Debt Collection and Patient Retention The Best of Both of Worlds presented to

1. Debt Collection and Patient RetentionThe Best of Both of Worldspresented to Physicians Management Association of NOVA

2. Topics • Time Value of Money • Best Practice – Collections Policy • Useful Ideas on How to Collect *any information in this presentation should not be construed as legal advice. Consult with your practice attorney for questions on legal issues.

3. Time Value of Money $100 1st Billing The Collector’s Calendar 2nd Billing Inquire/Trace Value of goods and services sold Demand Clarify Negotiate Arrange Follow-up Legal/Discontinue Persist FINAL SETTLEMENT $0 Erodes with passing time

6. How do you collect and keep more of YOUR hard earned money?

7. Best Practice - Collections policy Element One Identify people responsible for dealing with debtors - Who is authorized to negotiate - Who is allowed to make exceptions Element Two Define, in writing, the business attitude toward collecting debts - Patient Financial Form - Financial Policy Element Three Decide what techniques you will use internally -Statements - Letters - Personal contact - Stop seeing patient Element Four Determine how far you will go to enforce collections (using bona fide enforcement strategies) - Third Party Agency - Credit Reporting - Attorney Referral - Litigation

8. Best Practice - Collections policy Define, in writing, the business attitude toward collecting debts - Financial Policy - Patient Financial Form

9. If you do not develop and enforce a standard credit and collection procedure, your patients will pay when THEY want to…your statements go into the “I’ll pay it when I get to it” pile Best Practice - Collections policy You write financial policies, or debtors will write them for you

10. Patient Financial Form (sample 1) PATIENT INFORMATION FORMDate______________________ Name________________________________________________________________Birth date________________Sex_______ Address________________________________________________City______________________State____Zip____________ Phone____________________________Work Phone________________________Cell Phone__________________________ Social Security #__________________________ Driver’s License # _________________________ FINANCIALLY RESPONSIBLE PARTY: Name ______________________________________________________________________Relationship__________________ Address________________________________________________City______________________State___Zip_____________ Phone____________________________Work Phone________________________Cell Phone__________________________ Social Security #_______________________________Birth date______________________________ EMERGENCY CONTACT INFORMATION: Employer____________________________________________________________Phone_____________________________ Address________________________________________________City______________________State____Zip___________ Name of Spouse_______________________________________________________Work Phone_______________________ Name of Relative______________________________________________________Phone_____________________________ Home Address__________________________________________ City______________________State____Zip___________ REFERRAL INFORMATION: How did you hear about us? _______________ Name of Referring Party________________________________________________Phone____________________________ INSURANCE INFORMATION: Primary Carrier________________________________________________________________________________________ Address________________________________________________City______________________State____Zip__________ Phone_____________________________Policy #______________________Group #________________________________ Secondary Carrier______________________________________________________________________________________ Address_______________________________________________________________________________________________ Phone_____________________________Policy #______________________Group #________________________________ FINANCIAL RESPONSIBILITY: This information is accurate and true to the best of my knowledge. I understand I am responsible to pay for services rendered, including reasonable attorney’s fees and costs of collection in the event of default. Signature___________________________________________________________Date_______________________________

11. Financial policy (sample 1) Welcome Thank you for choosing us as your healthcare provider.  We are committed to providing you with the best possible care and to your treatment being successful.  Your clear understanding of our financial policy is important to our professional relationship.  Please understand that payment of your bill is considered part of your overall treatment.  In order to keep your cost of healthcare to an absolute minimum, we have adopted the following policies.  Fees and Payments Fees are standardized and are based on the complexity of your visit or procedure.  Payment of co-payments and any outstanding balance is required at the time of service.  We accept cash, personal checks, money orders, Visa or MasterCard.  While the filing of insurance claims is a courtesy that we extend to our patients, all charges are your responsibility from the date that services are rendered.   In order for us to file a claim, you must present a current copy of your insurance card at each visit and communicate any changes in your personal contact information. Most insurance policies specify that some of the cost of the patient’s care is the patient’s responsibility.  This can be accomplished through any combination of co-payments, coinsurance, or deductibles.  Co-payments are due when you check in for your appointment.  Coinsurance and deductibles are determined by your insurance company and reported to us on your explanation of benefits.  Once we are notified, we will add the appropriate charge to your account and send you a statement.  This charge is payable upon receipt of the statement.  Once payments are received, they will be automatically applied to the oldest outstanding balance.  If you would like a payment to be applied to a specific charge, please notify our staff at the time of payment. Insurance Plans Your insurance coverage is a contract between you, your employer, and the insurance company; we are not a party to that contract.  We must emphasize that as healthcare providers, our relationship is with you, not with your insurance company.  Before your visit, please contact your insurance company to verify the physician that you are scheduled with participates with your plan and that the services that you intend to receive are covered.  In addition, because some insurance plans require either pre-certification and/or a referral from a primary care provider before you can be seen, please ask if these are required and obtain them if necessary. Not all services are a covered benefit in all plans so it is very important that you understand the provisions of your individual policy.  Some insurance companies arbitrarily select certain services they will not cover and so we cannot guarantee payment of all claims by your insurance company.  If your insurance company pays only a portion of your claim or rejects your claim, they will notify you through an explanation of benefits.  Reduction or rejection of your claim by your insurance company does not relieve you of your financial obligation. Initials _________

12. Financial policy (sample 1) Screening Procedures Insurance plans will only cover services that they determine to be medically reasonable or necessary.  It is important that you check with your insurance company to determine your colorectal screening benefits.  Please note that if you are scheduled for screening procedure and any condition or diagnosis is found both the screening diagnosis and the discovered condition are required to be reported.  Some insurance plans including Medicare have different coverage for screening versus diagnostic procedures so it is important that you understand your benefits carefully. Procedure Charges Patients undergoing procedures will receive two separate bills.  One bill is the physician’s fee and the other will be from the facility where your procedure was performed.  In addition, if a biopsy is done during a procedure, you may receive an additional bill from the lab facility that performs your biopsy.  Please contact the lab facility directly to discuss any questions with your lab bill. Making and Keeping Appointments If you need to cancel your appointment, please call at least 24 hours in advance. This allows us to accommodate other patients who need to be seen.  Excessive no shows may result in a charge being added to your account and you may also be dismissed from the practice. Initials __________ Non-Payment of Outstanding Accounts Accounts that are not paid in a reasonable amount of time may be sent to an external collections agency and reported to the credit bureaus.  If this occurs, you may also be dismissed from the practice.  In addition to your outstanding balance, you may also be responsible for any fees or charges that we incur from the external collections agency while attempting to collect your balance. Initials ___________ Administrative Fees Forms Charge – If your employer requires Family Medical Leave Act or Disability paperwork to be completed by your provider, the turnaround time is five business days and there is a $25 fee for this service, payable in advance.  Medical Records Charge – If you would like a copy of your medical records sent to yourself or another physician, these copies are billed on a per page basis, payable in advance, in accordance with HIPAA and Ohio state law.  The per page fee schedule is available upon request.  If a collaborating physician (primary care or specialist) requests portions of your chart to assist in your care, there is no charge. Returned Check Charge – Non Sufficient Funds (NSF) checks are subject to a $30 fee (in addition to fees from your bank).

13. AAHE Patient Form

14. AAHE Financial Policy

15. Updating information Ideas on collecting more cash: Call the day before and remind patient to bring insurance card and method to pay co-pay Collect co-pays at time of service - One of the biggest excuses is “I don’t have it today”. Do we agree that people do not leave their house without a drivers license, checkbook, or credit cards? - A great one my Pediatrician uses: Add on the financial policy that if you have to bill them, a $5 billing fee will be added to the account – and the discharge staff asks that in a question format at time of dismissal. Get new insurance information on every visit - Ask for insurance cards to copy on every visit. When the guarantor calls for the appointment, remind them not to forget the insurance card! Require a new financial policy and patient financial form to be completed annually as a minimum Outsource all areas of the A/R process that are redundant or cost inhibitive - Outstanding Insurance and Self Pay A/R at 30 or 60 days + - including calls, letters, both Remind Patients of Standard Insurance Policies - As a reminder, most insurance plans do not cover all procedures and there may be a balance due in addition to your co-pay and will be shown on our statements. If you feel a procedure should be covered, notify our office immediately. Thank you!

16. Collections policy Techniques you use internally -Statements - Letters - Inbound phone calls - Personal contact

17. Statements and Letters On your statements, make sure to clearly state - (if) insurance has been exhausted - balance due - terms and conditions - next action

18. Inbound Phone Calls Stall tactics and delays in payments usually follow a pattern You get the same excuses from all types of patients Write down common excuses Develop a response to the most common excuses Role Play to become comfortable with the replies

19. Urgency deadlines Deadlines must be meaningful to debtor • When on the phone, ask for payment today, try to get something today • Date of staff meeting to discuss which debts go to collection • Date of staff meeting to review debtor requests for exceptions • Actual date debts go to collection (or referred to a third party agency) • Refresh in their mind your Financial Policy – “As stated in our Financial Policy…”

20. Personal Contact If patient comes in for another visit (with outstanding balance)… - payment is due (before the doctor can see you today) - new co-pay is due ‘today’

21. A best practice program uses the “decision makers”…

22. The “Decision-makers” 1. Final notice (or statement with dunning notice): “Contact us within ten days regarding payment or we have no alternative but to transfer this account to collections” 2. Third Party (soft letter) Calls and payments go back to practice instead of the agency …Guarantees 100% response • Pay you • Contact you • Ignore you

23. Third Party Options • Pre-Collect Programs • Accounts submitted earlier in cycle (day 30 - day 90) • Usually priced on a per account basis instead of higher contingency fees • Helps lower bad debt expense and increase cash collections • Bad Debt Programs • Accounts submitted usually 120 days or later • Usually contingency fee programs • Much more work effort needed in-house (increasing debt expense) • The longer it ages, the less chance of collecting the account • Efforts may include, multiple phone calls, multiple letters, credit reporting, • Insurance Collection Programs • Help collect from slow paying Insurance Carriers • Usually priced on per account basis instead of higher contingency fees • Cash inflow increases / lowering cost of follow-up • Attorney Referral • Letters and possible phone calls • Movement to litigation (if authorized) • Wage garnishment (in certain states) • Bad Address Search Programs

24. BEST PRACTICES… - Utilize Financial Policy - Streamline Collection Process - Standard Billing Procedure - including write off to bad debt - Outsource non-specific areas of A/R Process - bad address search -insurance follow up/resolution - pre-collect and collections STICK TO IT!!!

25. Dismissing the Patient Needs to be in writing Recommended that the letter be signed by the doctor Give referral information (how to find a new doctor) Letter should be sent certified mail If you’re contracted with the patient’s insurance company, refer to the contract.

26. The contract may require you notify the insurance company or have other requirements. Your malpractice insurance may have some guidelines as well. 6. Cancel any scheduled appointments for the patient 7. You may need to cancel prescription refills

27. Situations when you may want to dismiss the patient Patient files bankruptcy Before turning over to a collection agency Before taking to court Non-collection issues: 4. Non-compliant patients 5. Drug seekers 6. Repeat no-shows 7. Patient makes threats 8. Obnoxious patients

28. Collection laws • Federal • State

29. Conforming to state and federal laws • General rules to protect yourself • Always tell the truth • Be proud of who you are and what you do • Keep things confidential • Follow the golden rule • Stick to official debt collection and credit reporting channels • Record collection course participation.

30. THANK YOU Questions?