>
> Does anyone know if, in fact, there is anything "illegal" about
> extending professional courtesy? One of our physicians attempted to
> extend professional courtesy to one of our internists in town who very
> politely declined. He later called back to inform me that this isn't
> "legit" and told us how he handles it in his office.
>
> He said he ended up composing a letter to be given to those friends or
> colleagues which stated that, even though he would like to be able to
> provide professional courtesy to them, he legally is kept from doing so.
>
> Any comments....does anyone know the "rules" of this game?
>
> Karen Kohlruss, BSN RN
We recently have received letters from a large radiology group and an
anesthesiology group in town informing us that they were no longer going to
be able to extend professional courtesy because it was now illegal. They
cite the Health Insurance Portability Act of 1996. Their lawyers apparently
interpreted this legislation as covering both federal and private sector
health plans.
We have, however, received information from our state and county medical
societies that contradict this: "Legal opinion has been obtained from three
sources, and although the wording may differ, all have concurred on the basic
interpretation of the law. The Health Insurance Portability and
Accountability Act of 1996 prohibits, and provides penalties for, waiving
coinsurance and deductible obligations of Medicare and Medicaid eligible
patients. The Antikickback Law (which prohibits remuneration in exchange for
referrals) was expanded by HIPAA to include all federal health benefit
programs (i.e. Medicare, Medicaid, Champus, VA) except the Federal Employee
Health Benefit Plan. Thus, if a physician waives the co-payment obligation
of an individual in one of the above federal programs who is in the position
to make referrals, the treating physician must fully and accurately report the
waiver on the claim for payment and on the individual's invoice.
"Both the Medicare Antikickback Law and the Health Insurance Portability
and Accountability Act of 1996 limit a physician's right to waive coinsurance
and deductibles, but only where Medicare, Medicaid, or other government funds
are concerned.
"Currently, there is no federal statute prohibiting a physician from:
1. Rendering medical services for free
2. Forgiving a balance due from a patient in excess of insurance
collected.
3. Rendering medical services at a reduced charge.
AS LONG AS GOVERNMENTAL FUNDS ARE NOT INVOLVED."
I haven't read the actual legislation myself, so my knowledge is limited to
what we've been told. Have others received other legal opinions about this?
Ken Setter MD
Tulsa, OK