1. Collecting from and Billing Patients
Chapter 14

2. 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

3. 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 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

4. 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)

5. 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

6. 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

7. 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

8. 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

9. 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

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

11. 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

12. 60 days send first collection letter-reminder may look like another bill

13. 75 days send second letter; call

14. 80-90 days letter 3 is more firm

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

16. 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

17. 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

18. 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

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

20. 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.