Wiki Waiving Copays

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mmiele1979

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Coventry, RI
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Upon doing research, I have seen that waiving copays is something that CAN be done as LONG as documentation is on file that there is a financial hardship (ie: proof of being on unemployment, proof of being on foodstamps, last year's tax returns, etc) and it's not done on a consistent basis for any one patient. My question here is, if your practice is doing this, where are you keeping this financial documentation and what exactly are you collecting for proof of a hardship? Are you keeping it in a filing cabinet in the office? In the medical record itself? In the "documents" portion of your EHR software for that patient? (Epic) Any guidance would be appreciated if your office does this. (Please refrain from telling me this is a violation of my contract. I am aware copays must be collected and not collecting them is a breach of contract. I'm speaking in terms of patients with a legitimate financial hardship and I have done my research on this topic. thank you)
 
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Most of the regulations stipulate you may waive for financial hardship, but do not specify how or any exact requirements. I think the most important part is that you have an actual written policy, so you can demonstrate you are applying the same rules to all patients.
As a private practice, we had such a policy, using a percentage of Federal Poverty Level to determine discount. We would ask the patient to complete a form stating their income and family size, and proof (either tax return or pay stub/unemployment) We did not feel it appropriate to include this type of documentation in the EHR. There would be a note in our billing system that it was received/approved and the amount of discount. The originals were kept in a secured file cabinet. An approval was good for a year.
As an office that is now part of a large healthcare system, we cannot do the financial hardship approval within the practice. There is a separate department which handles this. In addition to the application, the patient must submit tax return, pay stubs, and anything else the financial assistance unit requests. I have heard they also run some type of check (similar to a credit check). Those records are not part of the EHR and are kept within the financial assistance unit department.
 
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Thank you. I'm doing this all by myself (creating this new policy) and have no idea how to calculate FPL nor do I know what the form should legally say.... I will look it up and do my best but I'm thinking this may be something that should be created by the practice's lawyer. Do you know who the policy at your private practice was actually written by and who calculated the percentage of the Federal Poverty Level?
 
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I wrote it myself over 10 years ago, following some google research. I'm pretty sure at one point we had some outside practice consultant who was looking at a bunch of other things look it over. Basically, it's totally at your practice's discretion how generous you want to be (or can even afford to be). We were really creating it for patients with large balances since we are a cancer surgery practice. And any patient could set up a payment plan.
The FPL is a published number. I set something along the lines of <250% FPL largest discount, 250-350% FPL lesser discount, 350-450% FPL smallest discount, >450% no discount (but can always do payment plan). Feel free to use and/or change however suits your needs.
Hope it helps!
 

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