Wiki Self pay for insurance bal

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ortho1991

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Can anyone tell me if it's ok to make adjustments on pt co-insurance. Example pt calls re bal owes $150.00 for co-insurance, pt states they will pay $100.00 now if we call his bal paid in full and make the $50.00 adjustment, is this ok to do?

Any feedback on this will be appreciated.
 
No you cannot do this the patient is under a contractual obligation to pay the full amount of the copay. Your office contract with the carrier usually states that you will collect the copay in its entirety. If the patient claims financial hardship, most of the time you will need to contact the carrier for permission to discount the patient owed amount.
 
Actually no. I worked for a provider that had a legal process in place for this scenario. Any patient that had a balance and stated that they could not pay due to financial hardship had to complete forms authorized our office to obtain copies of the pt's previous 2 years' tax returns, utilities info, etc. From there this was reviewed by the physician and his accountant. and if the patient qualified their balance or a portion there of was adjusted off.

What is "illegal' is to write off one pt's balance and not another's.
 
That's correct, it's technically a violation of the False Claims Act to discount patient share, and also can be construed as providing a patient an incentive to consume medical services. The only exception, as mentioned above, is if you've made an attempt to collect and you are following an established policy to verify that the patient has a financial hardship or cannot pay in full.
 
Right on, Teresa! Long ago, I worked as a physician billing manager at a local hospital and the chief of one department would arbitrarily write off someone's cost share but not another. I had to have a discussion with him, as well as the Director of patient accounts as to the possible consequences of his actions. The hospital had a defined policy and procedure for handling these types of requests.
 
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