Rehab Centers at Risk for Routine Copay/Deductible Waiver

pillDrug and alcohol treatment centers are often faced with the business decision of whether to waive copay and deductible obligations.  For many patients in one of the most vulnerable times of their lives, copay and deductible waiver can mean the difference between getting needed treatment or not!  The well intentioned desire of the treatment center to lower this barrier to entry may, however, expose the center to serious legal liability.

Though many treatment centers do not accept governmental payment (e.g. Medicare, Medicaid, CHAMPUS and TriCare), some do and all need to understand the thinking of governmental regulators and private insurers on the issue.  In 1994 the Office of the Inspector General of the Department of Health and Human Services (the “OIG”) issued a Special Fraud Alert stating, in essence, copayment waiver for any reason other than the patient’s demonstrated inability to pay is fraudulent!    Continue reading

CMS Issues Final Rule on E-Prescribing

By Emily P. Walker, Washington Correspondent, MedPage Today
Published: September 06, 2011 WASHINGTON — Doctors now have an extra month to apply for a hardship waiver to avoid being penalized for not adopting electronic prescribing in their practices, according to a final rule issued by the Centers for Medicare and Medicaid Services (CMS).

Physicians who use a qualified e-prescribing system are eligible for an additional 1% in Medicare Part B payments in 2011 and 2012, and a 0.5% increase in 2013. Providers who fail to complete at least 10 paperless prescriptions using a qualified e-prescribing system between Jan. 1 and June 30, 2011, will receive a 1% cut in Medicare reimbursements in 2012, a 1.5% cut in 2013, and a 2% cut in 2014.

In a proposed rule from May, CMS said doctors who are unable to e-prescribe should apply for a “hardship exemption” before Oct. 1. In the final rule issued Sept. 1, CMS announced doctors now have until Nov. 1 to apply for an exemption.

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