BC Advantage - 2014 Issue 10
Is Your Doctor Breaking the Law? The Truth About Waiving Co-Pays Revealed
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Article Overview
This article discusses the compliance issues surrounding patient cost-sharing waivers in medical billing. It is aimed at providers, billers, and practice staff who need a general understanding of how professional courtesies, managed care contracts, and federal or state rules can affect billing policies and patient responsibility practices.
Why This Topic Matters
Waiving patient responsibility can create compliance, contract, and fraud-and-abuse risk for practices. Understanding the broad legal and payer concerns helps offices review courtesy policies and reduce the chance of payment recovery, termination from payer panels, or other enforcement issues.
What You Will Learn
- How patient cost-sharing waivers are viewed in general billing and compliance discussions
- How professional courtesies differ from broader patient responsibility waivers
- Why managed care contracts and payer policies matter for courtesy discounts
- Why financial hardship documentation is relevant to waiver decisions
- How office policies can be reviewed for compliance considerations
Who Should Read This
- Medical billers
- Practice managers
- Physicians and other providers
- Compliance staff
- Front-office and billing office personnel
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