Optometry Coding & Billing Alert
Should Non-Par Providers Still Collect Copays?
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Question: Do we have any obligation to try to collect copays or deductibles when we are non-participating providers with a given insurance company? Answer: Most optometrists do participate with Medicare. But if your practice does not participate in a patient's private insurance plan, you can accept whatever dollar amount the patient's insurance plan allows. However, the practice still has to collect all copayments and deductibles required by the patient's plan. Don't waive copays or deductibles for these patients, because that violates the Stark anti-kickback rule.
Maryland Subscriber
Further, waiving copays or deductibles when your practice is a non-participating provider could very well be construed as insurance fraud.
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