decisionhealth Newsletters, Coder Pink Sheets - 2021 Issue 8 (August)
Compliance: Avoid routinely waiving patient copays; follow these tips instead
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Article Overview
This article addresses compliance concerns for practices considering whether to waive Medicare patient copayments or other patient-share amounts. It is aimed at providers, billing staff, and compliance professionals who need a high-level understanding of the legal risks, payer concerns, and the general types of good-faith collection and hardship considerations discussed by CMS and the OIG.
Why This Topic Matters
Routine copay waivers can create compliance exposure for government program billing and may also conflict with private payer contracts. Understanding the article helps practices recognize when waiver policies may be risky and why collection procedures and financial-need determinations matter.
What You Will Learn
- Why routine patient copay waivers raise compliance concerns.
- How government program billing and payer contract issues relate to waived patient responsibility.
- What general factors may be considered when evaluating patient financial need.
- What types of collection efforts are discussed in connection with occasional waiver decisions.
Who Should Read This
- Physicians
- Medical practice managers
- Billing staff
- Coding and compliance professionals
- Revenue cycle personnel
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