If you are participating and contracted with the insurance payers, you cannot legally waive a copayment because your contract (which is a legal document/agreement) is clearly stating and you agree that you need to collect the copay at the time of service or something like that.
See, you have a contracted rate with the insurance right? And so this is how it works:
If for that visit, CPT Code 99213, your contracted rate with insurance payer is $77.89 and on that particular claim:
- They allow $77.89;
- Paid you $62.89
- Applied $15.00 towards the patient’s copay
==> $62.89 (insurance payment) + $15.00 (Copayment of the patient) = YOUR AGREED CONTRACTED AMOUNT OF $77.89
Now, if you did not collect the copay for a processed claim (see above scenario); the contracted/allowed should have been $62.89 and NOT $77.89 – make sense?
And besides that. if you don’t collect the copay, you are losing money!
This is the reason you cannot waive the copayment because it is part of your agreed and contracted rate with the insurance payer.
I have always advised my clients to collect the Copayment at the time of service, this will also help your daily cash flow.
- When they call for appointment, as a courtesy let them know what their benefits are including their copayments;
- When you call the patient to confirm an appointment, remind them that they have a copay for tomorrow’s visit;
- Accept Credit Cards and Debits Cards (avoid personal checks if possible);
- If they forgot their purse and don’t have their check, offer credit card payment method or direct them to a nearest ATM Machine in the area
- For stubborn patients, just nicely tell them you are contracted with their insurance company and your contract says you have to collect copays at the time of service;
- Advise the patient to call their insurance if they still have issue with you collecting their copayment at the time of service
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