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Beware of Waiving Patient Responsibility

Friday, September 4, 2020   (0 Comments)
Posted by: Sheri Ryan
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Many wonderful Chiropractic Assistant’s (CAs) have the trust and support of their providers to run the business aspects of their practices. Often, a CA is entrusted to work with patients on their financial responsibilities while the provider works diligently on providing quality care. It is important to understand just how vital this role is and to realize the importance of protecting the provider who, as the business owner, ultimately bears the responsibility for all that happens in the practice. Be aware of the risks involved with routinely waiving patient co-pays and deductibles.

But My Patient Needs the Waiver!

Patients who are in extreme need of chiropractic care, may ask to have their copay and deductible waived for numerous reasons, most often financial. More often, however, the provider simply provides routine waivers, without the patient even asking. Whether the patient is covered under Medicare, Medicaid or a third-party plan, automatically waiving patient responsibility can amount to a serious situation. Reckless ignorance of the rules or a lack of understanding of the consequences can be costly and potentially lead to penalties, charges of insurance fraud, and, in rare cases, even jail time.

Most private insurers don’t allow the routine waiving of co-payments and deductibles. This could easily be considered an inducement for the patient. Word could get out in your community. Patients who know that you routinely waive patient responsibility and accept what the insurance company pays may expect the same consideration. Carefully review your contractual agreements with third party payers to ensure your understanding of the practice’s obligations as an in-network contractor. Ignoring the patient’s financial responsibility can lead to termination of these contracts.

When a patient has a legitimate financial hardship that would preclude them from receiving care, your office has options. Allowing the patient to make payments toward their balance or applying your financial hardship policy are options that will keep you safer than routinely waiving patient responsibility. 

Third-Party Payers Won’t Have It

A third-party payer is affected by your waiver because based on the failure to collect the patient’s coinsurance, this waiver changes the value of the service rendered to the patient. Health care providers can be sanctioned for filing false claims according to the False Claims Act. Civil monetary penalties, the threat of $10,000 fine per item, exclusion from federal and state funded programs, criminal fines and imprisonment are just some of the penalties one could face for these actions. Even if your adjustments and write offs are applied with good intentions, this practice can often hurt the provider and practice.

In-Network Practice? Hold-Up Your Agreement

Understanding the relationships that are in place as an in-network practice is vital. There are three relationships involved, all of which must be respected:

  • The relationship your office has with the insurer (your contract)
  • The relationship your patient has with the insurer (their contract)
  • The relationship your office has with the patient.

All participants must keep up their end of the agreement:

  • Your office ensures the carrier that you will collect co-pays and deductibles, and the carrier agrees to pay you based on a fee schedule you have agreed upon
  • Your patients agree to pay their financial portion of the care to the provider and the insurance company agrees to pick up the remaining financial responsibility
  • You agree to give quality care to the patients, and they agree to pay you their portion of the financial responsibility. If the patient is getting a discount, the payor may rightfully feel deserving of the same discount.

Establish Financial Hardship Policy

There are circumstances when a patient needs care and truly has a financial hardship causing an inability to pay. In this case, the best way to offer a lower fee is to establish a policy for cases of extreme hardship. Continue to maintain a consistent, policy-based method to obtain financial data from the patient and use these consistent, policy-based standards for determination. When developing a hardship policy, verification of hardship is important documentation that shows due diligence in ensuring financial hardship was warranted for the patient’s care. Be sure all information obtained is retained and documented in the patient health record. Do not make financial hardship cases a routine occurrence, as that in itself can be a problem. Use financial waivers sparingly for only true hardship cases.

Worth the Risk?

Ask yourself if the waiver of copayments and deductibles is worth the risk. Understanding that your patients chose their insurance plans and must be held accountable for their financial responsibility will help you to collect what is due for the services you’ve rendered. Keep in mind that any time you give away or write-off services you’ve rendered, you are devaluing these services to the patient. Stay on your game; understand your office policies; and work within these guidelines. Don’t allow non-compliant write-offs to subject the provider, yourself, or the practice to risk. Payment plans, at a minimum, are always a safe alternative to placing your practice at risk. Don’t jeopardize all you’ve worked for by doing the right thing, the wrong way!

 

Kathy Mills Chang is a Certified Medical Compliance Specialist (MCS-P). Certified Chiropractic Professional Coder (CCPC), and Certified Clinical Chiropractic Assistant (CCCA). Since 1983, she has been providing chiropractors with reimbursement and compliance training, advice, and tools to improve the financial performance of their practices. Kathy leads a team of 30 at KMC University and is known as one of our profession’s foremost experts on Medicare, documentation and CA development. Kathy or any of her team members can be reached at (855) 832-6562 or info@KMCUniversity.com

 

 

 

 


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