Collecting from and Billing Patients Chapter 14

Last Step of Billing Cycle Have a solid financial policy When payment is due (copay, coinsurance, balances) How payment is collected At time of service Billed after xx days from service Check, cash, credit card Arrangements for unpaid balances Returned check fees

Thinking It Through 14.1 Refer to Figures 14.1 and 14.2 pp. 462-463) Who is responsible for copays; when must copay be paid? What is a self-pay patient’s financial responsibility for the initial visit? When can a self-pay patient be billed after services? Whose job is it to explain the situation to patients when their insurance does not cover planned services? p. 464 p. 462 is financial policy Pt responsible and must pay at time of service before seeing provider Self pay is responsible for office visit before seeing the doctor. Can be billed after services once they have established themselves with positive payment history Nurse or receptionist

Patient Statements Use data from patient ledger Statements should Be clear Show provider information and date of service Explain costs covered and those still owed (balance due)

Cycle Billing Bill certain accounts at various times in the month (1st, 10th, 20th) Individual or guarantor billing Guarantor Billing advantages: Reduces paper and mailing materials Reduces time spent following up on claims Guarantor sees total amount owed for all dependents; can mail one check. Guarantor billing—one bill sent to one guarantor for several patients he is responsible for

Effective Collections Balance between bringing in money owed and showing concern for patients Why do patients not pay their bills? Don’t have the money Bill was not received Thinks insurance should be paying Thinks the amount due is inaccurate Treatment was ineffective

Collection Tasks Assign to variety of people to avoid mishandling of funds Collection Manager Account Representative Collection Specialist Assign at least two people money responsibilities Collection tasks can include implementing or changing collection policies, analyze effectiveness of collections Manager—doctor office manager or administrator Account rep—manages the finances making sure all that comes in is correctly recorded Collection specialist—work with patients to resolve questionable bills Show job postings

Federal Collection Regulations Fair Debt Collection Practices Act of 1977 Telephone Consumer Protection Act of 1991 Guidelines for When and how often can call To whom you can discuss unpaid bills Leaving messages Calling at places of employment Whether late fees can be added Any money owed to us falls under Fair Debt Collections Act Fair and Ethical treatment of debtors Call once a day and leave messages no more than 3 x week Not before 8 a.m. or after 9 p.m. Must identify yourself Cannot leave messages saying it is about a debt Cannot call if patient asks you to cease and desist

Patient Aging Reports Used to track what is owed and for how long balance has been overdue Increments of 30 – 60 – 90 – more than 90 days overdue Aging begins at the time the bill is originally sent, not date of service Bill patient within 30 days Call if not paid within 45 days Send letter after 60 days unpaid Sample letters p. 472

Figure 14.5—Karen Giroux The higher percentage of our money in past 61 days—not healthy financially

Collection Timetable 30 days – send bill 45 days call Courteous, professional Verify the bill was received Set up payment schedule Remember purpose of the call is to collect what is due Calls made in private Assure patients that unpaid bills will not affect the quality of their care. Go over Scenarios on p. 473 Make notes each time you have called the patient

60 days send first collection letter-reminder may look like another bill

75 days send second letter; call

80-90 days letter 3 is more firm

Documentation Document every phone call, letter, and attempt to collect in patient ledger Bills overdue more than 90 days may go to collections

Payment Arrangements Equal Credit Opportunity Act Truth in Lending Act Agreement stating balance due Finance charges and interest rates Total payments Payment schedule Equal Credit Opportunity Act—cannot discriminate based on race, color, religion, sec, marital status or age or public assistance CAN say no to credit based on current debt, income, and credit history Truth in Lending Act—notice of any additional charges if you accept credit. Arrangements can be up to the office, but all has to be disclosed

Skip Tracing Locating a patient with outstanding bill Contact post office for new address on file Search Internet Hire a specialist Subscribe to online databases When located, verify the person located IS the patient without revealing sensitive information

Sending to Collection Over 90 days Have tried number of times to collect without success Patients says will not pay No longer able to contact patient (moved, phone disconnected) Determine whether is will cost less to write off or send to collections

Writing Off Uncollectible accounts Unable to ever pay—indigent Bankruptcy Removed from patient’s A/R to show no longer owed

Patient Dismissal Letter sent to patient stating dismissal Offer to continue care for period of time after letter is sent (complete treatment) Do not state reason for dismissal Provider may dismiss for nonpayment, but must give the patient ample notice May need to continue to treat for a month or two.