1. Daily Financial Practices
Chapter 17
ICBS 120

2. Patient Fees
Usually the responsibility of the medical assisting staff.
Discussion of Fees
Fees vary depending on type of medical facility, needs of practice, and the professional services rendered.
If possible, try and approximate cost of procedure(s)/treatment for patient.

3. Patient Fees
Advanced Beneficiary Notice approved by Medicare should indicate type of procedure(s), the total responsibility of patient, and the reason why this is the patient’s responsibility.
Adjustment of Fees
If an office accepts assignment with Medicare and Medicaid, they are mandated to charge every patient the same amount for similar services rendered.
Adjustments may be made for patients experiencing hardships or with limited income.
Assist with payment planning

4. Managing Patient Accounts
Accounts receivable – money owed to the office by patients.
Track patient accounts via the “pegboard” system or “one-write” method.
Always work with care and accuracy
Keep work current
Double check all entries
Use consistent ink color
Align columns carefully
Write small enough to stay within columns

5. Managing Patient Accounts
Pegboard System – consists of day sheets, ledger cards, encounter forms or charge slips, and receipt forms.
Posting – entering charges, credits or adjustments onto the day sheet, encounter form, or receipt and patient’s ledger card.
Day sheet provides complete up-to-date information about accounts receivable status.

6. Managing Patient Accounts
Computerized systems
Being used by more and more medical facilities
Several software packages available
May hire consultant
Make sure system will meet current and future needs of practice.
Adopt a system that allows the practice to start with one component and add another component at a later date.

7. Recording Patient Transcations
Encounter form – charge slip, superbill, or multipurpose billing form.
Use in manual and computerized bookkeeping systems.
Provides patients one copy with a record of account activity for the day
Provide a second copy for possible need to submit to insurance.
Provides third copy that serves as the office’s permanent copy of account activity.

8. Patient Account or Ledger
Ledger – where patient accounts are recorded (accounts receivable ledger)
Lists services, payments and balances due.
Guarantor – the one responsible for payment of the account.
Debit – used for entering charges, services and procedure codes.
Credit – used for entering payments.
Balance – record difference between debit and credit.

9. Patient Account or Ledger
Adjustments
Indicate any insurance payments
Personal discounts, write-offs
Other adjustments
Indicated by the credit column and will generally reduce entries.
Day Sheet
All financial transactions posted here daily.
Legibility and accuracy are critical.
Balances carry over day-to-day.

10. Patient Account or Ledger
Receipts
Used for payments on accounts
When patient makes payment on account on day when no services were rendered.
Month-End Activities
Required when last day sheet for month has been balanced, verify month-end figures to make sure agree with patient accounts.
Computerized Patient Accounts
Software management programs for patient accounts; automatically calculates/creates billing statements.

11. Banking Procedures
Online banking – allows individuals to check account balances, transfer funds between accounts, pay bills electronically, check credit card balances, view images of check and deposits.
Types of Accounts
Checking – primary type
Savings – may or may not pay interest
Money-Market – pay a higher rate of interest

12. Types of Checks
Cashiers Check – often used when check must be guaranteed for amount written.
Certified Check – depositor’s own check that bank has “certified” with date/signature and check is “good.”
Money Order – purchased with cash
Voucher Check – check with a stub attached to indicate dates, services provided.
Traveler’s Checks – safer than cash when traveling. Written in specific denominations.

13. Deposits
Usually made daily since they serve as another proof of posting
Unwise to leave large sums of money in the office overnight
Checks should be stamped immediately upon receipt
Verify all checks have been endorsed before depositing them
All deposits should be 100% Accurate

14. Accepting Checks Inspect for date, amount and signature.
Do NOT accept a third-party check.
If a deposited check is returned and marked “insufficient funds” (NSF), call the bank and verify availability of funds.

15. Writing and Recording Checks
Accounts payable – refunds of overpayment, replenish petty cash.
Rules for preparing checks
Confirm numeric and written amounts
Confirm spelling
Follow proper office procedure
Determine check has been signed by proper authority
Confirm check is payable to correct payee and current date is used.

16. Purchasing Supplies/Equipment
Avoid purchase of unnecessary items.
Avoid duplication of items purchased.
Provide a system for payment of only those items properly ordered and received.
Nothing is ordered or paid for without a purchase order or purchase order number.
A copy of the purchase order should be retained by the office.

17. Petty Cash
Money kept in the office for minor, routine, or unexpected expenses.
Postage due
Coffee supplies
Patients that may pay co-payment with cash
Amount on hand is usually $75 to $100
Be sure to track your petty cash by completing a receipt

18. Accepting Checks
Inspect the check for the correct date, amount, and signature
Do not accept a third-party check unless it is from the insurance carrier
Lost or Stolen Checks
Report Immediately
Stop Payment

19. Monthly Reconciliation
Balance the checking account
Compare cleared checks to uncleared checks to bank deposits
Compare and balance bank deposits to month end payment reports

20. Documentation
Financial and ongoing billing records should not be maintained in the patient’s chart.
Keep financial information separate from medical information to ensure that the physician’s care is not influenced by the patient’s ability to pay