1. Billing and Collections
Chapter 20
Billing and Collections

2. Billing and Collections and the TPMS

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

4. 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.

5. 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)

6. 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

7. 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)

8. 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)

9. 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)

10. 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

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

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

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

14. 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.

15. 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

16. 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

17. 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

18. 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

19. Collection Techniques
Watch the video

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

21. 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

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

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

24. 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

25. 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

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

27. 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 (

28. 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

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