Results 1 to 2 of 2

Supercoder, CPC, CPC-D

  1. #1
    Default Supercoder, CPC, CPC-D
    Exam Training Packages
    Can anyone direct me to documentation on the guidelines of TWIP (take what insurance pays)? I know this has been a no no for many years but I am having a problem with my docs writing a discounted price for a procedure on an ABN because they expect the insurance to deny the claim as not medically necessary. Am I wrong that it is illegal to "write off" any balance that the insurance does not pay to insure that the patient pays only the "agreed upon discounted price" for the procedure. Example: billed insurance total amount of $500.00 but told patient that their responsibility would only be $200.00 if insurance didn't pay. My understanding was that you give the patient a choice of either submitting to insurance & they sign an ABN to pay what insurance does not pay OR you have them signa a "cosmetic waiver" & they pay the "agreed upon price" up front without billing to insurance at all. Please help!
    Donna Grimm, CPC, CPCD

  2. #2
    Location
    Tacoma, WA
    Posts
    1,087
    Default
    Quote Originally Posted by DONNA GRIMM View Post
    Can anyone direct me to documentation on the guidelines of TWIP (take what insurance pays)? I know this has been a no no for many years but I am having a problem with my docs writing a discounted price for a procedure on an ABN because they expect the insurance to deny the claim as not medically necessary. Am I wrong that it is illegal to "write off" any balance that the insurance does not pay to insure that the patient pays only the "agreed upon discounted price" for the procedure. Example: billed insurance total amount of $500.00 but told patient that their responsibility would only be $200.00 if insurance didn't pay. My understanding was that you give the patient a choice of either submitting to insurance & they sign an ABN to pay what insurance does not pay OR you have them signa a "cosmetic waiver" & they pay the "agreed upon price" up front without billing to insurance at all. Please help!
    Here is a recent guideline from the American Medical Association (AMA):

    "Ethical Opinion 6.12 - Forgiveness or waiver of insurance copayments.
    Under the terms of many health insurance policies or programs, patients are made more conscious of the cost of their medical care through copayments. By imposing copayments for office visits and other medical services, insurers hope to discourage unnecessary health care. In some cases, financial hardship may deter patients from seeking necessary care if they would be responsible for a copayment for the care. Physicians commonly forgive or waive copayments to facilitate patient access to needed medical care. When a copayment is a barrier to needed care because of financial hardship, physicians should forgive or waive the copayment.

    A number of clinics have advertised their willingness to provide detailed medical evaluations and accept the insurer's payment but waive the copayment for all patients. Cases have been reported in which some of these clinics have conducted excessive and unnecessary medical testing while certifying to insurers that the testing is medically necessary. Such fraudulent activity exacerbates the high cost of health care, is unethical, and violates Current Opinion 2.19. (Physicians should not provide, prescribe, or seek compensation for services that they know are unnecessary.)

    Physicians should be aware that forgiveness or waiver of copayments may violate the policies of some insurers, both public and private; other insurers may permit forgiveness or waiver if they are aware of the reasons for the forgiveness or waiver. Routine forgiveness or waiver of copayments may constitute fraud under state and federal law. Physicians should ensure that their policies on copayments are consistent with applicable law and with the requirements of their agreements with insurers."
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

Similar Threads

  1. cpc-cpc-h cpc-p looking for full time job
    By eeccleston in forum Employment General Discussion
    Replies: 0
    Last Post: 04-27-2012, 07:50 AM
  2. supercoder.com
    By ppt in forum Medical Coding General Discussion
    Replies: 3
    Last Post: 08-18-2011, 03:28 PM
  3. CPC, CPC-H, CPC-P seeking remote position
    By jana.gatton in forum Resume Postings
    Replies: 0
    Last Post: 10-17-2009, 11:29 AM
  4. Replies: 2
    Last Post: 06-09-2008, 09:24 PM

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.