Chapter 10 Office and Insurance Collection Strategies

1. Insurance Handbook for the Medical Office 13th edition Chapter 10 Office and Insurance Collection Strategies

2. Accounts Receivable Basics Explain the cash flow cycle in a medical office. Define accounts receivable, and explain how it is handled. Describe procedures for educating patients to the medical office. State policies of a medical office’s fee schedule. Lesson 10.1

3. Accounts Receivable Basics (cont’d) Describe guidelines for missed appointments. Recite types of fee adjustments available to patients. Discuss fees with patients. Name payment options available to patients. Lesson 9.1

4. Accounts Receivable Basics (cont’d) Define aging analysis. List the names of the federal credit laws applicable to a physician office setting. Explain statutes of limitations of three kinds of financial accounts. Lesson 9.1

5. 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

6. Accounts Receivable • Reasons for accounts receivable • Increased healthcare expenses • Health care perceived as a right • Legal proceedings • Insurance delays

7. Patient Education

8. Patient Registration Form • 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

9. Fee Schedule • Always quote fees and state policies about collection of fees at initial visit • List must be available to all patients • Inform patients of any fees that are not on fee schedule • Helps preserve patient-physician relationship

10. Missed Appointments • CMS allows a no-show fee billed to patients • Medical must do the following: • Establish written office policy on missed appointments • Inform patients of what will happen for a missed appointment, if no cancellation • Apply missed appointment policy to all patients • Bill all patients for missed appointments

11. Fee Adjustments • Discounted fees • Cash discounts • Financial hardship • Write-off or courtesy adjustment • Professional courtesy • Copayment waiver • No charge • Reduced fee

12. Communicating Fees • Be courteous at all times but express a firm, businesslike approach that will not offend the patient • Never badger or intimidate a patient into paying; merely state the payment policy and educate the patient • Inform the patient of the fee and any deductible and balance due in a clear manner • Verify the patient’s copayment listed on his or her insurance card and collect this amount before the patient’s office visit

13. Communicating Fees • Make it easier for the patient to pay rather than leave without making payment • Do not give the patient an option by asking if he or she would like to pay now or have a bill sent • Motivate the patient to pay by appealing to his or her honesty, integrity, and pride

14. Collecting Fees • Payment at the time of service • Payment by check • Itemized patient statements • Dun messages

15. Collecting Fees • Financial payment plan agreement

16. Collecting Fees • Demand letter for returned check

17. Collecting Fees • Itemized statement

18. Collecting Fees • Collection decision tree

19. Payment Options • Credit card billing • Debit cards • E-checks • Payment plans

20. Credit and Collection Laws • Equal Credit Opportunity Act (ECOA) • Fair Credit Reporting Act (FCRA) • Fair and Accurate Credit Transactions (FACT) Act (Public Law 108-159) • Fair Credit Billing Act (FCBA) • Electronic Fund Transfer Act (EFTA) • Truth in Lending Act (TILA) • Truth in Lending Consumer Credit Cost Disclosure • Fair Debt Collection Practice Act (FDCPA)

21. Statute of Limitations • Regulation or law setting time limits on legal action • Maximum time legal collection may be rendered against a debtor • Vary according to three kinds of accounts: • Open book accounts • Written contract accounts • Single-entry accounts

22. Collection Techniques Perform oral and written communication collection techniques. Describe insurance collection from the patient and from third-party payers. State the role of a billing service, collection agency, and credit bureau in the collection process. Describe credit counseling in a medical office. Lesson 10.2

23. Collection Techniques (Cont’d) 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. Identify special collection issues. Lesson 10.2

24. Telephone Collection Procedures • 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.

25. Collection Letters • Collection form letter

26. Collection Letters • Multipurpose collection letter

27. Insurance Collection • History of accounts • Coinsurance payments • Insurance checks sent to patients • Managed care organizations • Medicare • Medigap insurance • Workers’ compensation • Suing a third-party payer

28. Collection Agencies • When to use a collection agency • When patient says he/she 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

29. Collection Agencies • Choosing an agency • Types of agencies • Agency operating techniques • Agency charges • Agency assigned accounts

30. Small Claims Court • 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

31. Tracing a 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

32. Special Collection Issues • Bankruptcy • Terminally ill patients • Estate claims • Litigation • Patient complaints • Collection controls • Embezzlement • Precautions for financial protection • Bonding

33. Bankruptcy • Types of bankruptcy • Chapter 7 • Chapter 9 • Chapter 11 • Chapter 12 • Chapter 13

34. Estate Claims • 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

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

36. Questions?