Clear rules needed when waiv­ing de­ductibles

Modern Healthcare - - NEWS - —Dave Barkholz

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.

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