1. Copyright © 2008 Delmar Learning. All rights reserved. Unit 5 Financial Administration

2. Copyright © 2008 Delmar Learning. All rights reserved. Chapter 13 Fees, Credit, and Collection

3. Copyright © 2008 Delmar Learning. All rights reserved. 3 Objectives Review the learning and performance objectives for this chapter By the end of this chapter, demonstrate the procedures in the textbook and the job skills in the workbook

4. Copyright © 2008 Delmar Learning. All rights reserved. 4 Heart of the Health Care Professional Service –Answering questions and explaining fees is a courtesy to the patient.

5. Copyright © 2008 Delmar Learning. All rights reserved. 5 History of Credit Credit –Latin word “credere” –To trust or to believe Personal integrity Ability to meet financial obligations

6. Copyright © 2008 Delmar Learning. All rights reserved. 6 History of Credit The Great Depression –Start of credit for medical services Today –Payment expected at time of service –Health insurance contract

7. Copyright © 2008 Delmar Learning. All rights reserved. 7 History of Credit Credit and collection information –Complete, accurate Registration Personal information Financial history Employment information –Includes insurance information Used to bill insurance company

8. Copyright © 2008 Delmar Learning. All rights reserved. 8 Fee Schedules Every physician establishes fees –Specialty –Education –Experience –Geographic location –Overhead costs

9. Copyright © 2008 Delmar Learning. All rights reserved. 9 Fee Schedules Quantum merit –“As much as he deserves” Lists of fees for services –Required by federal regulations –Separate schedules Medicare Managed care Private pay

10. Copyright © 2008 Delmar Learning. All rights reserved. 10 Fee Schedules Medicare fees –Participating fee –Nonparticipating fee –Limiting charge –Example 13-1

11. Copyright © 2008 Delmar Learning. All rights reserved. 11 Fee Schedules Changes in fees and discounts –Hardship discounts Dependent on income level Hill-Burton Act –Professional courtesy –Copayment waiver Not recommended

12. Copyright © 2008 Delmar Learning. All rights reserved. 12 Fee Schedules Discussing fees –Fee-for-service –Copayment collected at visit –Communicating fees Clear and accurate Figure 13-1 Example 13-3

13. Copyright © 2008 Delmar Learning. All rights reserved. 13 Fee Schedules Discussing fees –Signs of a “deadbeat” Questionable employment record No business or home telephone Many moves of residence A motel address

14. Copyright © 2008 Delmar Learning. All rights reserved. 14 Fee Schedules Discussing fees –Signs of a “deadbeat” Record of doctor hopping No referral No insurance Incomplete registration form

15. Copyright © 2008 Delmar Learning. All rights reserved. 15 Billing Payment at the time of service –Emphasize incentives to patient Example 13-4 –Meeting with the patient Face-to-face Discussion of outstanding balance

16. Copyright © 2008 Delmar Learning. All rights reserved. 16 Billing Multipurpose billing form –Bill –Insurance form –Routing document –Receipt –Figure 13-3

17. Copyright © 2008 Delmar Learning. All rights reserved. 17 Billing Monthly itemized statement –Sent to patients –Charges, payments, adjustments –Figure 13-5 –Explain professional fees in an itemized billing statement Procedure 13-1

18. Copyright © 2008 Delmar Learning. All rights reserved. 18 Billing Monthly itemized statement –Office calculator –Perform math functions using a calculator Procedure 13-2 –Prepare and post to patient’s ledger card Procedure 13-3

19. Copyright © 2008 Delmar Learning. All rights reserved. 19 Billing Cycle billing –Billing distributed throughout month Distributes related duties –Prepare monthly itemized billing statement Procedure 13-4

20. Copyright © 2008 Delmar Learning. All rights reserved. 20 Billing Cycle billing –Credit card billing Patient pays fee with credit card –Debit cards Off-line On-line

21. Copyright © 2008 Delmar Learning. All rights reserved. 21 Billing Cycle billing –Individual responsibility program Patient pays physician Insurance reimburses patient –Billing services Business that handles billing Saves office money and time

22. Copyright © 2008 Delmar Learning. All rights reserved. 22 Billing 1. Itemized fees for professional services with line-by-line description. 5. Patient’s payment check received, listing check number. 4. Billed patient 20 percent copayment. 3. Payment received on account from insurance, listing voucher number. United paid 80 percent. 2. Insurance claim submitted showing dates or service billed.

23. Copyright © 2008 Delmar Learning. All rights reserved. 23 Credit and Collection Laws Fair Debit Collection Practices Act –Guidelines for collection practices Equal Credit Opportunity Act –If credit is extended to one patient, it must be extended to all who request it

24. Copyright © 2008 Delmar Learning. All rights reserved. 24 Credit and Collection Laws Federal Truth in Lending Act –Disclosure form to detail interest –Figure 13-8 –Establish financial agreement with patient Procedure 13-5

25. Copyright © 2008 Delmar Learning. All rights reserved. 25 Credit and Collection Laws Truth in lending consumer credit cost disclosure –Disclose all costs –Interest, late fees –Prior to time of service

26. Copyright © 2008 Delmar Learning. All rights reserved. 26 Collections Three types of accounts –Open-book account –Written-contract account –Single-entry account Aging accounts –Breakdown of days overdue

27. Copyright © 2008 Delmar Learning. All rights reserved. 27 Collections Office collection problem solving –Verifying checks Nonsufficient funds Bad check preventive measures –Dun messages Dun = To make a loud noise Payment reminder phrase

28. Copyright © 2008 Delmar Learning. All rights reserved. 28 Collections Telephone collections –Perform debt collection by telephone Procedure 13-6 –Insurance check sent to patient Assignment of Benefits –Solutions for payment excuses

29. Copyright © 2008 Delmar Learning. All rights reserved. 29 Collections Collection letters –Figures 13-11 and 13-12 Collection agencies –Business that collects overdue accounts

30. Copyright © 2008 Delmar Learning. All rights reserved. 30 Collections Take collection action –Write off an uncollectible account then post money from a collection agency –Procedure 13-7

31. Copyright © 2008 Delmar Learning. All rights reserved. 31 Collections Small claims court –Inexpensive –Judgment by court –Physician still has to pursue payment –File an uncollectible account in small claims court Procedure 13-8

32. Copyright © 2008 Delmar Learning. All rights reserved. 32 Collections Estate claims –Claim on estate of deceased patient Bankruptcy –Debtor protected by court –Creditor cannot send further statements

33. Copyright © 2008 Delmar Learning. All rights reserved. 33 Stop and Think Tackle payment obstacles –Review the scenario –Determine what your response would be

34. Copyright © 2008 Delmar Learning. All rights reserved. 34 Stop and Think Handle collection problems –Review the scenario –Formulate questions to ask the patient and state what action you would take