Medicare’s Mandatory Claims Processing Requirement Cash Pay Exception

Under rules promulgated in 2013 by the Department of Health and Human Services under the Health and Insurance Portability and Accountability Act of 1996 (HIPAA) an exception to Medicare’s mandatory claims filing requirement has been created.  In the 2013 guidance, HHS notes an existing proviso in Medicare law that if a Medicare patient refuses, of his/her own free will, to authorize the submission of a bill to Medicare, then the practice is not required to submit a claim to Medicare for the covered service and may accept an out-of-pocket payment, in full, from the patient.

Under HIPAA healthcare providers, CoachAmyPT must allow a patient’s request regarding restrictions on use or disclosure of his/her protected health information (PHI). This is only permissible if the patient, of his/her own initiation, requests to pay, in full (out of pocket) for a service or item.

While the law does not require the restriction requests to be in writing it does mandate that the provider document any restrictions to which it has agreed (or is required to agree).  It is however, CoachAmyPT’s policy to obtain the requesting patient’s attestation that the request was initiated by him/her.

My signature below is an attestation that I have read the above information presented as a result of my request to be a cash paying patient. I further attest that no one has provoked or encouraged the self-payment option I have elected.