Y khoa, dược - Y khoa, dược - Patient billing and collections

17Patient Billing and CollectionsLearning Outcomes 17.1 Discuss the importance of accounts receivable to a medical practice.17.2 Explain how to accept and account for payment from patients.17.3 Prepare an invoice.17.4 Manage a billing cycle efficiently.2Learning Outcomes (cont.) 17.5 Describe standard collection techniques.17.6 Explain how to perform a credit check.17.7 Identify credit arrangements.17.8 Recognize common collection problems. 3Introduction Medical assistants take on duties that are administrative in natureCustomers have various payment optionsThird-party payers (insurance carriers)Payment plansSome have large outstanding balances A proper understanding and administration of billing and payment collection methods is required4Basic Accounting Managing Accounts receivable – money owed to the businessAccounts payable – money owed by the businessBilling and collections convert account receivable into readily available income5Standard Payment ProceduresCollect payments from patients at each office visitBrings income into practice fasterSaves cost of Preparing and mailing bills Collecting on past-due accounts6Determine Appropriate FeeFee schedule is based onCost of servicesDoctor’s experienceCharges of other doctors in the areaFee allowed by insurance policiesUsual and customary feesAverage fee charged for a service by comparable doctors ORThe 90th percentile of all fees charged by comparable doctors for the same procedure7Determine Appropriate Fee (cont.)Relative value unit (RVU) Doctor’s skill and timeProfessional liability expensesOverhead costsRVU converted to $ amount for a serviceThis methodology has reduced the growth rate of spending for Doctors’ professional servicesRelated services and suppliesOther Medicare B services8Charge SlipsAlso called fee slips or transaction slipsNumbered consecutivelyPreprinted with common services and chargesUses:Pad of charge slips on physician’s deskGiven to doctor with patient record at time of appointmentDoctor enters services provided 9Accepting PaymentComplete charge slip and request paymentMost practices accept:CashCheckCredit cardsInsurance For today’s visit, the total charge is $50. How would you like to pay?10Accepting Payment (cont.)CashCount money carefullyRecord payment on ledgerGive patient a receiptCheck Check date and amountBe sure check is properly filled outEndorse it immediately11Accepting Payment (cont.)Debit cardImmediate removal of funds from bank accountProcessed like credit cardPatient enters PINCredit cardPrompt payment and reduces expense of mailing billsCosts practice a percentage of each chargeCheck expiration date before processing12Pegboard SystemNot often usedPost payment on ledger cardGenerates receipt at same time13Determining Payment ResponsibilityThird-party liability – responsibility of insurance company to payMinors Parents or person with legal custodyEmancipated minorElderly patients/patients with disabilities –proof of guardianship14Determining Payment Responsibility (cont.)Refunding and overpaymentMaintaining a credit balance vs.Refunding overpaymentProfessional courtesy – waived charges or accept amount that the insurance pays15Apply Your KnowledgeWhat is the difference between accounts receivable and accounts payable?ANSWER: Accounts receivable are monies owed to the medical practice and accounts payable are monies owed by the medical practice.Good Job!16Preparing InvoicesPreparing and mailingPatients who do not pay at time of appointmentPatients who make only a partial payment Using codes on the invoiceFor common proceduresItemized list on invoiceUsing ledger cards – photocopyand send to patient17Preparing Invoices (cont.)Generating computer invoice – print invoice for balance dueUsing independent billing servicesSending invoices electronically18Using the SuperbillEncounter formIncludesCharges for services rendered that dayInvoice for payment or insurance copaymentInformation needed to submit insurance claimMay be computerizedAttach to medical record for physician to complete at time of visit19Managing Billing CyclesCycle billing Bills each patient only once a month Spreads the work of billing over the monthInvoice groups of patients every few days 20Apply Your KnowledgeWhat is cycle billing?ANSWER: Cycle billing is a common billing system in which each patient is billed only once a month but groups of patients are billed every few days—spreads the work of billing over the month.Excellent!21Standard Collection ProceduresCollection of payment if not paid during standard period is guided byStatute of limitations – sets time limit on when a collection suit on a past-due account can legally be filed22Standard Collection Procedures (cont.)Statute of limitations and account typesOpen-book accountOpen to charges made occasionallyLast date of payment or charge for each illnessWritten-contract account Contract with patient to pay over four installationsRegulated by Truth in Lending ActSingle-entry accountAccount with only one chargeShorter time limit than open-book accounts23Using Collection TechniquesInitial telephone calls or lettersFriendly and sympatheticCall the patient at homeDo not Call patients at work Leave a message on an answering machine24Using Collection Techniques (cont.)Preparing statementsInvoice with a courteous reminder that payment is dueSend a collection letter when account is past due60 days – nice but firm90 days – stronger wording120 days – final letter before forwarding to a collection agency25Preparing an Age AnalysisThe process of classifying and reviewing past-due accounts by age from the first date of billingList all patients’ account balances and when the charges originatedUse patient ledger cards and color-coded tags to indicate the number of days past dueClick for SampleAge Analysis26Sample Age AnalysisBack27Laws Governing Debt CollectionFair Debt Collection Practices Act of 1977Prevents threats to take action that is illegal or that you do not intend to takeEliminates abusive, deceptive, or unfair practicesGuidelines:Do not call before 8 A.M. or after 9 P.M.Do not make threats or use profane languageDo not discuss patient’s debt with anyone elseDo not use any form of deception or violence to collect a debt28Laws Governing Debt Collection (cont.)Telephone Consumer Protection Act of 1991Protects against unwanted telephone solicitations (telemarketing)ProhibitsAutomated dialing device for calls to patientsPrerecorded calls to homes without prior permissionUnsolicited advertising via fax machineMost provisions do not apply to medical practices29Observing Professional Guidelines for Finance Charges and Late ChargesAppropriate to assess finances charges or late charges on past-due accounts if the patient is notified in advanceMust adhere to federal and state guidelines that govern these chargesThe physician should use compassion and discretion when assigning charges in hardship cases30Using Outside Collection AgenciesManagement of the accountAvoid collection agencies that use harsh or harassing collection practicesProvide agency with needed information only Do not send bills to or contact patient; refer patient to collection agency31Insuring Accounts ReceivableProtects the practice from lost income due to non-paymentProtects cash flow and ensures that the practice will have funds to cover expected expenses32Apply Your KnowledgeANSWER: The statute of limitations, Fair Debt Collection Practices Act of 1977, and Telephone Consumer Protection Act of 1991 guide the attempt to collect this debt. Mr. Jansen has not paid his bill for an office visit three months ago. What will guide your attempt to collect this debt?Correct!33Credit ArrangementsCredit – gives the patient time to pay for services provided on trust when patient is unable to pay immediatelyPerforming a credit checkMust have current informationVerify employmentRequest a credit bureau report34Laws Governing Extension of CreditEqual Credit Opportunity ActMay not deny credit based on patient’s sex, race, religion, national origin, martial status, or agePatient has right to know why credit was deniedTruth in Lending ActCovers credit agreements that involve more than four paymentsMust sign, discuss, and retain copies of a disclosure statement – a written description of the agreed terms of payment35Extending CreditUnilateral decisionPhysician decides that patient will be billed for full amount each monthPatient makes whatever payment possible each monthMutual (bilateral) agreementBetween patient and physicianIf no finance charges and if number of payments four or less, not subject to Truth in Lending Act36Apply Your KnowledgeWhat two places will the medical assistant contact when performing a credit check?ANSWER: When performing a credit check, the medical assistant will need to contact the patient’s employer to verify employment and the credit bureau to obtain information about the creditworthiness of the patient seeking credit.Very Good!37Common Collection ProblemsHardship cases – patients may be poor, uninsured, or underinsuredPatient relocation and address changesDo not to discuss a debt with anyone except the person responsible for the chargeMay ask for forwarding address only38Apply Your KnowledgeWhat are common reasons for difficulty collecting a medical bill?ANSWER: A patient may be unable to pay the bill because of economic circumstances (poor, uninsured, underinsured, elderly and on limited income) or the patient moved and did not receive the invoice or provide a forwarding address.Right!39In Summary 17.1 Accounts receivable is important to a medical practice. An understanding of accounts receivable ensures that money is collected, managed, and documented properly.17.2 Payments from patients can be accepted by check, debit card, cash, and credit cards. Give a charge slip to the patient and place a copy of the charge slip in the medical record. Record on the ledger sheet to track accounts receivable.17.3 Preparing an invoice is essential in the medical office. Invoices can be computer-generated, and you can apply all of the necessary information, such as name and amount due.40In Summary (cont.)17.4 To manage a billing cycle efficiently, maintain consistency in sending out bills.17.5 Standard collection techniques include calling or writing patients to determine the reason for non-payment or to set up a payment arrangement.17.6 To perform a credit check, you must have current information. Make sure you get the patient’s consent to perform a credit check.41In Summary (cont.)17.7 Credit arrangements for patients include extending credit based on trust, performing employment verification, and requesting a credit report.17.8 Two of the most common collection problems are 1) patients who cannot make payment; and 2) patients relocating without providing forwarding information.42End of Chapter 17Remember that credit is money. ~ Benjamin Franklin43