Billing and Collections Chapter 20 Billing and Collections

Billing and Collections and the TPMS

Billing Procedures Must be accurate Timeliness is important Streamline billing process Billing efficiency report can help

Credit and Collection Policies Have a formalized, straightforward policy that can be stated in a patient information brochure Questions providers may want to address Patient Education Box See Text for list of questions.

Payment at Time of Service Collect at least copayment and coinsurance at time of service Inform patients of the following when appointment is made: Whether provider has contract with their insurance carrier How payment is made if insurance does not cover Copayment and coinsurance expectations How payment is made if they have no insurance An approximate cost of service if appropriate (Procedure 20-1)

Payment at Time of Service Accommodate patients’ needs while still ensuring prompt payment of services Accept debit and credit cards Abide by all insurance contract rules

Truth-In-Lending Act May charge interest for installment arrangements Also called Consumer Credit Protection Act of 1967 Protects consumers by requiring providers of installment credit to state charges clearly Disclose finance charges in writing (Show sample on overhead)

Components of a Complete Statement What should be included: Explanation of services, provider’s NPI Insurance data and fees for each service May be encounter form May be photocopy of ledger card (Procedures 20-2 and 20-3)

Components of a Complete Statement Computerized statements Most commonly used for statements Search patient database for outstanding balances and print statements Ages accounts Most likely queued to insurance when service is completed Give copy to patient at the same time (Procedures 20-2 and 20-3) (Procedure 20-4)

Monthly and Cycle Billing Monthly billing Devote one or two days per month to preparing statements Place in mail the 25th of month Time consuming

Monthly and Cycle Billing Divide accounts alphabetically Schedule Figure 20-4

Past-due Accounts Inability to pay Negligence Unwillingness to pay Third-party payees Minors

Collection Process Establish how much has been owed for how long Prompt and conducted in timely fashion

Collection Process Collection ratio Accounts receivable ratio Divide total collections dollars by gross charges minus any adjustments Goal is for 90 percent or better Accounts receivable ratio Divide current accounts receivable balance by the average monthly gross charges Goal is payment in less than two months Samples in text.

Aging Accounts Identifies how long an account is overdue Pegboard system Color-coded strips may be attached to ledgers Notes or written code placed on ledger card may be used

Aging Accounts Computerized aging Key appropriate commands to age accounts Can age accounts by several criteria Generates accounts receivable report Additional types of reports available

Collection Techniques Correspondence to insurance carriers in two days or less Electronic claims processing Up-to-date claims register or insurance pending report Follow-up collection policy is important Figure 20-5

Collection Techniques Telephone collections Effective method that is more direct than correspondence Successful calls require tact and diplomacy Work with patients toward satisfactory solution Legal rules and ethical guidelines Fair Debt Collection Practice Act

Collection Techniques Watch the video

Collection Techniques Collection letters Office policy will help determine when to send Series of letters shown in Figure 20-6

Use of an Outside Collection Agency Used for highly delinquent accounts Discretion needed Seek collection agency compatible with a medical practice Procedure 20-3 Procedures 20-5 and 20-6

Use of an Outside Collection Agency Follow guidelines of collections agency Posting of payments collected through outside agency

Use of Small Claims Court When to use and questions to ask Advantages and disadvantages Collecting money

Special Collection Situations Bankruptcy Chapters 7 A proof-of-claim form of patient’s account is filed Chapter 13 Patients are allowed to pay bills over time by court-determined amount Unsecured medical debts are usually last to be paid

Special Collection Situations Estates Fee collection goes to executor of the estate Guidelines Show courtesy; prepare itemized statement; mail to executor of estate Address statement to “Estate of (name of patient)” Contact probate court for additional information

Special Collection Situations Tracing “skips” Check address Call patient Policy will determine how far to go in tracing skips Collection agency is a possibility

Statute of Limitations Defines period in which legal action may take place Defines class account falls into Open book accounts Written contracts Single-entry accounts Determine state’s limitations (http://creditinfocenter.com)

Maintain a Professional Attitude Collecting past-due accounts is difficult and can be discouraging Quickly identify accounts that cannot be collected and write them off Keep any bias and emotions out of the process

Maintain a Professional Attitude Rely only on the information from the aged account Strive for a “win-win” as much as possible