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  • Writer's pictureMuhammad Sair Khan

Do You Collect Patient Co-pays?




A new law is making co-pay collection more important than ever for behavioral health facilities—and changing the way some facilities do business.


The SUPPORT for Patients and Communities Act, which was signed into law and went into effect on October 24, 2018, addresses many issues related to the opioid crisis. One particular section addresses patient co-pays and deductibles, making it illegal to waive these away.


The goal of this section is to deter unscrupulous marketing practices used by some facilities to get new patients. Some of these facilities promise new patients discounts in order to get them in the door. If you do waive co-pays or deductibles, you could now face up to 10 years of imprisonment and $200,000 of fines for each occurrence.


To avoid this issue, you need to collect co-pays, at the time of service if possible. You should also be sure to carefully document co-pay collection, especially if you collect the co-pays after services are rendered. Keep track of every letter sent or every phone call you make in attempt to collect co-pays. These practices help reduce your legal liability.


An Exception to the Law



One exception to this law is if your provide waivers due to financial difficulties. However, to meet this exception, you need to have a written policy in place. This policy needs applied consistently to every patient and offered to each patient. These sorts of policies are not marketing techniques, but simply ways to ease a patient’s burden, which is why they fall on the right side of the law.


This policy, along with all of your billing policies, should be carefully and professionally worded. It may be wise to seek professional or legal help in creating hardship policies that waive co-pays or deductibles.


A Process for Co-Pay Collection


To ensure co-pay collection, you should empower front office staff to collect co-pays at the time of service. Front office staff should also:

  • Verify eligibility and benefits

  • Explain to patients their financial responsibilities for co-pays and deductibles

  • Collect driver’s license and insurance card information

To provide these services, a member or members of your front office staff need to be able to look up patient’s insurance information before the patient arrives—and certainly before admission. They can then outline financial expectations to patients so there are no surprises later. In addition to this in-person meeting, you should provide patients a letter outlining their financial responsibilities.


Because insurance policies are all different and many times complex, it is important to have a knowledgeable team member overseeing the collections process. It is common for inexperienced staff to misinterpret co-pay requirements. This can cause a delay in payment or worse, uncollected revenue that impacts your bottom line. Additionally, with newly enforced legislation, many practice managers are unaware of compliance issues, leaving you vulnerable to legal implications down the road.


The experts at Datapro Billing can help you stay compliant with collection laws and help you collect hard-earned revenue. We offer billing and collections support, benefits verification and staff training to ensure your compliance with federal and state laws. Schedule a complimentary consultation with a Datapro expert by calling 805-579-3537 or contacting us online.



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