When providers engage in forms of waiving and discounting Patient Financial Responsibility that are improper, insurance companies may seek admin. or criminal charges and more routinely open internal "special investigation unit" audits and investigations.
Los Angeles, CA (PRWEB) May 15, 2017
The Patient Financial Responsibility Toolkit was designed to clarify the issues and offer practical solutions to reduce risk, it addresses in detail, business practices in which healthcare providers are engaging that patients appreciate (at least at first) but that payors (i.e. private insurers and government) may find objectionable or even fraudulent. There are other practices that payors allege to be inappropriate, but that are in fact defensible as legally appropriate. It will illustrate to providers how to operate legally in actual and practical terms by offering a clearer understanding of the subject matter, and some suggestions for how to meet the underlying need in a legal manner.
The issue of “Patient Financial Responsibility,” or cost-sharing, presents widespread confusion and risk in the healthcare industry today. The central problem is different expectations on the part of patients, providers, and payors, about whether and how discounts and waivers of deductibles, copays, and co-insurance are permissible or, alternatively, whether they amount to a form of fraud or abuse.
In recent years, insurers have been increasingly aggressive in denying payment and accusing providers who discount or waive deductibles, copays, and co-insurance of committing fraud in the process.
When providers engage in forms of waiving and discounting Patient Financial Responsibility that are improper, insurance companies may seek administrative or criminal charges (in cases) and more routinely open internal “special investigation unit” audits and investigations and use the practices as a basis to deny or underpay claims.
“We want providers to have the right tools and resources to enable them to navigate the evolving clinical and regulatory landscapes successfully,” said Gina Meyer, Executive Director of AATA. “The recommendations and resources in the toolkit provide a series of model instructions on how patient financial responsibility should be handled. Teaching staff and implementing the additional forms and resources into a program, will only help addiction treatment programs to be compliant and have better outcomes.”
Included within the Toolkit:
- Insurance companies’ arguments about discounts and waivers
- Sliding fee assistant charts
- Application, and program policy
- Invoice and prompt pay discount template
- Sample promissory note
- Contrasting different states’ approaches
- Recommendations for reducing risk
- Prompt pay vs cash pay discounting
- Debt collection practices & bad write-offs
- Model policies
- Talking points for staff
- Strategies for reducing risk and much more!
AATA is also widening its reach in the state of California by providing its membership with access to the best information available in the industry.
“As part of our educational approach to support the addiction treatment and recovery industry, we’ve also expanded our reach by investing in a collaborative agreement with the California Consortium of Addiction Programs and Professionals (CCAPP). Our agreement allows current CCAPP members to take advantage of a reciprocal membership offer with AATA. CCAPP program members in good standing will receive 50% off of the Addiction Treatment Center membership at AATA. In reciprocation, AATA members in good standing will receive 50% off of the CCAPP program membership. New members to both organizations will receive 50% off both AATA’s Addiction Treatment Center membership and the CCAPP program membership,” Meyer added. “This is an agreement that provides additional benefits to members of both organizations in California.”
AATA's cornerstone is timely education about the challenges facing addiction treatment facilities, programs and professionals and practical solutions. In cooperation with legal experts, we meticulously track, organize, and interpret current compliance and regulation issues at both state and national levels, translating them into practical action steps. AATA members will have access to the most reliable, comprehensive tools needed to improve practices, manage risks and develop an effective roadmap for compliance.
For more information, go to: http://www.addiction-tx.com, call (888) 958-2282 or email: info(at)addiction-tx(dot)com.