Medical Office Billing & Collections Alert: Waiver Opportunities -- Ensure Compliance And Patient Pa

By Author: Leesa Israel
Total Articles: 4
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Documented financial hardship is all what you need

In medical billing, you must have heard it so many times: you should never waive a copy or deductible and avoid offering discounts! In many cases, this is correct.

There are times, though, when you can offer discounts or waiver to patients who have documented financial hardship. Here are medical billing expert pointers on how you can properly waive patient fees because of financial hardship.

1. The Exception:

If you are regularly waiving deductibles and copayments, you can violate numerous federal laws and regulations which include the federal False Claims Act, anti-kickback statutes, and compliance guidelines for both individual and small group physician practices. And in many case you may also violate payer contracts by doing so.

Even though the rule is that you should not offer waivers and discounts, you can make exceptions based on financial hardship -- if you follow a few guidelines. Besides, waivers or discounts should be made only on the basis of verified patient financial need and you ...
... should meet the following criteria:

1. You do not offer the waiver as part of any advertisement or solicitation

2. You do not offer waivers regularly to patients

3. You offer the waiver after confirming that the individual actually is in financial need or after reasonable collection efforts have failed.

Remember: You can provide discounts to patient without insurance who are self-paying with no proving financial hardship. Offering waivers or discounts to insured patients, including Medicare patients, may be suspect except they are non-routine and have genuine financial hardships.

Plus, you should also have a financial policy about how you handle patients with financial hardships.

2. Get Everything in Writing

Don't just believe the patient blindly as far as the patient's financial hardship is concerned. Before you decide to a debt write-off, the patient is required to prove that he cannot pay.

In order to prove financial hardship, you are required to ask the patient to provide you with information like income tax returns, W-2 and 1099 forms as proof of income and essential monthly household expenditures, such as mortgage/rent, utilities, insurance, and food.

You'll then use this information to decide whether the patient's earnings, which he has shown, meet state and federal poverty guidelines. You should ensure that you work within the poverty guidelines for your state.

Moreover, the patient and the physician are also required to sign a statement specifying that the practice reviewed the patient's proof of financial hardship and also listing what charges the practice is waiving. Your practice should always keep a copy and give a copy to the patient as well.

You also should only apply the determination of financial hardship to the particular visit or service you are billing for at the time, not to any future services.

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