Is it legal to write off the out of network copays and deductibles going to patients who do not have a secondary but billing them to a secondary payor if the patient has one. Example we are having issues with UHC Medicare Pathways and they are sending 78.06 to patient for out network. If patient doesn't have a secondary they are being wrote off but if they have say Medicaid secondary they are being billed the out of network 78.06. Is this correct?
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Out of network copays and deductibles
- Thread starter nklunk86
- Start date
Pam Warren
True Blue
- Messages
- 2,678
- Location
- Springvale, ME
That's some pretty thin ice. What you have to be careful of is not having a financial aid policy where you write off fees without a solid reason. This can be considered an anti kickback violation where you could be viewed as providing a financial incentive for patients to come to your practice. If Medicare is the secondary payer, you'll have to submit the balance and the original EOB to them. They may adjust the balance, but you can't write it off before you send it to Medicare. If the OON payer is primary, you should attempt to collect the balance from the patient, but per your financial aid policy (which you should have), later you can adjust as bad debt if they refuse to pay (or set up a payment plan). Overall, you shouldn't automatically adjust it off without attempting to collect from the patient.