What Do AA & PC Mean?
The special codes used are “AA” (Accept Assignment) and “PC” (Professional Courtesy). These codes inform the office or billing staff that you, the physician, agree not to bill the patient for any copay, co-insurance, and/or deductible due because you will accept the insurance company’s payment in full.

You, the Doctor, will have to write the balance off. This has been considered fraud for several years.

Your office manager or medical billing person might continue to submit claims this way, proceeding with the adjustments because they might not want to argue with the Doctor who writes their paycheck; however, both the office manager and physician can be held liable for fraud, resulting in possible legal action.

When you waive the patient’s responsibility of the financial obligations to your practice, you are breaking the contract with the insurance carrier. In some cases, you make it so that the patient has no responsibility to pay your practice, but what has really occurred is that you have relieved the insurance carrier of their responsibility to pay as well, since the insurance carrier is acting as a third party on behalf of the patient for the patient’s medical bills.

According to the Office of Inspector General
To briefly summarize, the Office of Inspector General (OIG) considers it fraudulent to waive copays because:

1. You end up “misstating” your actual charge and forcing the insurance carrier to pay out more than it should.
2. Waiving copays may induce patients to see you rather than other physicians. That could violate the anti kickback rules.
3. Patients are considered consumers and they need to participate in their cost of Healthcare. This is where their portion of responsibility of payments comes in. It will also make them think more carefully about coming in for care that may be unnecessary. By waiving the copay/coinsurance you are ruining that incentive that insurance carriers have instituted in their contracts to save the insurance carrier money.

What if the Patient has Financial Hardships?

• Offer monthly payment plans the patient can afford if possible, let them pick the 1st or the 15th of the month.
• Have financial hardship forms completed and reviewed by the medical billing person in charge and the physician who treated the patient.
• Offer a referral to the local social services office for medical assistance through the state. This would also help the patient with costs of other services such as medications, possible food stamps, and hospital admissions. By doing so, you will be helping the patient with the big picture of their medical needs not just your office‘s balance.
• Have form letters ready for the patient to check off what their situation is and let them sign their name. Having a form letter ready for your patients makes them feel like you care and also helps save their pride, knowing that others might be in similar financial situations (otherwise you wouldn’t have a form letter ready).
• If the patient refuses all your offers of help, make sure to document this fact. Remember, if they turn down all your offers of help, most likely they are not suffering a financial hardship situation.
• If the physician wants to help out a neighbor, colleague, or friendly repairman, he/she should perform the service for FREE or bill the correct way. There is no in between.
  

About EYE Bill FOR YOU

Based in Virginia with 54 years of combined experience and a broad range of medical billing knowledge, EYE Bill For You offers HIPAA compliant medical billing for many specialties. Our medical billing outsourcing solution is offered in the Virginia, Washington DC and Maryland areas.

Cathy Boddie (owner) has an established reputation for helping doctors lower their accounts receivables by examining super-bills and improving them to increase reimbursement levels. Cathy has taught students in medical billing and coding at Northern Virginia Community. Cathy has provided lectures and training sessions on medical billing and coding, Self Pay Issues, and working with Embassies accounts at Georgetown University Hospital and Medical Center.

http://www.eyebillforyou.com

EYE BILL FOR YOU
Cathy Boddie, Owner
email: cathy@eyebillforyou.com
phone: 877-EYE-BILL or 877-393-2455

For permission to republish the above article, please contact Cathy Boddie.