decisionhealth Newsletters, Answer Books - 2009 Issue 2 (February)
Compliance / Routine waiver of copayments
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Article Overview
This short compliance article discusses the legal and contractual issues associated with routinely waiving copayments and deductibles. It is aimed at providers, practice managers, billing staff, and compliance professionals who need a general understanding of how cost-sharing waivers can affect payer contracts and claims handling. The piece focuses on high-level compliance considerations and a court-related example without providing coding guidance.
Why This Topic Matters
Routine cost-sharing waivers can create compliance risk, affect payer relationships, and expose practices to disputes over claim payment and contract obligations. Readers should understand the broad compliance implications before adopting any waiver policy.
What You Will Learn
- How routine waiver of patient cost-sharing can raise compliance concerns
- Why managed care and government insurance contracts are relevant to waiver policies
- How payer and provider agreements may be implicated by waived patient responsibility
- Why practices should consider compliance implications before offering routine waivers
Who Should Read This
- Physicians
- Medical practice administrators
- Billing staff
- Compliance officers
- Revenue cycle professionals
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