decisionhealth Newsletters, Coder Pink Sheets - 2023 Issue 10 (October)
Ask the expert: Waive co-pay for indigent patients on urgent basis, but be clear it’s not forever
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Article Overview
This premium article addresses a common compliance and practice-management dilemma involving patient financial hardship, continuity of care, and payer obligations. It explains why urgent situations may be handled differently from later non-urgent visits, and it discusses the value of written policies, documentation of indigence, communication with patients, and coordination with insurers and alternative resources. The article is aimed at clinicians, practice managers, and billing/compliance staff who need a practical understanding of the risks and safeguards surrounding occasional cost-sharing waivers.
Why This Topic Matters
Policies around patient cost-sharing can affect compliance, patient access, continuity of care, and contractual relationships with payers. Understanding the general boundaries of hardship-based waivers can help practices reduce legal and operational risk while responding appropriately to urgent patient needs.
Article Sections
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Question
The opening scenario presents concerns about how a prior hardship-based waiver may affect later visits when the patient’s situation changes.
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Answer
This section discusses general considerations related to financial hardship, payer relationships, continuity of care, and the importance of practice policies.
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Policy and documentation considerations
This portion addresses practical steps for establishing standards, documenting indigence, and communicating that any waiver is conditional.
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Managing later visits and possible termination
This section covers broad issues that arise when a patient’s condition is no longer urgent, including referrals, coordination, notice, and related patient-relationship concerns.
What You Will Learn
- How hardship-related cost-sharing waivers fit into broader compliance and payer considerations
- Why practices benefit from having written policies for urgent and non-urgent situations
- General approaches to documenting financial need without overburdening patients
- How to communicate limits on future waivers and preserve continuity of care
- What broad patient-relationship and termination issues may arise when circumstances change
Who Should Read This
- Physicians
- Practice managers
- Billing staff
- Compliance professionals
- Health care attorneys
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