Question Not Billing Insurance but accepted patient copay

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There is a provider that saw patients but did not complete documentation. These patient's were under the impression that a claim would be submitted to insurance & paid their copay. Since nothing was documented, a claim was NOT submitted. The physician indicated that he provided the service so he is keeping that money indicating that he is not going to complete the documentation & will not bill insurance.

However, he did see other patients at the same time where the services were documented, copay's were collected, insurance was billed & the claims were processed and paid.

Can he legally keep the undocumented patient copay's? Would this be considered discrimination or subject to FWA since he not treating all patients equally?
 

CatchTheWind

True Blue
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619
Location
Boca Raton, FL
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This may be a question for a lawyer. Apart from the legalities, I do see an ethical issue: Whenever a patient pays a co-pay, his insurance credits that toward his annual out-of-pocket maximum. By not filing the claim, the provider is cheating the patient out of the chance to meet his OOP.
 

Michelle Thompson

Networker
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57
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Central Philadelphia chapter
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The medical record is a legal document. Providers are credentialed with payers/insurance carriers, that involves contractual agreements. See the 1995 & 1997 Documentation Guidelines.
If the visit is not documented it is considered incomplete and is non-billable. The copay should be returned to the patient.
 
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