Medicare Compliance & Reimbursement

Remember to meet the necessary criteria for waiver and back it with documentation.You could be up against compliance violation accusations if you offer a waiver or a discount for a copay or deductible. Financial hardship is one exception, but proper documentation is essential. Our experts tell you how to waive deductibles without finding yourself in the OIG's crosshairs.1. Understand the Exception to the RuleRoutinely waiving deductibles and copayments can violate several federal laws and regulations, including the federal False Claims Act, anti-kickback statutes, and compliance guidelines for individual and small group physician practices. Doing so may also violate payer contracts.In black and white: "Physicians or suppliers who routinely waive the collection of deductible or coinsurance from a beneficiary constitute a violation of the law pertaining to false claims and kickbacks," CMS says in the Medicare Claims Processing Manual, section 80.8.1.Even though the rule is that you shouldn't offer waivers and [...]