insurance equals payment

ok---Don't kill the messenger asking the question-BUT when an insurance company denies a service as non-covered...and they state it is patient responsiblility on the eob-what if the office wants to write it off without attempting to collect. After scouring payor contracts, questions to reps, there is still no clear answer on this. The question I have is this considered fraud and where can I find a resource that cites this so I can close this particular subject with staff.

Many, many thanks!

insurance equals payment

sorry add to that; adj off co-insurance as payment equals insurance.....that citation as well.

Here is one citation

First you have to differentiate Medicare from commercial- CMS publishes lots of guidance, other insurers do not. Also differentiate routine practice from the occasional forgiveness of a debt. And finally waiving a fee for non-covered services is much different (and totally up to the doctor ) than waiving a copay (routine copay waiver is fraud).

So CMS says this: routine waiver of deductibles and copayments by charge-based
providers, practitioners or suppliers is unlawful because it results in
(1) false claims, (2) violations of the anti-kickback statute, and (3)
excessive utilization of items and services paid for by Medicare. from: http://www.oig.hhs.gov/fraud/docs/alertsandbulletins/121994.html

insurance equals payments

thank you; can you share who you are? I was asked what source this info was from and I explained copapedia and who it was developed by; whom I think highly of btw! Unsure who signaturedoc is. If you don't mind.

thank you!

I am just a country doc...

I am an internist who reads a lot and likes to express his opinions (see post about female rectal exam). I do some case management work at my local hospital so know about the hospital side of stuff. Betsy Nicoletti the coding queen got me onto this site. In between patients I read postings and answer questions (don't tell my staff that's what I am doing- they think I am charting!)

ins equals pay

aahhhahahaha--that is good stuff! Thank you very much for your posts! And Betsy is the Coding Queen!!!!