Orthopedic Coding Alert

Question: Our front office manager has been writing off a lot of patient copays and deductibles lately based on patient explanations of why they aren’t able to pay. Is this legal?
Codify Subscriber

Answer: Although there are some rare instances when you can write off a patient’s copay or deductible, as a rule you should be collecting these. Financial arrangements that differ from the billing obligations laid out in your contract with government or third-party payers can result in fraud charges, penalties, and loss of carrier contracts.

According to the OIG, “the routine waiver of Medicare coinsurance and deductibles can violate the Federal anti-kickback statute if one purpose of the waiver is to generate business payable by a Federal health care program.” In addition, offering inducements such as cost-sharing waivers to Medicare patients that you know might be likely to influence that patient’s selection of provider can violate separate statutes, the OIG says.