Patient financial responsibility has increased significantly over the past decade. As a result, healthcare organizations sometimes feel pressure to waive copays, deductibles, or coinsurance to support patients.
While this may seem compassionate, routine balance waivers can raise serious compliance, legal, and contractual concerns.
This webinar explores how patient balance waivers intersect with coding, billing, compliance, and revenue integrity, and helps healthcare professionals understand how to handle these situations responsibly.
Webinar Objectives
- Explain the importance of patient cost-sharing and why insurers require copays, coinsurance, and deductibles.
- Understand legal and compliance risks associated with routinely waiving patient balances.
- Describe how federal regulations such as the False Claims Act and Anti-Kickback Statute apply to cost-share waivers.
- Differentiate expectations between federal health programs and commercial insurance plans.
- Recognize common contract language in payer agreements related to patient responsibility.
- Evaluate real-world legal cases to understand enforcement trends and compliance risks.
- Identify appropriate situations where cost-share adjustments may be permitted, such as financial hardship or prompt payment discounts.
- Develop practical strategies and internal policies that help organizations manage patient balances in a compliant manner.
Webinar Agenda
- Why Waiving Patient Cost-Share Responsibility Matters
- Federal False Claims Act: Liability and Penalties
- Anti-Kickback Statute: Compliance Considerations
- Federal Health Programs vs Commercial Health Plans
- Health Plan Sample Language
- Analysis of Legal Cases
- Professional Courtesy, Financial Hardship, and Prompt Payment Discounts
- Why Routine Waiving of Patient Cost-Share Is Risky
- Federal False Claims Act – Definition and Penalties
Webinar Highlights
- Understanding Patient Cost-Share Responsibilities
- Legal Risks of Routine Cost-Share Waivers
- Federal False Claims Act: Key Concepts and Penalties
- Anti-Kickback Statute and Financial Inducement Risks
- Differences Between Federal Programs and Commercial Health Plans
- Real-World Case Examples and Enforcement Trends
- Developing Compliant Policies and Best Practices
Who Should Attend
- All certified and non-certified coding practice professionals.
- All RCM professionals
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