Slide 1 Copyright © 2008, 2006, 2004 by Saunders an imprint of Elsevier Inc. All rights reserved. Chapter 10 Office and Insurance Collection Strategies

Slide 2Copyright © 2008, 2006, 2004 by Saunders an imprint of Elsevier Inc. All rights reserved.

Chapter 10 Office and Insurance Collection Strategies


Learning Objectives Define credit and collection key words terminology

and abbreviations. Translate collection abbreviations. Define aging analysis. State the names of the federal credit laws

applicable to a physician office setting. Define accounts receivable and explain how it is

handled. Recite types of fee adjustments available to

patients. Name payment options available to patients.


Learning Objectives (cont’d.)

Perform oral and written communication collection techniques.

State the role of a billing service, collection agency, and credit bureau in the collection process.

List possible solutions to collection problems. Explain the purpose of small claims court in the

collection process Name basic actions in tracing a debtor who has

moved and left no forwarding address.

Chapter 10 Lesson 10.1


Cash Flow Cycle

Physician revenue largely from reimbursement by third-party payers

Insurance contracts with payers Reimbursement provisions Medical services not covered Patient responsibilities Reimbursement process


Reasons for Accounts Receivable

Increased health care expenses Health care perceived as a right Legal proceedings Insurance delays


New Patient Confirmation

Letter


Signs of Potential Nonpaying Patient

incomplete information on registration form

multiple changes of residence questionable employment record no business or home telephone post office box listed with no street

address; or motel address listed incomplete insurance information no referral


Fee Adjustments

discount cash discounts financial hardship write-offs professional courtesy copayment waiver no charge reduced fee


Ledger Card

Financial Accounting Record


Communicating Fees

1. Be courteous at all times but express a firm, businesslike approach that will not offend the patient.

2. Never badger of intimidate a patient into paying; merely state the payment policy and educate the patient.

3. Inform the patient of the fee and any deductible and balance due in a clear manner.

4. Verify the patient’s copayment listed on his or her insurance card and collect this amount before the patient’s office visit.


Communicating Fees (cont’d.)

5. Make it easier for the patient to pay rather than leave without making payment.

6. Do not give the patient an option by asking if he or she would like to pay now or have a bill sent.

7. Motivate the patient to pay by appealing to his or her honesty, integrity, and pride.


Collecting Fees

Payment at time of service Payment by check Itemized statements


Financial Agreement Form


Demand Letter for Returned

Check


Itemized Statement


Collection Decision Tree


Billing and Collection Guidelines

First statement at time of service Mail second itemized statement Third statement 30 days later First phone call/suspense Second phone call with 5-day notice Written 10-day notice with next steps Take steps indicated in prior statement


Payment Options

cash check credit card debit card e-checks payment plans


Credit and Collection Laws

Equal Credit Opportunity Act Fair Credit Reporting Act Fair Credit Billing Act Truth in Lending Act Truth in Lending Consumer Credit Cost

Discloser Fair Debt Collection Practices Act Statute of limitations

Chapter 10 Lesson 10.2


Telephone “Don’ts”

Don’t raise your voice. Don’t accuse the patient of lying. Don’t act tough. Don’t consent to partial payment. Don’t debate. Don’t report disputed accounts to

collection agency or bureau.


Collection Form Letter


Multipurpose Collection

Letter


Collection Abbreviations


Insurance Payments

History of accounts Coinsurance payments Insurance checks sent to patients Managed care organizations Medicare Medigap insurance Worker’s compensation Suing a third-party payer


When to Use a Collection Agency

when patient says he won’t pay when patient breaks promise to pay when partial payments, but 60-day lapse failure to respond returned check insurance company payment not forwarded misinformation can’t be located


Collection Agencies

Choosing an agency Types of agencies Agency operating techniques Agency charges Agency assigned accounts


Filing a Court Claim

Obtain claim of plaintiff form. File papers with the court. Pay the filing fee. Arrange to serve the defendant. Set trial date.


Tracing a Debtor (“Skip”)

Check the address on returned envelope. Check the ZIP code. File a request at the post office. Look in the phone book. Call the primary care physician. Check with hospital accounts department. Inquire at place of employment. Call contacts on patient’s registration form.


Special Collection Issues

bankruptcy terminally ill patients estate claims


Types of Bankruptcy

Chapter 7 Chapter 9 Chapter 11 Chapter 12 Chapter 13


Filing an Estate Claim

Confirm death. Pursue payment from third parties. Contact the county. File the claim. Send itemized statement to the

attorney. Follow up as needed.


Patient Complaints

Listen. Thank the person. Apologize. Answer the complaint. Be professional, sincere. Take it seriously. Respond in letter form. Be cordial.


Other Considerations

Collection controls Embezzlement Precautions for financial protection Bonding

Documents

Slide 1 Copyright © 2008, 2006, 2004 by Saunders an imprint of Elsevier Inc. All rights reserved. Chapter 10 Office and Insurance Collection Strategies