Medical Billing Forum

General Category => General Questions => Topic started by: cpbridges on January 20, 2011, 09:10:07 PM

Title: Waived Copay
Post by: cpbridges on January 20, 2011, 09:10:07 PM
Can my doctor waive co-pays from patients?  Is it ok for a provider to waive copays for specific patients (i.e. rest home patients who are seen in the clinic, clozaril patients, etc.)?
Title: Re: Waived Copay
Post by: PMRNC on January 21, 2011, 06:21:43 AM
No, it is a violation of anti-kickback statute  for providers to routinely waive copay's or out-of-pocket expenses. It's also a direct violation of the contract between the patient and the insured. Occasional discounts for specific patients should have a financial hardship agreement attached and if planned discounts are given the insurance company must be given the same discount.
Title: Re: Waived Copay
Post by: cpbridges on February 08, 2011, 06:26:50 AM
What about patient who are residents of a nursing home.  I have a copy of NC Medicaid's October billing bulletin and it says that:

Copayment Exemptions - Providers may not charge copayments for the following services: Services provided to residents of nursing facilities.

Does this mean that when a provider sees a patient IN the nursing facility then they may not charge a copay?  Or does it mean patients who are seen in the doctors office may not be charged a copay?

I may be thinking too much into this.  All replies are appreciated.
Title: Re: Waived Copay
Post by: Pay_My_Claims on February 08, 2011, 07:01:50 AM
hey cp, that is only applicable to NC Medicaid. It also applies for the purchase of DME equipment. Certain services there is no copay to be paid. This isn't necessarily true for other insurances however, its just specific to NC medicaid.