1. The Art of Collections By Mary Ann Martinez-Gofigan Director of Client Services Pamela Zapien Salud Family Health Centers, Inc. Fort Lupton, CO Adapted by Migrant Clinicians Network

2. Training Objectives Becoming familiar with the different programs offered at The Health Center. Communication with patients Cashier duties Collecting from patients – Date of Service – Past Due Accounts Safe usage

3. Health Center Programs Child Health Program State Indigent Care Program Women’s Cancer Control Initiative Federal Clinic Rate Prenatal Program Migrant Program Family Planning Program Others

4. Health Center Programs For staff training, provide information regarding: source of revenue qualifying services patients eligible

5. Communication with Patients Patient Rights & Responsibilities: Payment is expected on date of service. Patients must sign Financial Policy form. Full pay services vs. discounted services Patients go through a financial screening process. Patients are placed in appropriate program. All sites have a “Please pay at time of service, Thank you” sign. Communicate – Communicate – Communicate when you: – Schedule Appointments – Registration – Throughout the visit – At the cashier desk

6. Communication Be clear that payment is expected at the time of service: – In full – Co-pay – Old Balance

7. Communication Remember – Patients generally don’t get upset about paying at the time of visit. They get upset if there are “surprises” regarding how payment is to be made or how much, or if it is not anticipated. Use your patient contact time during appointment scheduling to clarify the financial policy of The Health Center.

8. Let’s Get Started Have your cashier area organized and accessible Expect patient to pay fair share Collection more effective if done prior to visit Collect current patient demographics (ask if they are planning to move anytime soon) Obtain insurance information Verify Insurance information Explain payment policy Remind patient to bring insurance card Make copies of insurance, Medicaid, Medicare cards When patient calls for an appointment- Inform patient about financial policy and if needing financial update what documentation to bring

9. Collection Process Total charges on encounter (Super bill) Apply discount if applicable Let the patient know what the total charges were what the discount is and what their portion is…. “The charges for today’s visit is $120 after I apply your discount of $80 your co-pay is $40 would you like to pay with cash, write a check or credit card.” WAIT – WAIT – WAIT

10. Collection Tips Determine the sliding scale fee Always, always start off by saying “The total charge is $___ but after I apply your discount of $___your portion is $____. Sell the patient on the importance of paying today. It is the best collection chance you have Don’t ask if they want to pay today – Expect them to pay…. Don’t ask how much they want to pay – Expect that they will pay the full amount

11. Collection Tips If after your efforts the patient still cannot pay today, obtain date they will return to pay for today’s visit in full. (Do not go beyond 25 days) Develop urgency. Explain that the health center needs to be paid so it can continue to provide care. Persuade patients to pay their past due balances with a credit card when appropriate.

12. How to Ask! State the total charge for services and depending upon the discount policy how much they owe “Today’s visit is $75 with your discount of $50 your portion is $25 plus your outstanding balance of $25 your total amount is $50. WAIT WAIT WAIT Don’t say anything but keep eye contact with the patient.

13. How to ask! Be courteous – but remember: “The first person to speak, loses.”

14. Improve Patient Relationships Get accurate registration information including contact information (someone who will always know where the patient is) Verify insurance information Inform patient of financial policy when scheduling an appointment Let the patient know what to expect Payment is expected at time of Service Expect that The Health Center will be paid at time of service

15. What if the patient say’s NO! How to handle a patient’s objection to pay Patient: “I’ve never had to pay at the time of service before. What do you mean I have to pay today?” Response 1. Many patients like taking care of their balances up front so they don’t have to worry about it later. That’s why we’re giving you the opportunity to pay now. Would you like to pay by cash, check or credit card?’ 2. Paying now helps The Health Center to avoid further billing cost. We’re trying to do all we can do to control health care costs for our patients, and to make sure The Health Center is here if you need further care. Now, how would you like to take care of your balance today?

16. What if the patient say’s NO! Patient says: “I didn’t bring my checkbook.” Response: 1. We accept cash or credit cards. 2. Would you like to call home to get your credit card number, if you didn’t bring it? 3. Write in your own response.

17. What if the patient say’s NO! Patient says: “My ex pays for all medical bills” Response: 1. “No problem, I’ll give you a receipt showing you’ve paid and you can send it to your ex so he can repay you.” 2. “If you put this on your credit card today, you can send the credit card bill to your ex to pay.”

18. What if the patient say’s NO! Patient says: “I can’t pay in full.” or “I don’t have the money.” Response: 1. You know we applied the discount to your charges and payment is expected at time of service. 2. We do take credit cards. 3. You can pay with a post-dated check. 4. You can pay half today, and then come in and pay the remainder before statements go out.

19. When the patient “Forgets” their co-pay? Ask the provider if the patient can be rescheduled or if they should be seen. If the patient has an “urgent” condition, make sure the patient is seen. Be sure to check the contract to see if there is a past due payment. History being repeated…. Write down on the encounter in red when the patient expects to return to pay. – Ask patient to sign encounter…

20. Cashier Duties Taking Payment from Client Equipment Usage Customer Service Encounters Daily Deposit

21. Taking payment from Clients Day of Service Payments Paid on Account Payments Taking Prescription Payments Past Due Payments (Contract) Deposit Payments (Dental)

22. Equipment Cash Register Credit Card Machine Adding Machine Computer PCN/Scinet Web-sites Safe

23. Customer Service Answer questions about client account If unable to answer questions give them the phone number to billing and the contact name Collect Past Due Accounts Write up contract with client to pay large past due amounts Give clients receipts for any payment Remind client of The Health Center’s financial policy

24. Encounters Cashier is the last staff person to see encounter-- verify insurance with patient Make certain you have copies of insurance, Medicaid, Medicare attached to encounter List all charges on encounter while patient there Place encounters with batch in order Ensure all encounters are accounted for by end of day Key in encounters If you fall behind 3 days with keying encounters inform Client Services Director

25. Daily Deposits Must be done at end of each day Count all monies Subtract your starting bank Count Credit Card amounts (Attach copies) Count checks Add all collections Compare Cash to Collection on encounters Should always come out correct Place in bank bags and either deposit in bank or send in to accounting. Daily…..

26. Safe Usage Only two people within the site will know safe combination Do not keep the combination in your rolodex file or any location accessible to staff Safes must be kept locked at all times At the end of each day, the deposit will be completed Money will be counted, credit card slips, POS’s and Pharmacy receipts will be attached. Money will be placed in safe through the slot. Start cash will also be placed in the safe, daily. Deposit will be removed from safe and given to the internal courier in a locked bank bag. To be sent in daily. Bank deposit must be done on a daily basis. A copy of the deposit slip and bank receipt must be faxed to accounting. If safe combination changed, a call must be made to accounting with the new combination.

27. The Health Center Financial Policy  Has been approved by the Board of Directors.  Providers are in support of collections  Teamwork and communication with staff and the patient is the best way to collect what is due to the Health Center.  Collections allow for  Continued service  Pay raises  Better working environment  Patient knows the value of the service

28. Resources Refer to the Client Services Training Manual at your site Contact the Client Services Director if you have further questions. Contact Client Services Trainer for additional training or questions. Contact Data Entry for assistance with encounters. Others