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

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.

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• 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 Sessions

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Amanda L. Waesch, Esq., 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.ions.

Additional Information

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