ED Coding and Reimbursement Alert
Waiving of Coinsurance
Jan Loomis, CPC
TeamHealth West, Pleasanton, Calif.
Answer: Technically, with all health plans, it would be violating the contract provisions between the patient/health plan and, if participating with that health plan, the group/health plan. The group signs an agreement to charge a patient for any deductible and co-pay. If the group does not, the actual fee was lower than reported on the claim form.
The Kennedy-Kassabaum Act covers not only the government plans but commercial plans also. It states that not only is it illegal to waive coinsurance for government plans but also for commercial carriers. The group signs an agreement to charge the patient for any deductible and co-pay. If the group does not, the actual fee was lower than reported on the claim form.
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