Author Topic: Waived Copay  (Read 1151 times)

cpbridges

  • Newbie
  • *
  • Posts: 7
Waived Copay
« 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.)?

PMRNC

  • Hero Member
  • *****
  • Posts: 4254
    • One Stop Resources & Networking for Medical Billers
Re: Waived Copay
« Reply #1 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.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

cpbridges

  • Newbie
  • *
  • Posts: 7
Re: Waived Copay
« Reply #2 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.

Pay_My_Claims

  • Guest
Re: Waived Copay
« Reply #3 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.