Payments > Patient Billing

discounts for hardship patients

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Sophrosyne:
Answered my own question with this helpful article! ;D
http://oig.hhs.gov/testimony/docs/2004/40624oig.pdf
So it looks like it's ok to discount or waive cost-sharing amounts on a case-by-case basis in order to help someone who is genuinely financially needy.

Michele:
Yes you are correct.  Sorry for the delay - we had a terrible virus this week that knocked us out for 2 1/2 days!   >:(

PMRNC:
DMK said it the best. MAKE SURE IT IS IN YOUR PROVIDER'S P&P that should always be first place you go to for your answer on how to handle a procedure such as this and if it's not in there, get clarification and then make sure it makes it into your client's P&P!!   My clients have their hardship agreements on file along with a patient signature. What constitutes a hardship really NEEDS to be clarified on EACH provider's P&P and adhered to explicitly. for example, one of my client's financial hardship form is 2 pages long, he actually asks such questions as "Do you have Cable, please provide your cable companies name and monthly payment" reason being is that he feels if they can afford full cable with all the channels they can afford their $10 or $20 copayment. He's very fair but he's not an overly generous soul ..you would be surprised at some of the financial agreements don't even go into the clarification of what that provider constitutes a financial hardship when that really is important or you will have every patient claiming a hardship. Have the office come up with guidelines and adhere to them for every patient across the board with no special provisions, the terms should NEVER be on a patient-by-patient basis, but rather across the board with the patient's signature attached.  Good example, one of my providers had a patient for a couple of years with an arrangement on a one page hardship agreement (no terms) that they would not have to pay their copayment.. all was fine and dandy and then patient sued another provider for something and won a settlement enough to pay 20 doctors.. He never got a cent. I have another provider that covers that issue with an ROR (right of recovery) because he's also a lawyer as well as a family physician.  So you see these financial hardship agreements are NOT black/white..

DMK:
I know I will come across as harsh or cruel, and I don't mean to be that way at all, BUT..... I'm fed up to my eyeballs with people assuming that doctors all make a fortune and that they should all treat people for free.  They are a business providing a service, not a charity.  When a doctor or facility is willing to make special arrangements for you be grateful, because they don't have to! 

I always try to turn the tables.  You go to work and you expect to get paid for your work. Why should they be any different?

The extra twist is that the doctor or facility can get into serious trouble by making special arrangements, if they don't do it right! 

What the general public doesn't realize is that ALL doctors and facilities are constantly under the magnifying glass by the insurance companies, especially Medicare.  One infraction can open all their cases up to scrutiny, they get fined, and sometimes fined right out of business.  It's something a provider worries about constantly.  It doesn't matter how kind or generous they are, how a gifted a physician they are, there are paperwork technicalities and financial technicalities that can ruin them!

So be a little extra diligent for your clients and take their side a little more when they want to "waive" the co-pay, or the patients cry "financial hardship".  (That cable bill story is FABULOUS BTW, and very much to the point.)  Kindness can get the providers in a lot of trouble if they don't do it right.

PMRNC:

--- Quote ---I know I will come across as harsh or cruel, and I don't mean to be that way at all, BUT..... I'm fed up to my eyeballs with people assuming that doctors all make a fortune and that they should all treat people for free.  They are a business providing a service, not a charity.  When a doctor or facility is willing to make special arrangements for you be grateful, because they don't have to! 
--- End quote ---

I COULD NOT AGREE MORE!!  And let's not forget doctors are the most heavily govt regulated professionals in the country!! They are watched while even picking their nose! One of the first things I do when I take over a practice's billing is I go through ALL of their forms and their P&P, and compliance manual. I make sure they are consistent. There should be NO favorite patient's. A financial hardship practice should be in place from day one and adhered to to avoid special treatment. You don't know how many times I've gone into an office and asked for these and they don't have them.. that's completely unacceptable, I wouldn't expect a client to hire me without having a P&P or compliance plan! Normally this is how I will make some consulting cash too by offering to develop them. :)

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