2023 Copay Collection Rules – Compliantly Collecting Co-payments

Conference Materials (Password Required)

This webinar will review the federal and state compliance requirements concerning co-payments, deductibles and coinsurance amounts. Specifically, this presentation will review what to charge, when to waive, best practices for collections, and best practices for compliance. You may face compliance risk if you fail to collect copays and deductibles. There are lots of thing that you need to know:

• How much should you collect?
• Can you discount?
• Can copays be waived?
• Does waiving copay violate the Anti-Kickback Statute?
• Can you offer prompt payment reductions?

Proper collection of copays for both private and government payers can protect form severe violations like civil damages and forfeiture, civil monetary penalties, imprisonment, criminal fines, and payer exclusions. Nationally Recognized Healthcare attorney Amanda Waesch, Esq., can help you protect your practice. She will walk you through exactly how your practice can avoid copay collection violations and still receive the payments you are due.

Learning Objectives:

• Understand the definitions of patient cost-sharing amounts: co-payments, deductibles, and coinsurance
• Explore compliance concerns regarding routine waivers of patient cost-sharing responsibility under both federal and state law
• Discuss best practices for collecting patient cost-sharing portion
• Identify best practices to ensure compliance

Areas Covered in the Session:

• Definitions of patient cost-share responsibilities
• Federal law and compliance concerns related to waivers of patient cost-sharing amounts
• Best practices for collecting patient cost-sharing amounts
• Recommendations for policies and procedures to ensure compliance
• What to Charge
  • Deductible vs. Co-payments vs. Coinsurance
  • High Deductible Health Plan
  • Examination of Accounts Receivable (A/R)
• When to Waive
  • Routine Waivers
  • Medicare Fraud
  • State Law Violations
  • Breach of Contract for In-Network Providers
• Fraud and Abuse Laws
• Anti-Kickback Statute
• Anti-Kickback Statute Examples
• Anti-Kickback Statute Penalties
• Civil Monetary Penalties Law (42 U.S.C. §1320a-7a)
• OIG Example and Warning
• How to Collect More
• Best Practices for Collecting Copays and Deductibles
  • Patient Financial Responsibility Form
  • Payment At the Time of Service
  • Use of Technology
  • Policies and Procedures
• Patient Collection Policy and Practice
  • Staff education
  • Payment policies
    • Time of service
    • Credit card on file
  • Statements
  • Telephone calls
  • Payment options
    • Cash, check credit card
    • Online payment
  • Examine vendor relationships
• Use of Technology
• Payment at the time of services
• Payment Credit Balances
• Prompt Pay Policy
• Self-Pay Policy
• Charity Care Policy or Financial Hardship
• Bad Debt Policy
• Compliance Risk
• Lost Revenue
• Examining Total Payment for Services
• Usual and Customary fee
• Payor Negotiations
• Patient Termination Policies
• Payment Plan Agreement

Suggested Attendees:

• Practice administrators, CEOs, COOs, CFOs
• Compliance Officers
• Healthcare CPAs
• Revenue Cycle managers
• Billers
• Licensed Providers
• Physicians
• Office Managers
• Billing Staff
• Medical Auditors
• Practice Managers
• Auditors
• Billing Companies
• Clinic Owners
• Chief Quality Officers
• Presidents/ CEOs
• Senior Internal Auditors
• Directors of Compliance
• Regulatory/ Risk Officers
• Government Employees
• General Counsel
• Compliance Attorneys

Presenter Biography:

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This is a Live Virtual session.

A new way of immersive learning that allows you to engage live with our instructor and peers providing you with the flexibility to juggle the new work-life balance.

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