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Practice Management Alert

READER QUESTIONS:

Should Non-Participating Providers Still Collect Co-Pays?

Published on Mon Feb 20, 2006

Question: Do we have any obligation to try to collect co-pays or deductibles when we are non-participating providers with a given insurance company? 


Maryland Subscriber


Answer: If your practice does not participate in a patient's insurance plan,  you can accept whatever dollar amount the patient's insurance plan allows. However, the practice still has to collect all co-payments and deductibles required by the patient's plan. Don't waive co-pays or deductibles for these patients, because that violates the Stark anti-kickback rule. Further, waiving co-pays or deductibles when your practice is a non-participating provider could very well be construed as insurance fraud.

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