By - Thomas J. Force, Esq.
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Understanding the complexities and legal ramifications of waiving patient cost-share responsibilities—such as deductibles, coinsurance, and co-payments—is crucial for healthcare professionals. This session will explore the legal frameworks and potential penalties surrounding the waiver of patient cost-share responsibilities in both federal and commercial healthcare settings.
The Importance of Patient Cost-Share Compliance
Federal False Claims Act: Liabilities & Penalties
Anti-Kickback Statute: Liabilities & Penalties
Financial Hardship Considerations
Impacts of Medicare & Federal Programs vs. Commercial Health Plans
Sample Language from Health Plans
Case Studies & Legal Precedents
Professional Courtesy, Hardship Discounts & Prompt Payment
Exceptions for Waivers and Discounts
Physicians, Office Managers, Revenue Cycle Managers, Hospitalists, Nurses, Billing Staff, Third-Party Billing Providers, Ambulatory Surgery Center Staff, and Hospital Revenue Cycle Teams.
This session will provide healthcare professionals with practical strategies to navigate the legal landscape surrounding patient cost-share responsibilities, equipping them with insights for maintaining compliance while managing patient interactions effectively.
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Thomas J. Force, Esq.
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.
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