Daily Financial Practices in Patient Fees

1. Chapter 19 Daily Financial Practices

2. Patient Fees • Informing patients about charges • Collecting payments • Making credit arrangements • Making sure patients and their providers receive full benefit of medical insurance • Attitude that patients pay their medical bills in timely and responsible manner helpful

3. Patient Fees • Helping patients who cannot pay • MA might make financial arrangements with patients allowing full payment for services provided • Patients less likely to withdraw from medical treatment when their finances are low

4. Patient Fees • Determining patient fees • Managed care contracts pay predetermined fees • Concierge-type medical groups collect additional fee • Provider fees for procedures billed and reimbursed according to standard insurance guidelines

5. Patient Fees • Discussion of fees • Varies depending on type of medical facility, needs of practice, professional services rendered • Inform patients of charges and exactly what portion of bill they are expected to pay

6. Patient Fees • Adjustment of fees • Medicare and Medicaid mandated to charge every patient same amount for similar services rendered • Adjustments for patients with limited income • Medicare, Medicaid, Blue Cross Blue Shield, private health insurance adjustments • Refunds

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

8. The Bookkeeping Function • Managing patient accounts • For tax and legal purposes • Maintain account records for each patient • Accounts receivable records • Computerized accounting systems • Pegboard system • MA should understand both systems

9. The Bookkeeping Function • Importance of good work habits in financial transactions • Always work with care and accuracy • Work must be kept current • Double-check entries for accuracy • Rules and guidelines for manual bookkeeping system

10. The Bookkeeping Function • Pegboard system • Write-it-once system • Day sheets, ledger cards, encounter forms or charge slips, receipt forms • Advantages • Provides up-to-date accounts receivable status • Relatively inexpensive

11. The Bookkeeping Function • Computerized financial systems • Used by majority of medical facilities • Be sure system meets current needs and will grow with practice • Consider adopting system that allows practice to start with one component and to add another component

12. The Bookkeeping Function

13. Recording Patient Transactions • Bookkeeping activities must be exact • All entries must be correct

14. Recording Patient Transactions • Encounter form • Charge slip, superbill, multipurpose billing form • Used in manual and computerized bookkeeping systems • Designed to fit practice, computer system, pegboard • Patient information, insurance data, previous balance, current services and charges • Procedure and diagnosis codes; provider’s NPI

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 physical custody considered “guarantor” and responsible for payment if child not insured

16. Recording Patient Transactions • Patient account or ledger • Minimum of three columns: debit, credit, balance • Adjustment column is credit column • Ledger placed under charge slip or encounter form in pegboard system • In computerized system, account or ledger can be printed with same information

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

18. Recording Patient Transactions • Day sheet • In pegboard system • Ledger card and encounter form placed on top of day sheet • Bottom of day sheet, transactions totaled and balanced • In computer system • Requires same data • Matches correct charge and posts it to patient account and accounts receivable ledger

19. Recording Patient Transactions • Receipts • Used only when someone makes payment on account on day when no services rendered • Can be created in pegboard and computerized systems

20. Recording Patient Transactions • Month-end activities • Verify month-end figures on day sheet agree with patient accounts • Time-consuming in manual system • Find mistakes before they grow into major accounting or collection problems • Provide “checks and balances”

21. Recording Patient Transactions • Computerized patient accounts • Automatically create encounter form • Calculate charges for monthly billing • Transfer data to produce insurance forms, statements, list of checks received each day, deposit slips • Automatically age all accounts

22. Banking Procedures • Online banking • Check account balances, transfer funds between accounts, pay bills electronically, check credit card balances, view images of checks and deposits, download account information 24/7

23. Banking Procedures • Types of accounts • Checking accounts • Primary account • Savings accounts • Money market accounts

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

25. Banking Procedures • Depositing checks • Usually made daily • Endorsements • Take precautions

26. Banking Procedures • Cash on hand • For change • Receipts prepared • Cash drawer balanced 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 immediately • Stop payment • Check signatures for possible forgery

29. Banking Procedures • Writing and recording checks • Purposes • To pay bills (accounts payable) • Refunds of overpayment • Replenish petty cash • Sample of properly completed check

30. Banking Procedures • Reconciling a bank statement • Performed monthly • Online banking, bank statement can be accessed electronically at any time • Ensures accounts receivable accurate for previous month

31. Purchasing Supplies and Equipment • Ensure proper control over purchasing • Preparing a purchase order • Verifying goods received • Verify correct items and quantities shipped by vendor

32. Petty Cash • Minor, routine, unexpected expenses • Totally separate from cash drawer • Establishing petty cash fund • Tracking, balancing, replenishing petty cash • Track with petty cash vouchers • Balance and replenish when fund gets low