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This webinar will review the federal and state compliance requirements concerning co-payments, deductibles and coinsurance amounts. Specifically, this presentation will review what to charge, when to waive, best practices for collections, and best practices for compliance. You may face compliance risk if you fail to collect copays and deductibles. There are lots of thing that you need to know:
How much should you collect?
Can you discount?
Can copays be waived?
Does waiving copay violate the Anti-Kickback Statute?
Can you offer prompt payment reductions?
Proper collection of copays for both private and government payers can protect form severe violations like civil damages and forfeiture, civil monetary penalties, imprisonment, criminal fines, and payer exclusions. Nationally Recognized Healthcare attorney Amanda Waesch, Esq., can help you protect your practice. She will walk you through exactly how your practice can avoid copay collection violations and still receive the payments you are due.
Learning Objective:
Understand the definitions of patient cost-sharing amounts: co-payments, deductibles, and coinsurance
Explore compliance concerns regarding routine waivers of patient cost-sharing responsibility under both federal and state law
Discuss best practices for collecting patient cost-sharing portion
Identify best practices to ensure compliance
Areas Covered in the Session
Definitions of patient cost-share responsibilities
Federal law and compliance concerns related to waivers of patient cost-sharing amounts
Best practices for collecting patient cost-sharing amounts
Recommendations for policies and procedures to ensure compliance
What to Charge
Deductible vs. Co-payment vs. Coinsurance
High Deductible Health Plan
Examination of Accounts Receivable (A/R)
When to Waive
Routine Waivers
Medicare Fraud
State Law Violations
Breach of Contract for In-Network Providers
Fraud and Abuse Laws
Anti-Kickback Statute
Anti-Kickback Statute Examples
Anti-Kickback Statute Penalties
Civil Monetary Penalties Law (42 U.S.C. §1320a-7a)
OIG Example and Warning
How to Collect More
Best Practices for Collecting Copays and Deductibles
Amanda Waesch has experience of 18 years and operates a national healthcare practice and is licensed in both Ohio and Florida. She primarily focuses her practice on healthcare, employment law, corporate law, and healthcare litigation and advises all types of employers, in particular healthcare providers, including, hospitals and physicians, on various matters.
She also chairs the firm’s litigation team that is primarily responsible for handling all reimbursement audits and appeals for her firm’s healthcare clients and heads up BMD’s Provider Relations, Audit, Appeals, and Negotiations Unit (PRAAN) which handles all-payer audits, appeals, overpayments and payment extrapolations.
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Course Content
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