Health Information Management

Tip: Dos and don'ts for out-of-network billing for ambulatory surgery centers

APCs Insider, September 19, 2008

Consider the following dos and don’ts from Joshua M. Kaye, Esq., and Jerry J. Sokol, Esq., partners at McDermott Will & Emery, LLP, in Miami, when you consider exercising an out-of-network billing strategy:  

  • Don’t have an unspoken agreement with patients that you will allow them to disregard their copay bills. If the preferred provider organization or insurance company knew you were generally waiving the copays instead of collecting the remaining 30%–40%, they would most likely argue that the billed charges should be 30%–40% lower, Kaye says.
  • Do take meaningful steps to collect from patients if you’re taking the position that you’re not waiving copays
  • Don’t routinely waive copays without thoroughly analyzing current state laws
  • Do create a compliance policy that addresses waivers of copays and clarifies what kinds of situations may warrant waivers (for example., a patient’s extreme economic circumstances)

(This tip was adapted from Ambulatory Surgery Coding and Reimbursement Insider. To view the entire tip, click here.)




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