©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Unit 5 Financial Administration

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Chapter 13 Fees, Credit, and Collection 2

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Objectives Review the learning and performance objectives for this chapter By the end of this chapter, demonstrate the procedures in the textbook and the job skills in the workbook 3

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Heart of the Health Care Professional Service –Answering questions and explaining fees is a courtesy to the patient 4

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. History of Credit Credit –Latin word credere –To trust or to believe Personal integrity Ability to meet financial obligations 5

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. History of Credit The Great Depression –Start of credit for medical services Today –Payment expected at time of service –Health insurance contract –Debit and credit cards used 6

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. History of Credit Credit and Collection Information –Complete, accurate registration Personal information Financial history Review before patient leaves office –Includes insurance information Used to bill insurance company 7

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Fee Schedules “Quantum merit” –“As much as he deserves” Fee Schedule: List of Fees for Services –Required by federal regulations –Separate schedules allowed in some states Workers’ compensation Medicare/managed care Private pay 8

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Fee Schedules Every physician establishes fees Considerations: –Medical specialty –Education –Experience –Geographic location –Overhead costs 9

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Fee Schedules Concierge Fees –Retainer-based medicine –Opt out of insurance programs Medicare Fees –Participating fee –Nonparticipating fee –Limiting charge –See Example

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Fee Schedules Changes in Fees and Discounts –Hardship discounts Dependent on income level Hill-Burton Act (hospital) –Professional courtesy Waive or reduce fees –Copayment waiver Not recommended 11

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Fee Schedules Fee Splitting –One physician pays another for referrals –Unethical and felony in some states –Medicare and Medicaid have antifraud and abuse provisions against this practice 12

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Fee Schedules Discussing Fees –State fees, answer questions –Fee-for-service collected at time of visit –Copayment collected at visit –Guidelines for Communicating Fees State clear and accurate See Example

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Fee Schedules Discussing Fees –Signs of a “deadbeat” Incomplete registration form Questionable employment record No business or home telephone Many moves of residence or Motel address Record of doctor hopping No referral No insurance 14

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Billing Payment at Time of Service –Emphasize options and incentives to patient See Example 13-4 –Meeting with patient Face-to-face Discussion of outstanding balance 15

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Billing Multipurpose Billing Form –Combination bill –Insurance form –Routing document –Receipt –May be computer-generated 16

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Billing Multipurpose Billing Form –Other names: Charge slip, communicator, encounter form, fee ticket, patient service slip, routing form, superbill, transaction slip 17

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Billing Monthly Itemized Statement –Computerized bill sent to patient Itemized Balance bill 18

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Billing Ledger card –Charges, payments, adjustments, balance owed Explain Professional Fees in an Itemized Billing Statement –Procedure

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Billing Cycle Billing –Billing distributed throughout month Account number Insurance type Date of first service 20

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Billing Cycle Billing –Allows continuous cash flow –Distributes related duties –Prepare and Post to a Patient’s Account Procedure

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Billing Credit Card Billing –Patient pays fee with credit card –Patient billed by credit card company Debit Cards (Check Card) –Off-line (electronic check) –On-line (PIN) 22

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Billing Smart Cards –Like debit card; embedded with programmable microchip Individual Responsibility Program (IRP) –Patient pays physician –Insurance reimburses patient 23

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Billing Billing Services –Business that handles sending statements –Saves office money and time Prepare Monthly Itemized Billing Statements –Procedure

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Billing 1. Itemized fees for professional services with line-by-line description. 5. Patient’s payment check received, listing check number. 4. Billed patient 20 percent copayment. 3. Payment received on account from insurance, listing voucher number. United paid 80 percent. 2. Insurance claim submitted showing dates or service billed. 25

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Credit and Collection Laws Fair Debit Collection Practices Act (FDCPA) –Guidelines for collection practices Equal Credit Opportunity Act –If credit extended to one patient, it must be extended to all who request it 26

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Credit and Collection Laws Federal Truth in Lending Act –Governs all who charge interest and agrees to more than four payments –Interest rates governed by state laws –“Regulation Z” disclosure form for payment plans –Establish a Financial Agreement with a Patient Procedure

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Credit and Collection Laws Truth in Lending Consumer Credit Cost Disclosure –Disclose: All costs Interest, late fees Prior to time of service 28

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Credit and Collection Laws Fair Credit Billing Act –Patient: 60 days from statement to complain of error –Provider: acknowledged within 30 days –Provider: 90 days to correct Fair Credit Reporting Act (FCRA) –Accuracy and privacy in consumer reports 29

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Credit and Collection Laws Credit Bureaus –Noninvestigative consumer credit reports Applying for credit –Investigative reports Requested by insurance companies, employers, credit grantors, and others –Physician can join credit bureaus Obtain information over telephone 30

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Collections Three Types of Accounts –Open-book account –Written-contract account –Single-entry account Aging Accounts –Breakdown of days overdue 30, 60, 90,

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Collections Office Collection Problem Solving –Credit counseling –Verifying checks Nonsufficient funds Bad check preventive measures Red Flags Rule 32

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Collections Office Collection Problem Solving –Dun messages Dun: “to make a loud noise” Payment reminder phrases 33

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Collections Telephone Collections –Perform Debt Collection Using a Telephone Procedure 13-6 –Insurance check sent to patient Assignment of benefits 34

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Collections Collection Letters –Form letter –Letter with checklist –Personally composed letter –Solutions for payment excuses 35

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Collections Collection Agencies –Select Collection Agency Procedure 13-7 –Take Collection Action, Write Off an Uncollectable Account, Then Post Money from a Collection Agency Procedure

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Collections Small Claims Court –Inexpensive –Judgment by court –Physician has to pursue payment –File an Uncollectible Account in Small Claims Court Procedure

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Collections Federal Wage Garnishment Law –Attaching debtor’s property or wage Estate Claims –Claim on estate of deceased patient 38

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Collections Bankruptcy –Chapter 7: straight petition bankruptcy –Chapter 13: wage-earner’s bankruptcy –Debtor protected by court –Creditor cannot send further statements 39

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Collections Tracing a Skip –Patient owes balance, moves, no forwarding address –Procedure Search via Computer –Internet search using electronic databases 40

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Stop and Think Case Scenarios Review the scenario “Tackle Payment Obstacles” –Determine what your response should be 41

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Stop and Think Case Scenarios Review the scenario “Handle Collection Problems” –Formulate questions to ask the patient and state what action you will take 42