Guest guest Posted February 28, 2012 Report Share Posted February 28, 2012 Group, Is it legal to collect a $10 copay/visit no matter what the patient's Insurance plan dictates. No matter if the insurance plan is a copay or co insurance plan. Then tell the patient that the they (provider) will write off the remainder of the patients bill, the $10 co pay is payment in full. Roll PT, OCS, FAAOMPT Ocean Springs, MS Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 29, 2012 Report Share Posted February 29, 2012 I'll take a crack at this one and say no, it would not be legal. You would be overcharging some people and undercharging others. It could be viewed as an incentive to provide services since you are providing that reduction without consideration to the individual's financial situation. You are also not following your agreed upon contract with the insurance company, so they could re-adjust your rate based on your new accepted payment amounts. I have been told by the insurance companies that you can reduce copays based on a patient's financial limitations, but it must be on an individual basis and not applied across the board. I'd also be disgruntled, as a patient, to pay a copay when I didn't have to. Cohen PT, MS Pittsboro, NC > > Group, > > Is it legal to collect a $10 copay/visit no matter what the patient's Insurance plan dictates. No matter if the insurance plan is a copay or co insurance plan. Then tell the patient that the they (provider) will write off the remainder of the patients bill, the $10 co pay is payment in full. > > Roll PT, OCS, FAAOMPT > Ocean Springs, MS > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 29, 2012 Report Share Posted February 29, 2012 I'll take a crack at this one and say no, it would not be legal. You would be overcharging some people and undercharging others. It could be viewed as an incentive to provide services since you are providing that reduction without consideration to the individual's financial situation. You are also not following your agreed upon contract with the insurance company, so they could re-adjust your rate based on your new accepted payment amounts. I have been told by the insurance companies that you can reduce copays based on a patient's financial limitations, but it must be on an individual basis and not applied across the board. I'd also be disgruntled, as a patient, to pay a copay when I didn't have to. Cohen PT, MS Pittsboro, NC > > Group, > > Is it legal to collect a $10 copay/visit no matter what the patient's Insurance plan dictates. No matter if the insurance plan is a copay or co insurance plan. Then tell the patient that the they (provider) will write off the remainder of the patients bill, the $10 co pay is payment in full. > > Roll PT, OCS, FAAOMPT > Ocean Springs, MS > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 29, 2012 Report Share Posted February 29, 2012 I'll take a crack at this one and say no, it would not be legal. You would be overcharging some people and undercharging others. It could be viewed as an incentive to provide services since you are providing that reduction without consideration to the individual's financial situation. You are also not following your agreed upon contract with the insurance company, so they could re-adjust your rate based on your new accepted payment amounts. I have been told by the insurance companies that you can reduce copays based on a patient's financial limitations, but it must be on an individual basis and not applied across the board. I'd also be disgruntled, as a patient, to pay a copay when I didn't have to. Cohen PT, MS Pittsboro, NC > > Group, > > Is it legal to collect a $10 copay/visit no matter what the patient's Insurance plan dictates. No matter if the insurance plan is a copay or co insurance plan. Then tell the patient that the they (provider) will write off the remainder of the patients bill, the $10 co pay is payment in full. > > Roll PT, OCS, FAAOMPT > Ocean Springs, MS > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 29, 2012 Report Share Posted February 29, 2012 I agree with the others that have responded so far. I would give you an example like this: a insurer is billed for a PT evaluation. Your contract with said insurer call for you to recieve $200 minus any applicable co-pay from the patient. Your patient had a $35 copay but you only collected $10. You've now commited billing fraud and possibley wire or mail fraud dependinjg on how your claims were submitted to the insurer. By accepting $175 ($165 from insurer and $10 from patient)as payment in full you've " overbilled " the insurer for $25. Your saying that the service you billed the insurer $200 for wasn't worth $200 but rather it was worth $175. The insurer could than have paid you $140 and you would have collected the $35 from the patient. This was an example that was given when I took a Managed Care Contracting class in graduate school. Remember, insurers can always ask to see your books to see if you're abiding by the terms of your contract with them. Does it happen often? No, but do you really want to risk your status with a payer, possibley multiple payers? I wouldn't do it. It's not to say that you can't agreed to take less if the patient has a financial hardship. You should have a policy in place for extending charity/uncompensated care to patients. As long as you apply the guidelines of your charity care policy to all patients the insurer can't really complain too much. We do write-off reduce co-pays and co-insurance for patients who meet the income guidelines established by the federal government for our area. We keep the applications on file in the event we are audited. This way we can prove the patient met the guidelines and it wasn't just a case of us deciding we weren't going to collect what was due from the patient. J. LaBelle, MBA, ATC, LAT Utilization Coordinator Good Shepherd Penn Partners > > Group, > > Is it legal to collect a $10 copay/visit no matter what the patient's Insurance plan dictates. No matter if the insurance plan is a copay or co insurance plan. Then tell the patient that the they (provider) will write off the remainder of the patients bill, the $10 co pay is payment in full. > > Roll PT, OCS, FAAOMPT > Ocean Springs, MS > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 1, 2012 Report Share Posted March 1, 2012 Thank you group for your replies. You have confirmed what I was thinking. Hardship cases can be dealt with on an as needed basis. Roll Ocean Springs, MS > > > > Group, > > > > Is it legal to collect a $10 copay/visit no matter what the patient's Insurance plan dictates. No matter if the insurance plan is a copay or co insurance plan. Then tell the patient that the they (provider) will write off the remainder of the patients bill, the $10 co pay is payment in full. > > > > Roll PT, OCS, FAAOMPT > > Ocean Springs, MS > > > Quote Link to comment Share on other sites More sharing options...
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