Revenue Cycle Insider

Question: Can front desk staff waive copays at their discretion? For example, if a patient comes in and is obviously having a rough day, could we brighten their outlook via one fewer financial obligation?

Wisconsin Subscriber

Answer: No, neither front desk staff nor physicians nor anyone else can waive copays. Copays are contractual obligations between a practice and an insurance carrier, and waiving copays, deductibles, or other contract-specified fees means you are risking perpetrating a Stark Law violation or other form of noncompliance.

For example, if a provider who is out of network with a commercial carrier decides to charge a covered patient an in-network rate instead, the provider is essentially offering a bribe to keep that patient at their practice. When it comes to patient cost, commercial insurance carriers’ policies are binding contracts for subscribers or beneficiaries, and don’t necessarily involve a physician anyway: Providers cannot decide or determine what an insured patient pays for a provider’s services.

Rachel Dorrell, MA, MS, CPC-A, CPPM, Development Editor, AAPC