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Life Health > Health Insurance > Health Insurance

Inspector: Medicare Delay Relief Not a Kickback

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An agency that keeps tabs on the U.S. Department of Health and Human Services is offering some flexibility to doctors who are coping with the recent confusion over reimbursement rates.

The HHS Office of the Inspector General has put out a policy statement aimed at doctors, hospitals and other health care and health products providers who want to waive “retroactive beneficiary liability” for patients who receive care while the government is implementing retroactive increases in Medicare provider payment rates.

Technically, the increase in payment rates may mean the patients are supposed to pay higher cost-sharing amounts, according to officials in the HHS inspector general’s office.

Medicare provider rules normally require providers discourage patients from getting unnecessary care by imposing co-payment requirements, coinsurance requirements or other cost-sharing requirements.

But providers who served patients during the “retroactive period” can calculate cost-sharing using the old, lower payment rates without being found guilty of rules against kickbacks, officials say.

The policy statement applies only if providers provide waivers for all affected Medicare beneficiary patients, and only if the waivers are not part of an advertisement or other solicitation.

The policy statement does not apply to waivers of cost-sharing amounts calculated using the older, lower payment rates.


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