ED Coding & Reimbursement Alert - 2012 Issue 16
Compliance: Know When Your Financial Arrangements Could Cause Compliance Nightmares
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Article Overview
This article discusses how routine fee waivers, discounts, and other financial arrangements can create compliance problems for health care practices. It is aimed at providers, practice managers, and compliance staff who need a general understanding of fraud and abuse risks, payer contract concerns, and when legal review may be needed. The guidance focuses on federal compliance topics and common office situations involving patient cost-sharing and professional courtesy.
Why This Topic Matters
Financial arrangements that diverge from payer expectations can expose a practice to fraud and abuse scrutiny, contract issues, and regulatory penalties. Understanding the compliance landscape helps practices reduce risk before offering discounts, waivers, or similar patient assistance.
What You Will Learn
- How patient fee waivers and discounts can create compliance risk
- Why payer contracts and billing obligations matter in financial arrangements
- What general federal fraud and abuse issues may be implicated by cost-sharing assistance
- Why routine courtesy discounts and similar practices warrant caution
- When to consider consulting a payer or health care attorney
Who Should Read This
- Physicians
- Medical practice managers
- Billing and coding professionals
- Compliance officers
- Healthcare attorneys
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