Discounts and write-offs are options, if you follow these guidelines. When financial hardship strikes a patient, it's hard to resist the temptation to waive a copay or deductible -- or possibly even just write off the balance. The problem: Doing so may also violate payer contracts and could result in your removal from a health plan's provider panel. Know When You Can't Waive The Office of Inspector General (OIG) has issued guidance about waiving copays and deductibles. In the Federal False Claims Act, the OIG identifies three criteria that can result in a violation: • The waivers are routine • The waiver is given without regard to the individual's financial hardship • The provider fails to pass on to the payer its proportional share of the discount. Watch out: Alternative: Get the Proof You Need One reason you may be able to write off a patient's copay, deductible, or balance is if the patient meets financial hardship criteria. In order for your practice to accept financial hardship as terms for a debt write-off, the patient needs to be able to prove he is unable to pay. To prove financial hardship, you'll need to ask the patient to provide you with the following information: Gross monthly household income, including salary and wages and any court-ordered payments Other income, including dividends, interest, payments from property rental, support from family members, pensions, Social Security benefits, veteran benefits, unemployment compensation, trusts, and gifts Assets, including cash, all bank accounts, stocks, bonds, real estate equity, and equity in personal property, such as cars and boats Essential monthly household expenditures, such as mortgage/rent, utilities, insurance, and food Number of dependents in the household (include the patient). Also request copies of the patient's income tax returns and W-2 and 1099 forms as proof of income to determine whether the patient's earnings meet state and federal poverty guidelines. Keep in mind, "all documents should apply to all members in the household," Colburn says. Avoid this pitfall: The patient and the physician should also sign a statement detailing that the practice reviewed proof of financial hardship and listing what charges the practice is waiving, experts suggest. Your practice should keep a copy and provide a copy to the patient as well. Ideally, you should be able to determine the patient's ability to pay starting with the copay, says Catherine Brink, BS, CMM, CPC, CMSCS, president of Healthcare Resource Management in Spring Lake, N.J. "Copays should be -- must be -- collected upfront before the patient sees the doctor, so the question of the patient's ability to pay can be dealt with before service is rendered," she adds. Detour: