Results 1 to 3 of 3

specific laws prohibiting the write off of co-insurance and deductible?

  1. Default specific laws prohibiting the write off of co-insurance and deductible?
    Medical Coding Books
    Does anyone know what states have specific laws prohibiting the write off of co-insurance and deductibles? Or where I can find this information?

    Thank you,
    Carol Hall
    chall@xifin.com

  2. #2
    Location
    Columbia, MO
    Posts
    12,531
    Default
    HIPAA has a section that spells out that by knowing you are required to collect a copay or deductible and you failure to make reasonable attemt to do so can constitute fraud. The Copay and deductible are the patient's obligation as a part of their contract with the payer. You also have a contract that says you are required to collect the copay and deductible. If the patient claims they cannot pay then the payer can make the decision that they do not pay not the provider.There are numerous other statutes and laws that forbid this practice. Just go to the internet and start looking. You can google physician professional courtesy and find a ton of information.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Default
    Quote Originally Posted by chall View Post
    Does anyone know what states have specific laws prohibiting the write off of co-insurance and deductibles? Or where I can find this information?

    Thank you,
    Carol Hall
    chall@xifin.com
    See: Anti-Kickback Statute
    http://www.physiciansnews.com/law/1003.html

    "Generally, the civil money penalties law prohibits a physician from offering or transferring remuneration to any individual eligible for Medicare or Medicaid that such physician knows or should know is likely to influence the individual to order or receive from such physician any item or service for which payment may be made under Medicare or Medicaid. Violation of the Civil Money Penalties law can result in fines of up to $10,000 for each wrongful act.

    Remuneration includes the waiver of coinsurance and deductible amounts and transfers of items or services for free or for other than fair market value. Remuneration does not, however, include:

    • The waiver of coinsurance and deductible amounts by a physician, if the waiver is not offered as part of any advertisement or solicitation; the physician does not routinely waive coinsurance or deductible amounts; and the physician waives coinsurance and deductible amounts after determining in good faith that the individual is in financial need or failure by the physician to collect coinsurance or deductible amounts after making reasonable collection efforts."

    The jist of the AKS/Safe Harbor rules on this issue, is that you can waive coinsurance/deductible in some situations, (when the patient is financially disadvantaged), but routinely waiving them is prohibited. The rationale is, patients use healthcare services more often if it doesn't cost them anything, which costs the government more money.
    A. They don't want to pay more, in general, so the deductible is sort of a deterrent.
    B. If your doctor becomes known for not charging deduct/coinsurance, it would be an incentive for patients to see him, as opposed to other providers that might make them pay.

    As Debra said, waiving these fees without any good reason could violate several state and federal laws - AKS is only one. Additionally, it's probably explicitly prohibited in your contract, so check there as well.

Similar Threads

  1. Insurance Specific CPT
    By cways715 in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 06-22-2012, 01:45 PM
  2. Replies: 1
    Last Post: 01-16-2012, 12:28 PM
  3. Cob laws
    By laurabryant in forum Compliance General Discussion
    Replies: 3
    Last Post: 11-15-2011, 02:40 PM
  4. Recoupment Laws by State
    By Kelly Taylor in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 11-25-2008, 10:10 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.