Session Objective:

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.

Agenda:

The Importance of Patient Cost-Share Compliance

• Why patient cost-share waivers matter and their impact on practice and compliance.

Federal False Claims Act: Liabilities & Penalties

• Overview of liabilities under the False Claims Act and potential penalties.

Anti-Kickback Statute: Liabilities & Penalties

• Examination of anti-kickback laws and penalties related to cost-share waivers.

Financial Hardship Considerations

• Guidelines for evaluating and documenting financial hardship for patients.

Impacts of Medicare & Federal Programs vs. Commercial Health Plans

• Differences in compliance requirements across healthcare plans.

Sample Language from Health Plans

• Key terms and language often used in payer agreements regarding cost-sharing.

Case Studies & Legal Precedents

• Analysis of relevant legal cases affecting patient cost-share policies.

Professional Courtesy, Hardship Discounts & Prompt Payment

• When professional courtesy and financial hardship discounts are permissible.

Exceptions for Waivers and Discounts

• Overview of instances where OMS can legally waive or discount balances.

Who Should Attend:

Physicians, Office Managers, Revenue Cycle Managers, Hospitalists, Nurses, Billing Staff, Third-Party Billing Providers, Ambulatory Surgery Center Staff, and Hospital Revenue Cycle Teams.

Materials Provided:

• Presentation Slides
• Case Discussions: Review of key legal cases and their implications.
• Guidance on Payer Doubts and Whistleblower Risks: Why routine waivers can be legally risky.

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.