1. Credit and Collections
Comprehensive Medical Assisting Managing the Finances in the Practice

2. Fee Schedules Set by physician Sample Medicare Fee Schedule
Helps physician determine reimbursement
UCR (usual, customary, and reasonable)
RBRVS (resource-based relative value scale)
Vary with reimbursement schedules
Individual fee schedule for each insurance company contract
Each payer has its own
Vary with participation status
A fee schedule helps a physician determine amount of reimbursement they will receive for services rendered. This fee is based off of the UCR or RBRVS values.
Each provider will have an individual fee schedule for each insurance company contract. The fee schedules will also vary within a PAR and nonPAR provider.
Medicare fee schedules tend to be the foundation or reference point for all other third party payers.
Medicare schedule
Participating
Non-participating
Limiting

3. Discussing Fees In Advance
PATIENT
Inform the patient of costs and payment
PAYER
Identify the payer
PHYSICIAN
Determine whether the physician participates
With a new patient, establish identiy and credit worthiness
When discussing feeds in advance: - Inform the patient of costs and payment,
- Identify the payer, and
- Determine whether the physician participates.
With a new patient, establish identiy and credit worthiness.

4. Forms of Payment Insurance Company Personal Check Credit or Debit Card
The company charges but payment is prompt and risk is transferred
Cash
Personal Check
(get two forms of ID)
Credit or Debit Card
Forms of payment include: cash, personal check, and credit or debit card.
Because such a large amount of the physician’s income depends on insurance contracts, it’s important to obtain a copy of the patient’s insurance card at every visit. Eligibility should also be verified prior to the patient seeing the doctor.
Insurance Company
Check insurance card at each visit
Copy both sides of card and keep copies in the chart
Verify eligibility
INSURANCE CARD

5. Adjusting Fees A discount or adjustment is not a write-off
Always show the office’s full fee with any discount as a credit
INSURER’S DISCOUNT
Show the difference between full and insurer’s rates as a credit
A discount or adjustment
is not a write-off
PROFESSIONAL COURTESY
Show the amount as a credit
When adjusting fees, always show the office’s full fee with any discount as a credit.
When giving an insurer’s discount, show the difference between the full rate and the insurer’s rates as a credit.
When adjusting fees as a professional courtesy, show the amount as a credit.
When giving a full payment discount, show the percentage as a credit.
Remember that a discount or adjustment is NOT a write-off.
FULL PAYMENT DISCOUNT
Show the percentage as a credit

6. Offering credit is another way to receive payment
preferred
Credit cost – About $8/month
Credit source – In-house or third-party financing
Like Visa or
Mastercard
Offering patients credit is another way to receive payment for services.
It costs a practice about $8 per month, per patient to extend credit. Physician offices may elect to manage the credit themselves or use another financial institution.
Be aware that the Truth in Lending Act requires that any interest and additional charges be disclosed up front. Also, the Fair Debt Collections Act prohibits discrimination.
Legal Considerations
Interest and charges are legal but must be disclosed
Discrimination is not permitted

7. Collections: Monthly Billing
Keep schedule consistent
Installment billing includes the current amount due
Include:
Previous Balance
Remember the following
Payments
(by patient or third party)
When it comes to monthly billing:
Keep the schedule consistent. Give notice whenever there is a change.
Include the previous balance, payments (by patient or third party), and the current balance.
Installment billing includes the current amount due.
Change requires notice
Current Balance

8. Collections: Aging Accounts
Measure general collection efficiency
Age runs from billing and not service
Flag overdue accounts
Remember the following
When tracking aging accounts, remember the following:
Age runs from billing and not service.
You should measure general collection efficiency. Eight percent of fees should be collected within 30 days.
Lastly, flag overdue accounts.
80% of fees should be collected within
30 days

9. Sample Aging Schedules
Managed by
computer software
Paper-based
COMPUTERIZED
MANUAL
Here are examples of a manual aging schedule and a computerized aging schedule.
Both contain the same basic information. One is paper-based and the other is managed by a computer software.

10. Collecting Overdue Accounts
Mailed Notice
Send form letter via certified mail
Telephone Call
Document the call
Be careful in leaving messages
In-office Reminder
It’s not a concern if you don’t make it a concern
Third Parties
Collections agencies and small claims courts are the last resort
When collecting over due accounts, letters should be sent certified mail. Any telephone conversion should always be documented in the patient chart.
If the patient presents to the office, attempt to collect payment then.
Collections agencies and small claims courts are the last resort because the physician’s office must pay out of pocket expenses for these methods.

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