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Chapter 10 Office and Insurance Collection Strategies
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Learning Objectives Define credit and collection key words terminology
and abbreviations. Translate collection abbreviations. Define aging analysis. State the names of the federal credit laws
applicable to a physician office setting. Define accounts receivable and explain how it is
handled. Recite types of fee adjustments available to
patients. Name payment options available to patients.
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Learning Objectives (cont’d.)
Perform oral and written communication collection techniques.
State the role of a billing service, collection agency, and credit bureau in the collection process.
List possible solutions to collection problems. 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.
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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
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Reasons for Accounts Receivable
Increased health care expenses Health care perceived as a right Legal proceedings Insurance delays
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New Patient Confirmation
Letter
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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
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Fee Adjustments
discount cash discounts financial hardship write-offs professional courtesy copayment waiver no charge reduced fee
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Ledger Card
Financial Accounting Record
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Communicating Fees
1. Be courteous at all times but express a firm, businesslike approach that will not offend the patient.
2. Never badger of intimidate a patient into paying; merely state the payment policy and educate the patient.
3. Inform the patient of the fee and any deductible and balance due in a clear manner.
4. Verify the patient’s copayment listed on his or her insurance card and collect this amount before the patient’s office visit.
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Communicating Fees (cont’d.)
5. Make it easier for the patient to pay rather than leave without making payment.
6. Do not give the patient an option by asking if he or she would like to pay now or have a bill sent.
7. Motivate the patient to pay by appealing to his or her honesty, integrity, and pride.
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Collecting Fees
Payment at time of service Payment by check Itemized statements
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Financial Agreement Form
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Demand Letter for Returned
Check
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Itemized Statement
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Collection Decision Tree
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Billing and Collection Guidelines
First statement at time of service Mail second itemized statement Third statement 30 days later First phone call/suspense Second phone call with 5-day notice Written 10-day notice with next steps Take steps indicated in prior statement
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Payment Options
cash check credit card debit card e-checks payment plans
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Credit and Collection Laws
Equal Credit Opportunity Act Fair Credit Reporting Act Fair Credit Billing Act Truth in Lending Act Truth in Lending Consumer Credit Cost
Discloser Fair Debt Collection Practices Act Statute of limitations
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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.
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Collection Form Letter
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Multipurpose Collection
Letter
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Collection Abbreviations
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Insurance Payments
History of accounts Coinsurance payments Insurance checks sent to patients Managed care organizations Medicare Medigap insurance Worker’s compensation Suing a third-party payer
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When to Use a Collection Agency
when patient says he 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
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Collection Agencies
Choosing an agency Types of agencies Agency operating techniques Agency charges Agency assigned accounts
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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.
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Tracing a Debtor (“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.
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Special Collection Issues
bankruptcy terminally ill patients estate claims
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Types of Bankruptcy
Chapter 7 Chapter 9 Chapter 11 Chapter 12 Chapter 13
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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.
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Patient Complaints
Listen. Thank the person. Apologize. Answer the complaint. Be professional, sincere. Take it seriously. Respond in letter form. Be cordial.