Daily Financial Practices Chapter 19 Daily Financial Practices

Daily Financial Practices and the TPMS

Patient Fees A major part of managing the clinic’s business details Informing patients of fees and financial arrangements falls to medical assisting staff A positive attitude that anticipates that a majority of patients pay their medical bills is helpful

Helping Patients Who Cannot Pay Recognize that there are patients who can have difficulty paying their bills Those who cannot pay often have to make difficult choices—food or medicine

Determining Patient Fees Usual, reasonable, and customary fees Discussion of fees Depends on type of medical facility Establish fee schedule Notify patients of fee policies Medicare: Advanced Beneficiary Notification Medicaid waiver Usual, reasonable, and customary fees: see Chapter 17

Determining Patient Fees Adjustment of fees Medicare, Medicaid, Blue Shield, private health insurance adjustments Limited-income patients’ “write-offs” Pitfalls of adjusting fees

Determining Patient Fees Refunds May occur when insurance pays more than anticipated Prepare a check for overdue amount to patient Enter transaction on day sheet and patient account Total the balance—may bring balance to zero

Credit Arrangements Payment planning Acceptance of credit/debit cards

The Bookkeeping Function Managing patient accounts For tax and legal purposes Maintain account records for each patient Accounts receivable records Most common methods to track patient accounts are the manual (pegboard) and computerized accounting systems Medical assistant should understand both systems

The Bookkeeping Function The importance of good work habits Always work with care and accuracy The work must be kept current Double-check entries for accuracy List of other good habits for manual bookkeeping system noted in text

The Bookkeeping Function The pegboard system Write-it-once system Identify pegboard components Advantages Provides up-to-date accounts receivable status Relatively inexpensive

The Bookkeeping Function Computerized financial systems Used by the majority of ambulatory care settings Advantages Removes much of the “manual” application of bookkeeping process Can be a part of a total practice management system (Critical thinking Box in Text)

Recording Patient Transactions Bookkeeping is an “exact” science Accuracy is a must Encounter form (charge slip, superbill, multipurpose billing form)

Encounter Form Includes patient information, insurance data, previous balance, current services and charges Often includes procedure and diagnosis codes Includes patient’s ID number and provider’s NPI Fits over pegs in pegboard system

Recording Patient Transactions Patient account or ledger Patient’s financial history recorded in accounts receivable ledger Each adult in a family has her/his own ledger Parent with custody is considered “guarantor” and responsible for a minor’s charges, no matter what a parenting plan states (Procedure 19-1 – Manual; Procedure 19-2 - Computer)

Recording Patient Transactions Patient account or ledger Usually a minimum of three columns: debit, credit, balance Some have space for another column for adjustments Adjustment column is credit column (Procedure 19-1 – Manual; Procedure 19-2 - Computer) see the text for detail, Procedure 19-3 and 19-4 – Computer

Recording Patient Transactions Day sheet Posting of all financial transactions for professional services Balanced at the end of the day; gives a complete picture of day’s activities Come in many different styles; some provide a deposit portion and a section used for business analysis (Procedure 19-5 – Manual)

Recording Patient Transactions Day sheet In the pegboard system The ledger card and encounter form are placed on top of the day sheet In a computer system The same data is recorded Computer database pulls up correct charge, posts to patient account and accounts receivable ledger (Procedure 19-5 – Manual)

Recording Patient Transactions Receipts Used for payments on accounts when no services are rendered on that day Can be created in both pegboard and computerized systems

Recording Patient Transactions Month-end activities Reconcile month-end figures on day sheet with patients’ ledgers Time-consuming in manual system but is essential Provides “checks and balances”

Recording Patient Transactions Computerized patient accounts Automatically creates encounter form Calculates charges for monthly billing Transfers data to produce insurance forms, statements, and deposits Automatically ages all accounts

Recording Patient Transactions Watch the video

Banking Procedures Types of accounts; online banking Checking account is primary account Selecting an account Features are identified in text Savings accounts Money market Interest generating checking/savings accounts (see Critical Thinking in the text)

Banking Procedures Types of checks Cashier’s check Certified check Money orders Voucher check Traveler’s checks or ATM machines when traveling

Banking Procedures Deposits Usually made daily Endorsements Deposit slips Procedure 19-6

Banking Procedures Cash on hand For change Receipts required Balance daily

Banking Procedures Accepting checks Inspect check for correct information Do not accept a third-party check unless it is from insurance carrier “Insufficient funds” See the text on steps to take. (Procedure 19-9)

Banking Procedures Lost or stolen checks Report to bank Stop payment order Check signatures for possible forgery

Banking Procedures Writing and recording checks Purposes To pay bills (accounts payable) Refunds of overpayment Replenish petty cash Check components Rules for writing checks (Procedure 19-10)

Banking Procedures Reconciling a bank statement Performed at least monthly Ensures that accounts receivable is accurate for previous month (Procedure 19-7)

Purchasing Supplies and Equipment Ensure proper control over purchasing Preparing a purchase order Verifying goods received Check against purchase order as unpacking items Note discrepancies

Petty Cash Totally separate from cash on hand Establishing a petty cash fund Tracking, balancing, and replenishing petty cash Track with petty cash vouchers Balance and replenish when fund gets low