decisionhealth Newsletters, Part B News - 2021 Issue 8 (August)
Avoid routinely waiving patient copays; follow these tips instead
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Article Overview
This article is a compliance-focused discussion for medical practices, billers, and revenue cycle staff who handle Medicare patient cost-sharing. It addresses the legal and contractual risks associated with routine copayment waivers, discusses when case-by-case waivers may be considered, and summarizes broad guidance from government sources on patient financial need and collection efforts.
Why This Topic Matters
Routine copayment waivers can create exposure under federal health care program rules and payer contracts. Understanding the general compliance framework helps practices reduce risk while still handling legitimate hardship situations appropriately.
What You Will Learn
- Why routine copayment waivers can create compliance risk
- What broad factors may be considered when assessing financial hardship
- How practices are expected to approach collection efforts in general
- Why payer type and patient circumstances can affect waiver decisions
Who Should Read This
- Physician practices
- Medical billers
- Coders
- Revenue cycle staff
- Practice administrators
- Compliance staff
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