There are a variety of reasons why an optometry practice may want to waive the patient co-payment, co-insurance and/or deductible amounts, but unless this write-off falls into one of the three categories below, you could be putting your practice at risk.
Government programs such as Medicare and Medicaid may consider routine failure to hold the patient accountable as a violation of the Federal Anti-Kickback Statute. Commercial carriers may consider routinely waiving these amounts as a breach of contract. Regardless of the payer, failing to collect the patient responsibility is a missed revenue opportunity for your practice. With increasing deductibles leading to decreasing insurance payments, now is the time to reevaluate your current processes and begin holding your patient accountable.
Occasionally there may be a need to consider waiving the patient financial responsibility. This may be appropriate if the circumstances fit into one of the following exceptions:
-Customer Recovery: In rare instances situations are brought to your attention following the patient’s appointment that affect the relationship between the patient and the practice. Waiving an out of pocket amount may need to be considered if other remedies did not resolve the issue.
-Prompt Pay Discounts: Patients may be offered a prompt pay discount when payment in full is made within the timeline specified within your practices policy.
-Hardship Discount: Adopt a policy to fairly determine financial hardships for your patient population. Discounts can be provided to any patient meeting the qualifications. Keep good documentation for all discounts applied.
Ideally, your practice will implement a collections policy that will hold patients accountable for the amount they owe. Implement front end procedures to collect at the time of service whenever possible. Create a process to ensure patient statements are sent on a monthly basis. Partner with a collection agency for those hard to collect balances and create a due diligence policy to assist in determining non-collectable balances.
While waiving patient balances may be your current process, now is the time to reevaluate and reeducate your patients on their financial responsibilities. You will increase your overall collections while avoiding issues with Federal guidelines and commercial payer contracts.