Outpatient Facility Coding Alert - 2004 Issue 15
Billing Insurance, But Not Physician Patient, Also A Dangerous Game
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Article Overview
This short article explains why routine waiver of copayments can create compliance and contract issues for physician offices. It is aimed at physicians, practice managers, and billing staff who need a general understanding of insurer and Medicare concerns surrounding patient cost-sharing policies.
Why This Topic Matters
Copayment waiver practices can affect insurer contracts and Medicare compliance, so practices need to understand the general legal and billing risks before adopting informal discount policies.
What You Will Learn
- The general compliance concerns associated with waiving patient copayments
- How private payer contracts and Medicare can be implicated by cost-sharing waivers
- Why billing and patient discount practices may require careful review in physician offices
- How related policies can affect physicians, staff, and family-member care arrangements
Who Should Read This
- Physicians
- Medical practice managers
- Billing staff
- Compliance personnel
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