Professional Courtesy: It's Just Bad Business!

This article provides an insight to collecting copay and deductible amounts from your patients and what to do when they refuse. 

Is waiving a copay or deductible Fraud?  The answer used to be yes and you got to stop immediately because of The False Claims Act (31 U.S.C. 3729-3733).  Waiver of copay or deductibles could also implicate the Antikickback Statutes and The Prohibition of Inducements to Beneficiaries, section 1128A (a) (5) (codified at 42 U.S.C. 1320a-7a (a) (5).

How is that for an answer? Has my answer changed much over the years?  The answer is no but I do put a different spin on it.  Today practices are dealing with decreasing reimbursement. In 2006 physician practices are looking at a 4.4% reduction in their Medicare Conversion Factor. Keep in mind, where Medicare goes you are certain to find others following very closely behind them. The majority of your contracts with insurance carriers are based on a percentage of the RBRVS. There is one area where we all saw an increase in 2005 and will again in 2006, our malpractice premiums.  Premium increases ranged from 40% up to 100% last year and are expected to be in the double digits again. 

This takes me to the point of the article.  Sure Fraud is a major reason not to routinely waive copay and deductible amounts but the main reason is the loss of revenue.  Below, I have provided for you 2 examples used to illustrate just how much a practice could lose in a year by not collecting patient amounts owed the practice.

Author: Sean M. Weiss, CPC, CMPE, RMC, RMM

This entire article will be available in the printed version of BC Advantage - Issue 1.2 out early February 2006

To request a back issue of Issue 1.1 please email

or to subscribe to BC Advantage click here