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Office Managers, Medical Billers and Medical Coders
Can You NOT COLLECT Or Can You Waive Patient's Copay?
All About Copays and Copayments.

Let me tell you why you should not waive copays!

1. Your contract says you collect copay at the time of service!;
2. Your patient knows they have to pay their copay based on what their policy
says (it's absolutely false that they do not know they have a copay!);
3. Your are actually losing money in your practice if you do so!

What is a copayment? It's a part responsibility of the patient's based on their
policy and coverage. Mostly, their copays are applied towards their annual out
of pocket amount for family, single or individual.  And it is always due at the
time of service (the time they came in to your office). Copay for Primary Care
Physician and for Specialist Office may differ too!

So why do you think you should not waive a copay? -- let's take a look at this
way:

Assuming the insurance payor allows $58.00 for an Evaluation and
Management - E/M Code and you waive a copay of $20.00, you only get
reimbursed at $38.00 because the $20.00 was applied towards the patient's
copay.

So why waive the copay when it is an actual additional revenue to your daily
cash flow, is it not?

Here are some scenarios of problem collecting copays and what you should do
to deal with these:

1. The Patient has a Secondary Insurance and would like you to submit his/her
claim to the secondary insurance after the primary insurance pays for the claim
-- what you should do; explain to the patient that their copay is due at the
time of service regardless if they have a secondary insurance! Most of my
patients would even send claims to their secondary to pick up for their copays.
The key here, educate them!
2. The Patient always "forgets his/her checkbook" --- give the patient one
chance! Again, explain to them their copay is always due at the time of service.
Hand them a self-addressed envelope and let them mail a check as soon as
they get home. Or know your area, I'm sure there is a bank or an ATM Machine
nearby, you can let the patient go the nearest  ATM and withdraw money. Or
for their convenience too, if they have credit cards --- your practice should be
able to accept major credit cards.


Helpful ideas too, post in your waiting room and at the window that says "Your
Copay is Due at the Time of Service",  "You Must Pay Your Copay Before You
Can Be Seen".

And here is your last course, it is alright too to refuse to see the patient if
they do not pay their copay. Maybe on the 3rd visit, if obviously the patient
have been deliberately "forgetting" his/her check - inform them when you make
the confirmation before their appointment that hey can not be seen if they do
not pay their copay balance.

I don't think you can purchase any material thing that you use them first
before you pay for it. Realistically,  why render the service before the patient
pays their copay? A private physician practice is not running a charity program
or else you will go out of business. Just my one cent  idea.

**** For more references: Consult your CPT code books.  The National
Correct Coding Initiative (NCCI) and third pary payer payment policies
and guidelines
*** Source: HCPCS Book 2008.