Chapter 19

1. Chapter 19 Daily Financial Practices

2. Daily Financial Practicesand the TPMS

3. Patient Fees • A major part of managing the clinic’s business details • Informing patients of fees and financial arrangements falls to medical assisting staff • A positive attitude that anticipates that a majority of patients pay their medical bills is helpful

4. Helping Patients Who Cannot Pay • Recognize that there are patients who can have difficulty paying their bills • Those who cannot pay often have to make difficult choices—food or medicine

5. Determining Patient Fees • Usual, reasonable, and customary fees • Discussion of fees • Depends on type of medical facility • Establish fee schedule • Notify patients of fee policies • Medicare: Advanced Beneficiary Notification • Medicaid waiver

6. Determining Patient Fees • Adjustment of fees • Medicare, Medicaid, Blue Shield, private health insurance adjustments • Limited-income patients’ “write-offs” • Pitfalls of adjusting fees

7. Determining Patient Fees • Refunds • May occur when insurance pays more than anticipated • Prepare a check for overdue amount to patient • Enter transaction on day sheet and patient account • Total the balance—may bring balance to zero

8. Credit Arrangements • Payment planning • Acceptance of credit/debit cards

9. The Bookkeeping Function • Managing patient accounts • For tax and legal purposes • Maintain account records for each patient • Accounts receivable records • Most common methods to track patient accounts are the manual (pegboard) and computerized accounting systems • Medical assistant should understand both systems

10. The Bookkeeping Function • The importance of good work habits • Always work with care and accuracy • The work must be kept current • Double-check entries for accuracy • List of other good habits for manual bookkeeping system noted in text

11. The Bookkeeping Function • The pegboard system • Write-it-once system • Identify pegboard components • Advantages • Provides up-to-date accounts receivable status • Relatively inexpensive

12. The Bookkeeping Function • Computerized financial systems • Used by the majority of ambulatory care settings • Advantages • Removes much of the “manual” application of bookkeeping process • Can be a part of a total practice management system

13. Recording Patient Transactions • Bookkeeping is an “exact” science • Accuracy is a must • Encounter form (charge slip, superbill, multipurpose billing form)

14. Encounter Form • Includes patient information, insurance data, previous balance, current services and charges • Often includes procedure and diagnosis codes • Includes patient’s ID number and provider’s NPI • Fits over pegs in pegboard system

15. Recording Patient Transactions • Patient account or ledger • Patient’s financial history recorded in accounts receivable ledger • Each adult in a family has her/his own ledger • Parent with custody is considered “guarantor” and responsible for a minor’s charges, no matter what a parenting plan states

16. Recording Patient Transactions • Patient account or ledger • Usually a minimum of three columns: debit, credit, balance • Some have space for another column for adjustments • Adjustment column is credit column

17. Recording Patient Transactions • Day sheet • Posting of all financial transactions for professional services • Balanced at the end of the day; gives a complete picture of day’s activities • Come in many different styles; some provide a deposit portion and a section used for business analysis

18. Recording Patient Transactions • Day sheet • In the pegboard system • The ledger card and encounter form are placed on top of the day sheet • In a computer system • The same data is recorded • Computer database pulls up correct charge, posts to patient account and accounts receivable ledger

19. Recording Patient Transactions • Receipts • Used for payments on accounts when no services are rendered on that day • Can be created in both pegboard and computerized systems

20. Recording Patient Transactions • Month-end activities • Reconcile month-end figures on day sheet with patients’ ledgers • Time-consuming in manual system but is essential • Provides “checks and balances”

21. Recording Patient Transactions • Computerized patient accounts • Automatically creates encounter form • Calculates charges for monthly billing • Transfers data to produce insurance forms, statements, and deposits • Automatically ages all accounts

22. Recording Patient Transactions Click Here to play the video

23. Banking Procedures • Types of accounts; online banking • Checking account is primary account • Selecting an account • Features are identified in text • Savings accounts • Money market • Interest generating checking/savings accounts

24. Banking Procedures • Types of checks • Cashier’s check • Certified check • Money orders • Voucher check • Traveler’s checks or ATM machines when traveling

25. Banking Procedures • Deposits • Usually made daily • Endorsements • Deposit slips

26. Banking Procedures • Cash on hand • For change • Receipts required • Balance daily

27. Banking Procedures • Accepting checks • Inspect check for correct information • Do not accept a third-party check unless it is from insurance carrier • “Insufficient funds”

28. Banking Procedures • Lost or stolen checks • Report to bank • Stop payment order • Check signatures for possible forgery

29. Banking Procedures • Writing and recording checks • Purposes • To pay bills (accounts payable) • Refunds of overpayment • Replenish petty cash • Check components • Rules for writing checks

30. Banking Procedures • Reconciling a bank statement • Performed at least monthly • Ensures that accounts receivable is accurate for previous month

31. Purchasing Supplies and Equipment • Ensure proper control over purchasing • Preparing a purchase order • Verifying goods received • Check against purchase order as unpacking items • Note discrepancies

32. Petty Cash • Totally separate from cash on hand • Establishing a petty cash fund • Tracking, balancing, and replenishing petty cash • Track with petty cash vouchers • Balance and replenish when fund gets low