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Medicare Compliance & Reimbursement

PHYSICIANS:

Waiving Copays Too Much Could Wave A Red Flag

Published on Tue Jan 25, 2005

11 tips for avoiding indigent patient woes

With health care costs skyrocketing, demanding 20 percent of all physician charges from patients seems cruel - especially if they've been hit hard by rough economic times.

But if a doctor appears to be using easy-going policies to bring more patients in, that could spell trouble. Luckily, MLR's experts offer 11 tips to keep copayment policies kosher:

1) Make a "good faith effort" to collect everything that is billed. Also, gather information from patients to see if they're eligible for a "hardship waiver," advises attorney Clay Stribling with Brown & Fortunato in Amarillo, TX.

2) Have a written policy. Doctors can't set a number, such as a percentage of patients for whom they will waive copayments, says attorney Wayne Miller with the Compliance Law Group in Woodland Hills, CA. Instead, "define the circumstances and conditions" under which waived copayments would be acceptable, Miller says.

3) Be more careful with Medicare and Medicaid patients. These patients raise more compliance worries, Miller warns. But they can receive waivers if they have demonstrated a financial need. 

4) Don't advertise waived copayments. This includes word of mouth, say experts.

5) Make sure application forms make it easy to determine whether a patient has financial need. The form should reduce decision-making by having clear standards.

6) Make some effort to verify the financial need information patients provide. Some providers will perform a credit check on indigent patients, Stribling reports. Others will have patients bring in a bank statement.

7) Go back every year and audit some copayment waivers, on a random basis, to make sure the patient filled them out properly, Stribling urges. Ensure that your staff isn't granting waivers in questionable cases.

8) Don't let your staff talk out of line. If a patient expresses financial concerns during patient intake, the intake personnel or other staff shouldn't say something like, "All you've got to do is ignore our first three statements, " Stribling says. Such loose talk could appear to be an inducement to Medicare patients to join a practice.

9) Don't give patients a financial need form up front unless they ask for it, Stribling advises.

10) Go ahead and waive copayments in rare instances to pacify patients. For example, if a patient's been waiting for an hour and expresses frustration, it's okay to waive that person's copayment, says attorney David Glaser with Fredrickson & Byron in Minneapolis, MN.

11) Beware waivers with private insurers. With some private payers, doctors waiving the patient's copayment may be giving up their rights to receive payment from that carrier, says Glaser. Waiving copays for a private health plan's patient may translate to a breach of contract. Or the health plan may claim that the physician relinquished his or her claims on it as well as the patient.

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