General Category > General Questions
Fraud and Abuse - Coda
RichardP:
OIG is implying we should have known better
Has OIG suggested what you should have done differently?
gary999:
--- Quote from: RichardP on February 09, 2013, 10:32:49 PM ---OIG is implying we should have known better
Has OIG suggested what you should have done differently?
--- End quote ---
No.
RichardP:
Keep us posted on how this plays out.
gary999:
--- Quote from: RichardP on February 09, 2013, 10:38:38 PM ---Keep us posted on how this plays out.
--- End quote ---
I will.
Very chilling. We run a very ethical business.
PMRNC:
Note that the ABN is an issue only if the doctor intends to charge the patient for the procedure if Medicare does not pay. If the doctor does not intend to charge the patient if Medicare denies payment, if he is simply going to write off the charge, the ABN is not an issue.
Isn't the provider required to "attempt" to collect? In the Beneficiary options of the ABN they select one, they are told they are "financially responsible'' Granted Medicare is not the same as a commercial carrier, however they still have cost sharing and beneficiary provisions to follow.
In for example the patients Medicare Handbook it says they are responsible for all out of pocket and non covered items.
When I was dealing with Medicare, the procedure we followed was based on our policies/procedures. If one provider had a policy to collect financial hardship than that is what we did. We did not routinely discount or waive patient responsibility no matter the insurer. IF it's not prohibited, I would suppose a provider could have a general policy to waive ALL fees if there is an ABN and Medicare has not paid (or will not paid) But isn't this ONE of the reasons the ABN is used, not just to protect the beneficiary and procedure to Medicare but it's there to protect the financial interests of the provider. If your provider intends NOT to charge a patient is there a general policy to do so? Or do you do it on a case by case basis? Financial Hardship? Why wouldn't the provider get a signed ABN?
Don't misunderstand, I'm not actually saying it can't be done. I'm asking what the difference would be between a Medicare patient and a patient with a commercial (par or non par) that requires patients pay their out of pocket/cost sharing. Since non covered charges ARE a part of cost sharing I am just curious as to how physicians can "routinely" waive these. Just seems iffy to me. Does your provider have this procedure standard for all? or does he do it for certain ones? That's the part I'm questioning.
--- Quote --- if Medicare denies payment for a charge that the doctor has not given us a signed ABN for, we automatically write off the charge, no questions asked. Medicare denied payment, patient was not billed, no question at all of whether there are legal issues involved. The patient is not billed and that ends it.
--- End quote ---
Again, I don't want you to misunderstand, I get that you are only writing off the ones you did NOT get an ABN and that would be correct.
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