Waiving copays, deductibles and co-insurance

[cerullhon]

Help! My provider wants proof that it is illegal to write off patient responsiblity without first making a "reasonable attempt" to collect. We are a Physical Therapy office and if patients had to pay their copays in full (even on a payment schedule), the doctor is afraid he will lose their business.

So he "wheels and deals" with them in the room and tells them they only have to pay "x-amount instead of their regular copays". Sending statements is also a nightmare as it provocks many unhappy patients who said the doctor made "other arrangements" with them.

I've explained it is a violation of many rules including false claims act (ins companies do not know we are reducing patient amounts), IRS, OIG etc.

Is there an "official place" where I can get this information from? We are in Florida.

Thank you!

 

[sdeaton]

http://oig.hhs.gov/authorities/docs/cmpfinal.pdf

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Office of Inspector General
42 CFR Parts 1001, 1003, 1005 and 1006
RIN 0991–AA90
Health Care Programs: Fraud and Abuse; Revised OIG Civil Money Penalties Resulting From Public Law 104–191
AGENCY: Office of Inspector General (OIG), HHS.
ACTION: Final rule

Also check your payer contracts. I'm sure there are other sources but Medicare is specific and the OIG guidelines cover Medicare/Medicaid.

Hope this helps!

 

[Cyndi113]

Definitely check your payer contracts. It's usually very clearly spelled out in them as well.