Medical Billing Forum

General Category => General Questions => Topic started by: Tifsmom1 on May 23, 2014, 01:32:43 PM

Title: Collecting Copays and co-insurance
Post by: Tifsmom1 on May 23, 2014, 01:32:43 PM
I am in the state of Colorado, I was told that it is illegal for a provider not to collect a patients co-pays and co-insurance and deductibles. Is this true and if so where can I find this information. I have checked DORA.
Title: Re: Collecting Copays and co-insurance
Post by: rdmoore2003 on May 23, 2014, 02:27:42 PM
Read your insurance contracts.   Basically, when you do not collect, you are jeopardizing your contract with the insurance company and the contract between the insurance company and patient.
Title: Re: Collecting Copays and co-insurance
Post by: rdmoore2003 on May 23, 2014, 02:29:02 PM
also jeopardizing your office's cash flow.   Once the patient leaves the office and doesnt pay at time of service, chances decline on getting your payments from the patient.
Title: Re: Collecting Copays and co-insurance
Post by: Michele on May 23, 2014, 04:11:45 PM
RDMoore is right, but not only is it jeopardizing the contract with the insurance carrier it is against the law. 

All of these concepts, deductible and co-insurance, are cost share obligations.  The rules of managed care state that the patient CANNOT see the doctor until they make their co-payment. Managed care is governed by federal law and is not open to interpretation. To "write-off" a co-pay, or to allow a patient in to see the doctor without collecting the co-payment, is against the law.

Basically, providers are not supposed to 'forgive' patient responsibilities without proof of financial hardship.
Title: Re: Collecting Copays and co-insurance
Post by: shanbull on May 23, 2014, 04:48:02 PM
Not collecting copays/coinsurance/deductibles may constitute breach of contract and fraud. These blog posts from law firms that specialize in this area offer the best explanations I've found about this so far:

https://www.kirschenbaumesq.com/article/collecting-co-pays-required#sthash.uiqFkMLy.dpuf (https://www.kirschenbaumesq.com/article/collecting-co-pays-required#sthash.uiqFkMLy.dpuf)
http://www.ober.com/publications/2472-health-care-providers-may-waive-patients-copayment-obligations-but (http://www.ober.com/publications/2472-health-care-providers-may-waive-patients-copayment-obligations-but)
Title: Re: Collecting Copays and co-insurance
Post by: Tifsmom1 on June 17, 2014, 09:23:29 PM
Thank you all for the replies. I was finally able to find the information and convince the company that what we were saying was correct.
Title: Re: Collecting Copays and co-insurance
Post by: RichardP on June 18, 2014, 10:37:48 AM
Note this distinction, tho:

1.  Collect at time of office visit;
2.  Collect by billing.

It seems that one is playing by the rules if they bill the patient for the co-pay.  So no one is going to be convicted of insurance fraud if the co-pay is not collected at the time of service.  But that is assuming you can actually collect the co-pay by billing the patient.

From Shanbull's link:

When collecting or attempting to collect co-pays, you are required to make a good faith effort to collect, which means speaking to your patient population about paying at the time of service, sending out notices of late payments and possibly sending off late bills to collection.  Rule of thumb - make at least 3 attempts.