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true or false? NEVER WAIVE A CO-PAYMENT???

  1. Default true or false? NEVER WAIVE A CO-PAYMENT???
    Medical Coding Books
    I can remember while in school that it was a major compliance issues and you could not write-off a co-payment. If physican decided to make a adjustment for a patient for what ever reasons, it could be done, but never waiving the co-pay.
    Now, I am unable to present the documentation to this.

    Am I alone on this one, or is this a fact or fiction?

  2. #2
    Location
    Columbia, MO
    Posts
    12,531
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    True, you never waive the co pay or discount the deductible. This is the patient's required contractual amout to pay per their contract with the carrier. HIPAA states: as paraphrased by an attorney
    By knowing that you are required to collect a copay and failure to do so constitutes an act of health care fraud.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Location
    Phoenix, AZ
    Posts
    620
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    It's a breach of your contract with the insurance company as well as, I think, a violation of the Stark Law (not sure?). It's in our annual compliance training.
    Cyndi Allen, CPC, CIRCC
    2015 Local Chapter President, Casa Grande, AZ

  4. #4
    Default
    I understand it's a law... but we were taught in class that it is up to the medical office manager and/or physician to make that rule. If a patient is a long standing customer and she forgets or is short the whole copay... in situations like that they (the dr. or medical office manager) will make a payment arrangement or bill them.

  5. #5
    Location
    Sioux Falls South Dakota
    Posts
    358
    Default
    Quote Originally Posted by kmincie View Post
    I understand it's a law... but we were taught in class that it is up to the medical office manager and/or physician to make that rule. If a patient is a long standing customer and she forgets or is short the whole copay... in situations like that they (the dr. or medical office manager) will make a payment arrangement or bill them.
    That is not waiving the co-pay, but billing the patient for it, which is acceptable. Of course, it's best practice to collect at the time of service, because unless they pay right away, you end up spending more sending statements than the copay is. Waiving the copay is not charging the patient for it at all, and writing it off. As earlier respondents said, that is a violation of your contract with the insurance company. The only time we write things off (including copays, deductible, coinsurance, etc.) is when financial hardship is proven and approved.
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

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