Hardship Policy [Healthcare Compliance Tips]

Review your insurance contracts for information about professional courtesy and waivers of payments.  And, consider creating a financial hardship policy.

A common compliance concern is waiving copays/deductibles or providing discounts.

Remember, when practices continuously waive patient financial responsibilities it affects the negotiated insurance contract.  It is required that both parties adhere to what is stated in the agreement, which is to collect the owed amount from the patient.

The OIG also doesn’t want practices to continuously waive fees because it may influence a patient’s decision-making.  The patient may feel obligated to stay with the practice or neglect to report errors due to waived fees.

A best practice is to provide payment alternatives, such as creating a financial hardship policy that follows the federal poverty guidelines.

Here are a few tips:

• Create forms, policies, and procedures surrounding financial hardship.
• Decide what type of documentation you will accept as proof of hardship (i.e., household income, tax return, unemployment).
• Train staff on how to handle the request.
• Ensure payments are being collected from the patient (i.e., bank account).

Patients genuinely want to pay what is owed to your practice even if it is a little bit at a time.  Therefore, as you create your policies, be sure to review your financials to ensure that the timing of patient payments corresponds with your overhead costs.

**The opinions and observations from the group/author are not a promise to exempt your practice from fines and penalties.  Research, modify, and tailor the advice to fit your specialty.