md aaham presented by: mary prendergast i.c. system, inc. nice people can collect delinquent patient...

MD AAHAMPresented by: Mary PrendergastI.C. System, Inc.

Nice People Can Collect Nice People Can Collect Delinquent Patient Delinquent Patient AccountsAccounts

© 2012 I.C. System, Inc.

Policy formation Enforcement alternatives Telephone pre-call plan Collection laws Objections Urgency

AGENDA


Write Financial Policies ORPatients Will Write Them for You

Financial policies include both credit and collection Most healthcare providers have a

credit policy Few have an effective collection

policy

PATIENT INFORMATION FORM Date______________________

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_______________________________

Patient Financial Form (sample 1)

WelcomeThank 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 professionalrelationship. 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 PaymentsFees 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 PlansYour 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 _________

Financial Policy (sample 1)

Screening ProceduresInsurance 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 ChargesPatients 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 AppointmentsIf 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 AccountsAccounts 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 FeesForms 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).

Financial Policy (sample 1)

Ideas on collecting more cash:Call the day before and remind patient to bring insurance card and method to pay co-payCollect 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 visitAsk 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 inhibitiveOutstanding Insurance and Self Pay A/R at 30 or 60 days +- including calls, letters, both

Remind Patients of Standard Insurance PoliciesAs 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!

Updating Information


Keys to Remember When Writing Your Collection Policy

Write it when you are focused Keep it simple Talk through the policy with your staff Tell your patients about it Four elements of a policy…


Define, in writing, the hospital’s or practice’s attitude toward collecting delinquent patient accounts

Collection Policy Element One


Identify people responsible for dealing with delinquent patients

Authorized to negotiate?

Allowed to make exceptions?

Collection Policy Element Two


Decide what techniques you will use internally Statement messages Letters Phone calls Personal contact inside Termination of services Discounts, charity care Payment plans, charge

interest

Collection Policy Element Three


Collection Policy Element Four

Determine how far you will go to enforce patient collections

Legality Ethics Practice financial

viability Consistent with

practice discount and charity care policies


Bona Fide Patient Payment Strategies

Internal

Termination of Services

Charge interest, fees

Third party

Impact credit

Court action

Small claims, attorney

Collection agency


Time is Money…Your Money!

SOURCE: ACA International’s Top Collection Market Survey(percents rounded to nearest tenth)


When do Delinquent Patient Accounts go to Collection?

Decision-maker Final Notice: “Contact us within ten

days regarding your payment plans or we have no alternative but to allow this account to proceed to collections.”

Guarantees 100% “response”1. Pay you2. Contact you3. Ignore you


Other Pre-collection Options

Send letters Make phone calls Face-to-face meetings Know each patient’s issues When enough is enough


Six Signals of Lost Communication

Patient tells you when to act

1. Ignores phone calls, letters2. Lies, breaks promises3. Displays bullying attitude4. Uses loud, abusive language5. Threats or wild accusations6. Refuses to talk or hangs up


Collection Policy Timelines

Activity1. Internal efforts2. Letter services3. Collection

agency4. Credit reporting5. Litigation

Time to fulfill role 60 to 90 days 30 to 90 days 6 to 24 months 30 days to 7

years 2 years average


Compare credit and collection policies

Four elements of your collection policy

Bona fide collection strategies Signals of lost communication Collection policy timelines

Policy Review


Federal State Tips to learn law,

remember it, and avoid violations

Collection Laws


Remove unfair competitive advantage by abusive third-party collectors

Stop abusive, deceptive, unfair practices bythird-partycollectors

FDCPA (1978) Purpose


Governs collection agencies and attorneys who collect for their clients

FDCPA Coverage


The TCPA is the Telephone Consumer Protection Act

States that an agency cannot call a cell phone on an auto-dialer without consent

Any guesses on the PENALTY ($_____) per dialed attempt IF the court findsthe violation willful?

TCPA (1991)


The PENALTY per dialed attempt IFthe court finds the violation willful is…

$1,500!

TCPA PENALTY


Maryland State Law Maryland has in place financial assistance programs, regulations and laws

that protect consumers from medical debt and medical debt collectors. The law, known as Senate Bill 776, requires that health care providers and collection agencies follow the policies below.

Health care providers and hospitals need to set up and adhere to policies that providing free and reduced cost health care services. In addition, they need to ensure patients are aware of these programs, and they must post notices about these assistance programs in areas throughout the facility that are accessible to patients.

Hospitals need to have standard applications for people to use when applying for financial assistance, and they must provide these applications to all uninsured and/or low income patients. Many also offer free health care.

If a hospital sends an paid bill to a medical debt collector who then proceeds to collect the balance on behalf of the hospital, the hospital must manage, follow up on, and actively oversee the debt collector’s practices and methods.


Maryland State Law (continued)

Per the Maryland law, a hospitals can’t sell outstanding medical debts to a debt collection agency. Selling unpaid bills to debt collectors had previously been a way for hospitals to get partial payment on the bill while letting go of their collection responsibilities. When this occurred in the past, this policy often resulted in aggressive, abusive, and sometimes illegal debt collection practices.

When a consumer receives a bill, the hospitals must also send an easy-to-read information sheet along with the hospital bill that explains who the patient can contact about the bill, how to apply for financial assistance and government programs such as Medicaid or other programs that might help, they need to advise them as to the patient’s rights with respect to the bill, and they need to notify them that they will receive separate medical bills for physician services or what may not be covered.

Charity care and financial assistance programs are required by Maryland law, and these programs need to provide free or low cost medically necessary care for low to moderate income families and patients. Free health care is provided to patients with family incomes that is at or below 150 percent of the federal government poverty level. Reduced costs must also be offered to other low income patients with total family incomes above 150 percent of poverty levels.


Hospitals are prohibited from charging interest on medical bills and debts that are incurred by self-pay patients before a court judgment is obtained, so it must go through the legal process.

Another Maryland law (Health General §19-710) prohibits health care providers and hospitals from collecting from a patient money for any bills that are owed by a health maintenance organization (HMO) for a covered service, and this process is widely known as balanced billing

Unfortunately current Maryland laws and regulations still allows liens to be placed on patients’ homes to collect unpaid medical debt, and these liens can even result in foreclosure and the patient losing their home. However, this issue is currently under review by the state government.

Maryland State Law (continued)


General rules to protect yourself Always tell the truth Don’t pretend to be an attorney or collection

agency 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; record of

training

Conforming to State and Federal Laws


Purpose of federal law

Who this law covers

Tips to help you understand, remember and avoid violations

Collection Law Summary


Preparation turns potential into reality

The pre-call plan Gather facts and documents Review history, potential objections Know what you will/won’t accept Call when patients are available

Telephone Pre-call Plan


Purpose of a system

Increases chances in any situation

Get money vs. win arguments

Handling Payment Objections (four-step system)


Acknowledge that you are listening

Words that say you are paying attention I see Yes Uh huh Really

I see…

Yes…

Uh huh…

Really…

Handling Objections Step 1


Agree with what the patient said as being reasonable “I can see how you would feel that way” “Others have said that” “That must have been awful”

Stick with steps 1 and 2 as long as necessary



Use a transitional word or phrase as a bridge to the answer

The best words

And Furthermore Likewise Moreover



Don’t blow up your bridge with the worst word to say at this point…

Any guesses on the worst wordthat you could say?



Don’t blow up your bridge with the worst word to say at this point…




Answer the objection if you can Identify the most common patient

payment objections Write official answers to these

objections Practice the 4 steps with a partner

Use a turnabout question if you don’t have an answer


Turnabout Questions

Are you refusing to pay? What is preventing you from paying? What has to happen to get this bill paid? When can I expect a check in my office?


Create Urgency Through Word Choice

Any guesses on the best wordthat you could say to create urgency?


Create Urgency Through Word Choice


Create Urgency by Using TODAY

How much will you handle today? Pay all today Pay something today Post-dated check today, credit card payment today Commitment today Make haste calmly

Important, vital, now, immediately, crucial, this morning,this afternoon…

When today won’t work Rush future results by assuming earliest action


Urgency to RushFuture Payments

Patient view: Practice view:

Next month = 29th, 30th, 31st Next month = 1st

Next week = Friday Next week = Monday

Tomorrow = pm Tomorrow = am Today = 5 pm Today = 9 am


Urgency Through Deadlines

Deadlines must be meaningful to patient

Date of staff meeting to discuss which delinquent patients go to collection

Date of staff meeting to review patient requests for exceptions

Actual date the delinquent patient account goes to collection


Urgency for Bigger Payments

Don’t ask Do ask How much per month? How long to

pay off? How much you’ll send? How much

short? Can you… Will you...


REVIEW Policy formation Collection alternatives Collection laws Telephone pre-call plan Patient payment objections Urgency


Thank you for attending!

Questions on collections?Call 800-279-3511Visit www.icmemberbenefits.com

Currently available…FREE booklet of collection tips titled THE IN$IDE FACT$

Nice People Can Collect Nice People Can Collect Delinquent Patient AccountsDelinquent Patient Accounts

md aaham presented by: mary prendergast i.c. system, inc. nice people can collect delinquent patient...

Documents

work phone

cell phone

wor phone

credit policy

patient information

insurance information

financial policies

referral information