Hardship Discounts for Copayments and Deductibles One of the most significant inducement violations in health care is routinely waiving copayments and deductibles. It is such a serious violation that a number of federal advisory opinions have been written on the subject. Often, providers believe that simply proclaiming a hardship is enough, and high copayments or…
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Implications of Discounting for Federal Patients The Patient Solicitation Anti-Inducement Provision Section 1128A of the Social Security Act, enacted as part of the Health Insurance Portability Act (HIPAA), provides for the imposition of civil monetary penalties against any person that offers or transfers to a Medicare or Medicaid beneficiary any remuneration that the person knows…
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Our friends at ChiroHealthUSA have shared this short and simple explanation of the dangers of inducement violations. Many physicians think they are doing the right thing with discounts or freebies, but they are doing it the wrong way. Spend a couple of moments here and then determine whether your practice’s systems may be unknowingly exposing…
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Determining if Your Fee Schedule Legal and Appropriate Some people find it easier to talk about the personal details of their life than to talk about money. And for some health care providers, it’s even harder to talk about what they charge and why. Often, it’s rather like a fast “Texas-Two Step” trying to explain…
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Limiting Charge Provisions for Non-participating Medicare Providers A limiting charge defines how much non-participating providers can charge Medicare patients. Chiropractic covered services (98940, 98941, and 98942) rendered by non-participating providers (those not accepting assignment) are still billed to Medicare. The patient must wait to be reimbursed by Medicare. The provider is only allowed to charge the…
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Excluded Services in Medicare FAQs Q: According to Medicare, what is considered a statutorily excluded service when rendered by a Doctor of Chiropractic? A: A statutorily excluded service is a service the Medicare never covers when it is rendered by a Doctor of Chiropractic. This includes exams, x-rays, and physical therapy. The only service always…
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