Credit and Collections Comprehensive Medical Assisting Managing the Finances in the Practice

Fee Schedules Set by physician Sample Medicare Fee Schedule Helps physician determine reimbursement UCR (usual, customary, and reasonable) RBRVS (resource-based relative value scale) Vary with reimbursement schedules Individual fee schedule for each insurance company contract Each payer has its own Vary with participation status A fee schedule helps a physician determine amount of reimbursement they will receive for services rendered. This fee is based off of the UCR or RBRVS values. Each provider will have an individual fee schedule for each insurance company contract. The fee schedules will also vary within a PAR and nonPAR provider. Medicare fee schedules tend to be the foundation or reference point for all other third party payers. Medicare schedule Participating Non-participating Limiting

Discussing Fees In Advance PATIENT Inform the patient of costs and payment PAYER Identify the payer PHYSICIAN Determine whether the physician participates With a new patient, establish identiy and credit worthiness When discussing feeds in advance: - Inform the patient of costs and payment, - Identify the payer, and - Determine whether the physician participates. With a new patient, establish identiy and credit worthiness.

Forms of Payment Insurance Company Personal Check Credit or Debit Card The company charges but payment is prompt and risk is transferred Cash Personal Check (get two forms of ID) Credit or Debit Card Forms of payment include: cash, personal check, and credit or debit card. Because such a large amount of the physician’s income depends on insurance contracts, it’s important to obtain a copy of the patient’s insurance card at every visit. Eligibility should also be verified prior to the patient seeing the doctor. Insurance Company Check insurance card at each visit Copy both sides of card and keep copies in the chart Verify eligibility INSURANCE CARD

Adjusting Fees A discount or adjustment is not a write-off Always show the office’s full fee with any discount as a credit INSURER’S DISCOUNT Show the difference between full and insurer’s rates as a credit A discount or adjustment is not a write-off PROFESSIONAL COURTESY Show the amount as a credit When adjusting fees, always show the office’s full fee with any discount as a credit. When giving an insurer’s discount, show the difference between the full rate and the insurer’s rates as a credit. When adjusting fees as a professional courtesy, show the amount as a credit. When giving a full payment discount, show the percentage as a credit. Remember that a discount or adjustment is NOT a write-off. FULL PAYMENT DISCOUNT Show the percentage as a credit

Offering credit is another way to receive payment preferred Credit cost – About $8/month Credit source – In-house or third-party financing Like Visa or Mastercard Offering patients credit is another way to receive payment for services. It costs a practice about $8 per month, per patient to extend credit. Physician offices may elect to manage the credit themselves or use another financial institution. Be aware that the Truth in Lending Act requires that any interest and additional charges be disclosed up front. Also, the Fair Debt Collections Act prohibits discrimination. Legal Considerations Interest and charges are legal but must be disclosed Discrimination is not permitted

Collections: Monthly Billing Keep schedule consistent Installment billing includes the current amount due Include: Previous Balance Remember the following Payments (by patient or third party) When it comes to monthly billing: Keep the schedule consistent. Give notice whenever there is a change. Include the previous balance, payments (by patient or third party), and the current balance. Installment billing includes the current amount due. Change requires notice Current Balance

Collections: Aging Accounts Measure general collection efficiency Age runs from billing and not service Flag overdue accounts Remember the following When tracking aging accounts, remember the following: Age runs from billing and not service. You should measure general collection efficiency. Eight percent of fees should be collected within 30 days. Lastly, flag overdue accounts. 80% of fees should be collected within 30 days

Sample Aging Schedules Managed by computer software Paper-based COMPUTERIZED MANUAL Here are examples of a manual aging schedule and a computerized aging schedule. Both contain the same basic information. One is paper-based and the other is managed by a computer software.

Collecting Overdue Accounts Mailed Notice Send form letter via certified mail Telephone Call Document the call Be careful in leaving messages In-office Reminder It’s not a concern if you don’t make it a concern Third Parties Collections agencies and small claims courts are the last resort When collecting over due accounts, letters should be sent certified mail. Any telephone conversion should always be documented in the patient chart. If the patient presents to the office, attempt to collect payment then. Collections agencies and small claims courts are the last resort because the physician’s office must pay out of pocket expenses for these methods.

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