2025 Federal and State Rules for Co-payments, Deductibles and Coinsurance Changes

Event Materials (Key Required)

Course Description

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 Objectives

• 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   
• Know about prompt payment policy, Self-Pay Policy, financial hardship policy and how to draft these documents compliantly
• Know why the routine waiving patient cost share is dangerous
• Key considerations in waiving patient cost share responsibility
• Impact of Medicare & federal healthcare programs versus commercial health plans

Areas Covered in the Session

• What to Charge
• Deductible vs. Copayment 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
• The Anti-Kickback Statute 
• Anti-Kickback Examples
• Anti-Kickback Statute Penalties
• Civil Monetary Penalties Law (CMPL)
• Criminal Penalties
• Civil Monetary Penalties Law (42 U.S.C. §1320a-7a)
• OIG may impose civil monetary penalties
• Civil Monetary Penalties Law
• OIG Examples and Warning
• How to Collect More
• Best Practices for Collecting Copays and Deductibles
• Patient Financial Responsibility Form
• Payment At the Time of Service
• Use of Technology
• Policies and Procedures
• Patient Credit Balances
• Prompt Pay Policy
• Self-Pay Policy
• Charity Care Policy or Financial Hardship
• Bad Debt Policy
• Written policy
• Collection efforts
• Identify when A/R will be written off as bad debt
• Reference other policies
• Assists in defending “routine” waiver of copayments and deductibles  
• Other Considerations
• Compliance risk
• Lost revenue
• Examining total payment for services
• Usual and customary fee
• Payor negotiations
• Patient Termination Policies
• Payment Plan Agreement
• Live Q&A Session

Suggested Attendees

• Practice Administrators, CEOs, COOs, CFOs
• Compliance Officers
• Healthcare CPAs
• Revenue Cycle Managers
• Billers
• Licensed Providers
• Physicians
• Office Managers
• Billing Staff
• Medical Auditors
• Practice Managers
• Auditors
• Billing Companies
• Clinic Owners
• Chief Quality Officers
• Presidents/ CEOs
• Senior Internal Auditors
• Directors of Compliance
• Regulatory/ Risk Officers
• Government Employees
• General Counsel
• Compliance Attorneys 

About the Presenter

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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Additional Information

After Registration: You will receive an email with login information and handouts (presentation slides) that you can print and share with all participants at your location.

System Requirement:

• Internet Speed: Preferably above 1 MBPS
• Headset: Any decent headset and microphone which can be used to talk and hear clearly

Live Course Cancellation Policy: If for any reason Skillacquire need to cancel this program, Skillacquire will notify participants by email of the cancellation no less than 24 hours prior to the expected start time.

Can’t Listen Live? No problem. You can get access to an On-Demand webinar. Use it as a training tool at your convenience.

For more information, you can reach out to the below contact:

Toll-Free No: 1-302-444-0162

Email: care@skillacquire.com 

This is a Live Virtual session.

A new way of immersive learning that allows you to engage live with our instructor and peers providing you with the flexibility to juggle the new work-life balance.

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