Waiving Copays

I know it is typically against the rules per ins co's to waive copays and pt responsibilities. However, our Dr would like to provide this to employees and outside help in the office. Also, she will occasionally have a patient come back teh next day to go over labs that wern't all available on the DOS of the 1st appt, and she wants to waive the 2nd office copay.
Is it allowed for the dr to say she will "cover the copay" as opposed to waiving it? Does anyone currently do this, or have any suggestions? Thanks!

co-pays

Co-Pays are a contract between the patient and the payer. No-one has the authority to "waive" this responsibility. Deductibles and co-insurance amounts cannot just be written off. IRS code demands that you do one of two things before you write it off. And understand, an adjustment is different from a write-off. You eat an adjustment. Write-offs can be included on your Schedule C, and be accounted toward your profit and loss statement for the year.

The IRS demands that we either: 1.) Substantiate that the patient suffers a financial hardship; 2.) make a collection effort.

A financial hardship is more laborious and time consuming, but offers better protection if you are audited. Basically, you must gather paycheck stubs, tax info, mortgage or rent info, car note info, utilities bills, and anything that will assist in documenting the fact that the patient suffers a financial hardship. This process must be repeated every 180 days. However, once established, you can simply write the amounts off that the patient would normally owe.

Making a collection effort is defined by the IRS as sending a bill (statement) once each 30 days for a period of 90 days, followed by a demand letter on day 120. If funds are not received to reimburse us for that expense, we can then write it off.

These are the rules as stated by the IRS when it comes to write off allowances. The managed care scenario is covererd by federal law, so please be careful what you do.

but...

you are allowed to give discounts to employees, right? Our hospital offers a 25% discount off of amount due for services provided to employees and physicians and they are VERY conservative with compliance issues and would not do it if it was not approved by legal.

So the questioner could adopt a policy offering a discount and that would provide the same benefit.

co-pay adjustment

Along the same lines, we have an insurance company in Ohio that will charge a patient co-pays by CPT codes -- if three services are provided in the same visit, ie adult wellness, breast and pelvic (G0101) and a separate E/M for a problem or other procedure such as wart removal, the insur. charges the patient 3 co-pays. At $15 per co-pay, or more, our doc wants only to collect one feeling it is very unfair to the patient vs. making them return for 3 separate visits. Your thoughts if only one co-pay for the visit is collected?

co pay adjustment

You really have to go back to your contract: you are probably obligated to collect the co-pays.

It's the patient's insurance: you didn't make up the rules.

Also, the insurance company is decreasing what they pay you for the service by the amount of the copay.

Finally, in my opinion, do not bill G0101 to commercial insurers with a preventive medicine service. A pelvic and breast exam is part of an age/gender appropriate exam. We only have that carve out code because Medicare doesn't pay for physicals.

Copays

It's really a matter of what should be done versus what is typically done, which we all know is not always the same thing.

According to contracts, providers should not be waiving copays or deductibles. It is against most contracts.

However, I have yet to meet a doctor in the last 30 years who hasn't waived something for someone somewhere along the line. Some more than others.