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Thread: Writing off copays

  1. #11

    Smile Writing off copays

    AAPC: Back to School
    On the CMS web site if you do a search on Unisured you will get a Q&A from 2004. The rules are for hospitals but they apply for physicians also. You can waive collections if you follow certain guidelines. A policy for indigent or hardship is usually the best. These guidelines have been in place for some time and as of 1/2008 I have not been able to find any changes. It is always better to collect, but before your AR gets out of control prepare some type of financial assessment for the patient. Make sure the physician has reviewed the assessment and signs off on it. Always make the attempt to collect any amount due and make notes of such. Make sure you have adjustment codes for you policy, Indigent and or Financial Hardship. Hope this help!
    Last edited by vlwinfrey; 01-22-2008 at 12:28 PM. Reason: Left info out.

  2. #12


    This is the way I have always been told. That you have to make numerous accepts to collect before writing off. The companies I have worked for have always used 3 billing cycles. In a meeting I attended, what ever you do needs to be standard across the board and should there should be a written policy in your complaince plan.

    Any government (federal) insurance, Medicare, Medicaid, Tricare, BCBS Federal, you are suppose to collect copays/deductibles (or make sure there are reasonable collection effort. If not, "Anti-kickback statutes and even the False Claims Act can be invoked to prosecute physicians that routinely do not make this effort".

    I agree with the person who applied about the small balance write off code in reference to the prof. write off code.

    If you (the billing agency) uses the same software as the office, you may want to check out and see if you post sticky notes/flashers on the accounts to let the offices know the correct copay. When I was posting payments for a billing service I worked for, I would try to do this when I could, especially for the patients who keep being seen over and over again. I also had they problem that a lot of the patients were paying too much

    Quote Originally Posted by Belinda Frisch View Post
    For Medicare B patients, and this goes to coinsurance and deductible amounts, Medicare REQUIRES a "reasonable collection effort" which is industry-defined as 3 billing cycles. Anti-kickback statutes and even the False Claims Act can be invoked to prosecute physicians that routinely do not make this effort. The mindset being that the claim is for an inflated amount if the provider does not collect coinsurance amounts hence, the bill should have been sent to Medicare for the "reduced rate".

    For other payers, in our area the prevalent two being MVP and CDPHP, the specific language regarding collection of copays and/or deductibles is in the fine print of the provider enrollment contract. Again, you MUST collect the copays! Failure to do so can result in the loss of your payer contracts.

    The ONLY times is it acceptable to "waive" copayment or deductible amounts are after reasonable collection efforts fail or in the case of DOCUMENTED indigence of the patient. Practices will often have an indigence waiver for this purpose.

    Hope this helps.

  3. #13
    Join Date
    Apr 2007


    I cannot speak from a global perspective because I only work for the radiologists and all our charges are the professional components (well, except for the surgical codes). We don't collect a copay. Most insurances we are under a capitate agreement with our hospital. With any small balances we have, we do write off using the adjustment code of a "small balance write off". Our credit and collections company will not accept any thing under $10. We have to look at it a few ways: 1: How much manpower went into trying to collect $2.00? 2. How much postage has gone out w/ statements and warnings? 3. Does the patient have any other outstanding charges? If I am getting paid $20 an hour, how much time does my boss want me to spend on that. I don't think it is illegal to write off charges in that case, but copay would be a different situation. We also have professional courtesy and deceased write offs. I would be interested in hearing if there is any catch to using these?

  4. #14
    Join Date
    Apr 2007
    Charleston, South Carolina


    It is also in most of our insurance contracts that copays must be collected. If they are not, the provider and the patient are in default of their contracts and can be cancelled.

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