s diagnosis); and may not offer the waivers as part of any advertisement or solicitation.

This OIG policy statement does not apply to waivers of beneficiary cost-sharing amounts that were calculated using the prior, lower payment rates; nor does it apply if the waivers are conditioned in any manner on the provision of items, supplies, or services.

Providers are expected to calculate and collect cost-sharing amounts for items and services furnished after the retroactive period based on the new, increased payment rates. This OIG policy statement, however, does not prohibit physicians from waiving any coinsurance amounts based on a good-faith, individualized determination of a beneficiary’s financial need.

Source: OIG policy statement

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