decisionhealth Newsletters, Coder Pink Sheets - 2020 Issue 1 (January)
Compliance: Government continues to crack down on routine waiver of copayments
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Article Overview
This article explains why routine waivers of patient copayments, coinsurance, and deductibles can create compliance exposure for health care providers. It is aimed at billing, compliance, and practice management audiences who need a high-level understanding of government scrutiny, enforcement trends, and the general categories of permitted exceptions discussed by CMS and the OIG.
Why This Topic Matters
Routine cost-sharing waivers can trigger fraud-and-abuse concerns, payer disputes, and broader compliance risk. Understanding the general boundaries of when waivers may be permitted helps practices reduce exposure and keep policies aligned with federal guidance.
What You Will Learn
- Why routine waivers of patient cost-sharing are a compliance concern
- How government scrutiny and enforcement activity have shaped attention to waiver practices
- What broad exceptions and safeguards are discussed in federal guidance
- Why accurate staff education and current policies matter for waiver decisions
Who Should Read This
- Medical practice administrators
- Billing and coding professionals
- Compliance officers
- Revenue cycle staff
- Healthcare attorneys
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