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|Patient Financial Responsibility Toolkit|
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Included within the Toolkit:
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.
This Toolkit seeks 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 Toolkit is divided into three parts. In the Background Section, the problem and solutions are explained. In the Recommendations Section, we offer an overview of practices that are permissible and general strategies to avoid legal problems. In the Resources Section, we offer a series of model documents with instructions on how they should be used. Finally, in the Final Recommendations Section, we offer some thoughts on how to go about implementing the resources and what to look for ahead in the shifting “battle” over this issue.