General Surgery Coding Alert

Question: We always try to collect copays and deductibles from patients as required by their insurers, but sometimes we just can’t get a patient to pay. After reading about practices charged with Medicare fraud for not collecting these fees, we’re concerned. What should we do?

Codify Subscriber

Answer: While it’s true that you could be charged with Medicare fraud for routinely trying to attract patients by waiving copays or deductibles, your situation does not fit that description.

According to CMS, if you make a good faith effort to collect deductibles and copayments from your patients and you document your efforts in the patient’s medical records, then you shouldn’t really have to worry about this issue.

Do this: The industry standard for “good faith effort” is three attempts to collect. If your practice makes three attempts to collect on a claim and documents the efforts, you won’t be considered in violation of collection standards as a Medicare provider.