As a general rule, the practice should not routinely dispense with supplements or deductibles or offer discounts based on a patient`s assertion that the patient is suffering from financial difficulties. If the practice regularly offers rebates or deductible exemptions without properly examining a patient`s financial means, the practice risks violating their payment contracts, being charged with insurance fraud and/or paying an illegal kickback to induce patients to come to the office. Some payer contracts require the practice of charging the payer the lowest rate charged by practice to each of their patients, what is called a “most favoured nation plan.” Medicare`s typical participation agreements are subject to this type of provision. When the practice waives deductibles or co-payments, insurers often feel that the amount charged by practice to the insurer should be reduced by the corresponding amount. In addition, a regulator could criticize the practice of forgoing co-countries and franchises as a means of encouraging patients to seek care in violation of anti-kickback laws. The practice should keep all records and information it collects to determine financial difficulties and keep a record of amounts that have not been abandoned. The waiver of co-payment obligations for privately insured patients can also be problematic. Like CMS and OIG, private insurers and courts are generally not alerted by the occasional accommodation of individual patients with documented financial constraints. However, insurance companies have repeatedly successfully challenged the routine waiver of co-payment obligations in court. Because of these concerns, it is not advisable to offer Medicare beneficiaries any type of discount.
The OIG may consider that waiving co-payment obligations on the basis of other specific findings of destitution, hardness or irrecreability is offered to purchase or order Medicare refundable services, which may result in prosecution under Antikickback`s status. Otherwise, your actual costs may be lower than the Medicare pricing plan and your reimbursement should be reduced accordingly. Although the Centers for Medicare and Medicaid Services (CMS) and the Office of Inspector General of the Department of Health and Human Services (OIG) are not concerned about the occasional abandonment of co-payment obligations – due to financial difficulties or ineligibility – the systematic abandonment of co-payment obligations under Medicare is clearly problematic. It is important that firms strategies to distinguish who is able to pay for health services. Even if charitable physicians want to be, the law does not allow routine amortization of Co-Country and deductibles without risk to the physician for violation of payers` contracts or federal and regional laws. If patients have insurance, the practice must demonstrate that there are indeed financial difficulties and record all costs that are cancelled. In addition, difficult cases should be assessed regularly, as a patient`s financial situation may change. The practice should offer discounts, waive co-payments and/or deductibles after careful consideration of the patient`s finances and decide for itself whether the patient is suffering from financial difficulties.
The practice should conduct this review at regular intervals for repeat patients to ensure that the patient`s financial situation has not changed.