Can a practice write off a patient's copay or deductible?

Not as a routine. The HHS Office of Inspector General has warned that a provider paid on the basis of its charges who routinely waives Medicare copayments or deductibles is misstating its actual charge and can face liability under the anti-kickback statute. It allows forgiving the amount for a particular patient's financial hardship, used occasionally, and otherwise expects a good faith effort to collect. Write a hardship policy, document each decision and post it with its own adjustment code.

What Is a Write-Off in Medical Billing?

Write-off

Short answer

A write-off is an adjustment that removes all or part of a balance from accounts receivable because it will not be collected, whether the reason is a payer contract, a denial that cannot be overturned, a documented hardship or a patient balance judged uncollectible.

Last reviewed October 30, 2026 by the Remitwright billing team. Editorial policy

Also written aswrite-offs

Not every dollar billed is collectable, and a write-off is how the part that is not leaves the books. The usual kinds are contractual adjustments for the gap between your charge and the payer’s allowed amount, denial write-offs for claims that cannot be corrected or appealed, hardship or charity adjustments made under a written policy, small-balance adjustments if your policy allows them, and bad debt for patient balances that collection efforts did not recover. On the ERA, the group code on each adjustment says who the payer holds responsible: CO for a contractual obligation, PR for patient responsibility, and OA or PI for other and payer-initiated reductions.

Each kind tells you something different, which is why each needs its own adjustment code. A contractual write-off is expected and planned for. A timely filing or missing-authorization write-off is a loss someone caused, and if it is posted as contractual, the net collection rate hides it. Hardship adjustments carry their own rule: federal guidance treats forgiving a patient’s copay or deductible as an occasional decision about one patient’s finances, never a habit.

The mistake is letting anyone write off anything. Decide who can approve a write-off and above what amount, require a reason code on every adjustment, and review denial and timely filing write-offs every month by payer and cause, because those are the ones a better front end prevents.

Example

Write-off in practice

A claim for a March visit is filed in September, past the payer's filing limit, and denied. The contract bars billing the patient for it, so the balance posts to a timely filing write-off code rather than to contractual adjustment, and the month-end report shows it as a preventable loss. Hypothetical example.

Write-off

Write-off in practice

A write-off is part of payment posting, one of the services a dedicated biller runs for you.

Questions about a write-off