I do admin/billing for a small clinic. After working in disability advocacy for several years (services are Medicaid-funded), I have a solid background/understanding when it comes to HIPAA, but have had a lot of catch up to do with all other areas of compliance; I was hired for my soft skills and given a decent budget for compliance resources and consultants, all of which has helped a ton.
I see a lot of advice on this sub around “asking the provider if they will work with you” on large medical bills. Everything I have read and every consultant I have worked with has pointed to this sort of thing being against regulation/very high risk for provider offices – insurance fraud basically. Can anyone provide more perspective on this matter? I have had several scenarios where I would love to be able to “cut a bill in half” or reduce it, both in cases where the cost burden came as a surprise (despite all my best effort and literal hours on the phone with provider services to get a sense of actual out-of-pocket costs for patients prior to being seen), and in cases where my estimate based on their benefit plan details has been pretty spot on. Most recently I had a patient who read and signed a copy of the estimate and then was shocked by the claims that started coming in a few weeks later. It wasn’t jargony; it was very straightforward with projected CPT codes and her insurance carrier’s fee schedule for those codes and a “total appointment cost” estimate. She is a lovely person who didn’t understand what she read; and now she feels bad, and I feel bad, and there’s nothing I can do about it? Even as a one-off?
So yeah. What do the Reddit experts think about this? 99% of patients I’ve encountered have *no idea* that it is against regulation – and apparently kind of a big deal – for providers to waive patient cost sharing responsibility. Deductible, coinsurance, and copays. Am I really jeopardizing my office’s provider contracts with insurance carriers and risking huge fines from the Office of Inspectors General by occasionally “working with” a patient on their cost liability – even when I am the one who got the estimate wrong or there was a misunderstanding? If provider hands are tied, why do people on this sub encourage patients to ask for a discount/leniency?
submitted by /u/mother_of_wagons
[link] [comments]I do admin/billing for a small clinic. After working in disability advocacy for several years (services are Medicaid-funded), I have a solid background/understanding when it comes to HIPAA, but have had a lot of catch up to do with all other areas of compliance; I was hired for my soft skills and given a decent budget for compliance resources and consultants, all of which has helped a ton. I see a lot of advice on this sub around “asking the provider if they will work with you” on large medical bills. Everything I have read and every consultant I have worked with has pointed to this sort of thing being against regulation/very high risk for provider offices – insurance fraud basically. Can anyone provide more perspective on this matter? I have had several scenarios where I would love to be able to “cut a bill in half” or reduce it, both in cases where the cost burden came as a surprise (despite all my best effort and literal hours on the phone with provider services to get a sense of actual out-of-pocket costs for patients prior to being seen), and in cases where my estimate based on their benefit plan details has been pretty spot on. Most recently I had a patient who read and signed a copy of the estimate and then was shocked by the claims that started coming in a few weeks later. It wasn’t jargony; it was very straightforward with projected CPT codes and her insurance carrier’s fee schedule for those codes and a “total appointment cost” estimate. She is a lovely person who didn’t understand what she read; and now she feels bad, and I feel bad, and there’s nothing I can do about it? Even as a one-off? So yeah. What do the Reddit experts think about this? 99% of patients I’ve encountered have *no idea* that it is against regulation – and apparently kind of a big deal – for providers to waive patient cost sharing responsibility. Deductible, coinsurance, and copays. Am I really jeopardizing my office’s provider contracts with insurance carriers and risking huge fines from the Office of Inspectors General by occasionally “working with” a patient on their cost liability – even when I am the one who got the estimate wrong or there was a misunderstanding? If provider hands are tied, why do people on this sub encourage patients to ask for a discount/leniency? submitted by /u/mother_of_wagons [link] [comments]Read Morer/HealthInsurance