H ave you ever been near spontaneous combustion? For those unfamiliar with the term, spontaneous combustion basically means when someone or something just bursts into flames right on the spot without explanation. It's not a common occurrence to see at a clinic, unless your wife is covering the front desk when a patient says, "Hey, I can't pay you today. I just bought that new Lincoln out front. Do you want to see it? It's so nice!" Poof! Luckily, the fire extinguisher was close to the front desk. At that point, I thought I had heard it all. That was a brand new definition of hardship which I simply had not considered for my office's financial hardship policy. If I had, it would have been there right along with, "Sorry, Doc, I can't pay you today. I just bought that new four-wheeler I've been looking at," or, "I'd love to pay you today, but I've got to go to the tanning bed when I leave here." Obviously, our definition and a patient's definition of a "hardship policy" are quite different—or are they? What is your definition? If you don't have a written policy, then their reason may be just as reasonable to them as yours is to you! My point is that it is best to have a formal, written policy based on objective criteria to avoid situations like these and to make sure you really can help those in need, instead of those in need of a new Lincoln. According to most sources, as a general rule, a valid financial hardship waiver process requires that: It is not advertised or otherwise used in a manner intended to induce patients to select the provider for services. A decision to grant or deny a financial hardship waiver of some or all patient payment will be made based on the provider's individualized determina tion of the patient's financial need.The provider's standards for granting a financial hardship waiver arethesameforall payers, includingthe uninsured If you are considering waving a deductible or co- payment as a network provider, you may want to contact the carrier to see if they have any specific criteria you must follow to avoid violating your agreement. In general, hardship polices can be based on your common sense judgment and tied to either state or federal poverty guidelines. This type of policy will stop you from being considered as the "good guy or bad guy" when it comes to helping those in need. When you do choose to extend the courtesy of "financial hardship," it should not be indefinite, but for a limited time or only as long as needed (i.e., not until the end of the 72-month Lincoln lease). Developing a solid hardship policy can help keep you out of hot water if there is a true need to waive an occasional deductible or copayment. Believe it or not, it is not against the law to do so, especially if it is rare and follows your written hardship policy. It's the "routine waiver" of deductibles and copayments that may get you in trouble. A solid hardship policy also allows you to extend discounts to certain classes or categories of patients, even without them belonging to a discount medical plan like ChiroHealthUSA. The key is, like everything else we teach, to document correctly, code correctly, and bill correctly. In addition, if you offer discounts, also discount correctly using a discount medical plan and follow your written hardship policy for those truly in financial need. If you would like more information on developing a solid hardship policy for your office, or a simple one-page financial policy, e-mail [email protected] and put HARDSHIP in the subject line. Dr. Foxworth is a certified Medical Compliance Specialist and President ofChiroIIealthUSA. A practicing Chiropractor, he remains "in the trenches" facing challenges with billing, coding, documentation and compliance. He has served as president of the Missis- sippi Chiropractic Association, former Staff Chiropractor at the G. ]'. Sonny A lontgomery \ 'A Medical Center and is a Fellow of the International College of Chiropractic. He founded ConservaCareCorp, the first chiropractic network selected by the State of Mississippi to serve over 195K covered lives in the State Health Plan. You can contact Dr. Foxworth at 1-888-719-9990, info'dphirohealthusa.com or visit the ChiroIIealthUSA website at www.chirohealthusa.com
