# Courtesy Adjustments



## AprilSueMadison (Mar 5, 2013)

Boy, what a day today is for me and posting!  

Scenario - BCBS 
We send charges to BCBS, they state 50 dollars is patient's copayment.  If the patient refuses to pay, can we write this off or are we obligated to attempt to collect it through collections after a certain time period goes by?

When can we do courtesy adjustments?


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## Twixle2002 (Mar 6, 2013)

We do not adjust the balance off because the patient refuses to pay.  That is a requirement by their ins.  I believe that if you are adjusting them off it is a violation of your contract.  I would check with the contract of the payor to find out the specifics.  We send our patients 3 statements and if they do not pay they get sent to collections.  We are owed that money.  They wouldn't go to the grocery store and get a buggy full of food and refuse to pay and walk out with the food.


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## AprilSueMadison (Mar 7, 2013)

That's what I thought, but I'm not getting much support or anything about it here.  Our doctors like to do courtesy adjustments for various reasons, mainly to help the patients.  Most our patients are elderly...but we can't keep writing these things off.  

I'll go through one of our contracts and see if I can find something about it.  If you happen to have any other resources about this, I would love to read them.


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## MnTwins29 (Mar 7, 2013)

Something else to consider is that consistently writing off co-pays or deductibles can be construed as a violation of anti-kickback laws because some may see doing this as a means of recruiting patients to your practics ("Come to ABC clinc and you don't have to worry about co-pays and deductibles.")


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## AprilSueMadison (Mar 7, 2013)

We don't do it on a regular basis thankfully, but recently our department manager has been reviewing accounts for bad debts.  This is a large amount of accounts.  She writes off anything under 100 dollars and sends everything else to collections.  These are deductibles, copays, coinsurances....patient balances.

Second, our doctors like to do favors for our patients.  For example, we had a patient who recently came in and complained about a bill he received a year ago.  The doctor offered to write it off and came to me to do it.  It was the patient's coinsurance amount after medicare paid.  

Shouldn't we only be writing these things off if we can prove the patient cannot afford to pay?  I think we are writing off too much, but I need to get that across here.


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## mdoyle53 (Mar 18, 2013)

The practice should have a financial policy for write-offs (i will not call this a courtesy because it is not).  
Every contract requires effort to collect payment - ie: statements.

The policy should be written around this and then abided by.  

BTW - I would say a balance under $100 is far to high to just write off and not send to collections.  That would be almost all copays/deductibles, esp when it comes to CMS.  This could be seen as inducement.


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## AprilSueMadison (Mar 18, 2013)

Thanks for your reply.  I'm certainly working on getting it changed here.

What do you think the limit should be for us sending to collections?  Should there be one or should we just send everything?  Everything doesn't seem logical because we lose a portion of the payment to the collection service, so that probably wouldn't be worth it on 20 dollars...but maybe I'm wrong.


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## la_0922 (Apr 9, 2013)

As far as patients who are unable to pay due to hardship, look into a "Charity" program your office can offer. Never extend beyond 12 mos, and if patient has insurance certain requirments are needed. For example, recent pay stubs, last W-9, current bills etc. Set guidelines that will apply to everyone and create an application. Lastly pull your states Medicaid poverty guidelines and work off those to create a percentage -- for example, if a single person makes less than $11k a year, he or she would be eligible for 100% charity (provided that they prove their income etc.), alternatively if a family of 3 make less than $22k they would be eligible for 80% etc.  
I had the same problem and since we created this, it is fair across the board to all our patients and providers feel at ease knowing that balances are being adjusted based on the patient's income. I no longer have the issue of the docs and midlevels telling the patients that because they cannot afford it we can write it off, either the patient has already spoken to my business office or provider will explain that they need to speak with us -- 

Louise


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## AprilSueMadison (Apr 10, 2013)

Thanks!  

We finally had a meeting about the situation, and I'm creating a financial policy for us that covers many of these topics.  Then we'll meet about what I've put together, make changes and meet again.  I think by the end of May we'll have a set plan and a policy that works!


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## MnTwins29 (Apr 11, 2013)

Been following with interest - what did you set as the maximum amount to write off?


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