Understanding Patient Cost Share Waivers: Legal Pitfalls and Compliance Strategies

Marketing and Empathy Psychology

By - Thomas J. Force, Esq.

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Session Overview:

Navigating the complexities of waiving patient cost share responsibilities, such as deductibles, coinsurance, and copayments, is crucial for healthcare professionals. Improperly handling these waivers can lead to significant legal and financial repercussions under both commercial and federal healthcare programs. This session will provide an in-depth understanding of the laws, regulations, and potential penalties associated with waiving patient cost share responsibilities, helping you safeguard your practice against compliance risks.

Key Topics to be Covered:

The importance of understanding patient cost share waivers.
Liabilities and penalties under the Federal False Claims Act.
Risks associated with the Anti-Kickback Statute.
Guidelines on assessing financial hardship.
Differentiating the impact on Medicare and other federal programs versus commercial health plans.
Reviewing health plan contract language regarding waivers.
Case studies and legal analysis.
Discussion on professional courtesy, financial hardship exceptions, and prompt payment discounts.
Circumstances where healthcare providers can legitimately waive or discount patient balances.

Who Should Attend:

This webinar is designed for a wide range of healthcare professionals, including physicians, physician assistants, office managers, revenue cycle managers, hospitalists, nurses, billing staff, staff from third-party billing companies, and revenue cycle staff in ambulatory surgery centers and hospitals.

Materials and References Provided:

Comprehensive PowerPoint presentation
Detailed discussions on relevant legal cases
Examination of potential risks from payer scrutiny and whistleblowers
Insights into why routine waivers of patient cost share can be legally dangerous

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Webinar Type

Clear

Speaker Detail

Thomas J. Force is a state and federally licensed attorney with over 34 years of experience in the healthcare and insurance industries. As a former U.S. Marine and a successful Wall Street insurance litigator, Mr. Force served as General Counsel for a New York-based Accident and Health Insurance Company, where he also served as Chief Compliance Officer. These experiences led to the founding of The Patriot Group. Mr. Force is a nationally recognized expert in revenue collection techniques, appeal strategies, and healthcare compliance. He is on the Advisory Board at Hunter Business School, a New York-based school for medical billing and coding students. Mr. Force is an active member and frequent speaker on managed care and collection techniques for the Health Finance Management Association, several state medical associations, and other healthcare organizations. On March 29th, 2022, Thomas J. Force, J.D, Esq, President of The Patriot Group, served as moderator for the forum on Clinical Denial Management at Hofstra University, organized by the Health Finance Management Association – Metropolitan Section. For more information on this forum, please email Mr. Force.