Chapter 10 Office and Insurance Collection Strategies

Copyright ©2014 by Saunders, an imprint of Elsevier Inc. All rights reserved 1

Chapter 10

Office and Insurance Collection Strategies

Insurance Handbook for the Medical Office

13th edition

Copyright ©2014 by Saunders, an imprint of Elsevier Inc. All rights reserved

Accounts Receivable Basics

1. Explain the cash flow cycle in a medical office.2. Define accounts receivable, and explain how

it is handled.3. Describe procedures for educating patients to

the medical office.4. State policies of a medical office’s fee

schedule.

2

Lesson 10.1


Accounts Receivable Basics (cont’d)

5. Describe guidelines for missed appointments.6. Recite types of fee adjustments available to

patients.7. Discuss fees with patients.8. Name payment options available to patients.

3

Lesson 9.1


Accounts Receivable Basics (cont’d)

9. Define aging analysis.10. List the names of the federal credit laws

applicable to a physician office setting.11. Explain statutes of limitations of three kinds

of financial accounts.

4

Lesson 9.1


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

5


Accounts Receivable Reasons for accounts receivable

Increased healthcare expenses Health care perceived as a right Legal proceedings Insurance delays

6


Patient Education

7


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

8


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

9


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

10


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

11


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

12


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

13


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

14


Collecting Fees Financial payment plan agreement

15


Collecting Fees Demand letter for returned check

16


Collecting Fees Itemized statement

17


Collecting Fees Collection decision tree

18


Payment Options Credit card billing Debit cards E-checks Payment plans

19


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)

20


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

21


Collection Techniques12. Perform oral and written communication

collection techniques.13. Describe insurance collection from the patient

and from third-party payers.14. State the role of a billing service, collection

agency, and credit bureau in the collection process.

15. Describe credit counseling in a medical office.

22

Lesson 10.2


Collection Techniques (Cont’d)16. Explain the purpose of small claims court in

the collection process.17. Name basic actions in tracing a debtor who

has moved and left no forwarding address.18. Identify special collection issues.

23

Lesson 10.2


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.

24


Collection Letters Collection form letter

25


Collection Letters Multipurpose collection letter

26


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

27


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

28


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

29


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

30


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

31


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

32


Bankruptcy Types of bankruptcy

Chapter 7 Chapter 9 Chapter 11 Chapter 12 Chapter 13

33


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

34


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

35


Questions?

36

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Chapter 10 Office and Insurance Collection Strategies

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