Clear rules needed when waiving deductibles

Hospitals intent on waiving deductibles for patients must have clear guidelines to avoid running afoul of the federal anti-kickback statute and payer contracts, experts say.

“Whatever your policy is, it must be applied consistently,” said Randy Notes, principal in KPMG’s healthcare and life sciences advisory practice.

Ascension is waiving out-of-pocket costs for any patient, insured or uninsured, who earns less than 250% of the federal poverty level, CEO Anthony Tersigni said.

Other hospital chains have different approaches to the insured and uninsured.

Dallas-based Tenet Healthcare Corp. has a published compliance policy that details the circumstances under which it will reduce or waive co-payments and deductibles.

First, it states upfront that Tenet operations may not routinely waive or reduce co-payments, co-insurance or deductibles for federal healthcare program patients.

But if they do, they may not claim the payments as bad debt to try to collect them through another federal or state program or waive the amounts as part of a negotiated price-reduction program, the policy states.

Novant Health does not waive deductibles on the premise that payers generally prohibit the practices, said Melanie Wilson, the system’s vice president of revenue cycle.

Instead, Novant will offer insured patients financial counseling and interest-free payment plans that can be combined across all hospital and ambulatory locations, Wilson said.

“We will work with patients in a one-off scenario if their financial need is such that they need special circumstances,” she said.