M any wonderful CAs have the trust and support of their providers to run many of the business aspects of their practices. Often, you are entrusted to work with patients on their financial responsibilities while the provider works diligently on providing quality care. It's imperative that you understand the importance of this role. Protecting your provider is essential because he or she is the business owner, and that means being responsible for what happens in the practice. Be aware of the risks involved with the routine waiver of co-pays and deductibles. We often see that patients in extreme need of chiropractic care will ask their provider to waive their co-pay and deductible for numerous reasons, mostly financial. This can become a serious situation if the practice agrees to the waiver, whether Medicare, Medicaid, or a third-party plan covers your patient. It can be costly if you don't understand the consequences of your actions or recklessly ignore the rules. Such actions can lead to lawsuits, charges of fraud, and even jail time. Most private insurers don't allow waiving co-payments and deductibles. This could easily be considered an inducement once word gets around your community and new patients arrive knowing that you offer to waive these responsibilities and accept only what the insurance company pays. Read the contracts your office holds with third-party payers carefully and understand your responsibilities as an in-network practice. Engaging in the activity of waiving the patient responsibility portion of payment can cause the termination of these contracts, among other consequences. A third-party payer can sue the provider based on your failure to collect the patient's portion of financial responsibility because this waiver changes the value of the service rendered to the patient. Keep in mind, CAs are not immune to having action taken against them as well. Healthcare providers can be sanctioned for filing false claims according to the False Claims Act. Civil monetary penalties, threat of $10,000 fine per item, exclusion from federal and state funded programs, criminal fines, and imprisonment are just some of the penalties one could face for these actions. Even if you are doing adjustments and write-offs with good intentions, this can often come back to hurt you, your provider, and your practice. It is vital to comprehend the relationships that are in place as an in-network practice. There are three relationships involved, all of which must be respected: The relationship your office has with the insurer (your contract). The relationship your patient has with the in surer (their contract). The relationship your office has with the pa tient. All participants must keep up their end of the agreement: Your office ensures the carrier that you will collect co-pays and deductibles and the carrier agrees to pay you based on an agreed upon fee schedule. Your patient agrees to pay his or her financial portion of the care to the provider and the insurance company agrees to pick up the re maining financial responsibility. You agree to give quality care to the patient who agrees to pay you his or her portion of the financial responsibility. If the patient is getting a discount, the payer rightfully may feel deserv ing of the same discount. There are circumstances when a patient needs care and truly has a financial hardship causing an inability to pay. In this case, the best way to offer a lower fee is to establish a policy for cases of extreme hardship. You then use a consistent, policy-based method to obtain financial data from the patient and use your consistent, policy-based standards for determination. When developing a hardship policy, verification of hardship is important documentation that shows you had due diligence in ensuring financial hardship was warranted for the patient's care. Be sure all information obtained is retained and documented in the patient's health record. Do not make financial hardship cases a routine occurrence in your office, as that can be a problem. Use financial waivers sparingly for only true hardship cases. Ask yourself if the waiver of co-payments and deduct-ibles is worth the risk. By understanding that your patients choose their insurance plans and must be held accountable for their financial responsibility, it will help you to collect what is due for the services you've rendered. Always keep in mind that any time you give away or write off services you've rendered, you are devaluing these services to the patient. Stay on your game, understand your office's policies, and work within these guidelines. Don't allow noncompliant write-offs to subject the provider, yourself, or the practice to risk. Kathy Mills Chang is a Certified Medical Compliance Specialist (MCS-P) and, since 1983, has been provid- ing chiropractors with reimbursement and compliance training, advice and tools to improve the financial performance of their practices. Kalhy is known as one of our profession sforemost experts on Medicare andean he reached at (855) TFASIK.\K'orwfoakmcuni-versity.com
