Patient Cost-Share Waivers: Legal Guidelines and Compliance for Healthcare Providers

Marketing and Empathy Psychology

By - Thomas J. Force, Esq.

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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.

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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.