CHAPTER © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 10 Collections in the Medical Office

© 2013 The McGraw-Hill Companies, Inc. All rights reserved. Learning Outcomes When you finish this chapter, you will be able to: 10.1 Explain the importance of prompt follow-up on insurance claims Summarize the importance of a financial policy in a medical office Identify the laws that regulate collections from patients Demonstrate how to post a payment from a collection agency Discuss the process of writing off uncollectible accounts Explain how to use a patient aging report to identify past-due accounts. 10-2

© 2013 The McGraw-Hill Companies, Inc. All rights reserved. Learning Outcomes (continued) When you finish this chapter, you will be able to: 10.7 Demonstrate how to add an account to the collection list Demonstrate how to create a collection letter Demonstrate how to create a collection tracer report. 10-3

© 2013 The McGraw-Hill Companies, Inc. All rights reserved. Key Terms collection agency collection list collection tracer report payment plan prompt payment laws Tickler timely filing uncollectible accounts write-off 10-4

© 2013 The McGraw-Hill Companies, Inc. All rights reserved Following Up On Insurance Claims 10-5 Receiving prompt payment for services is a critical factor in determining the financial success of a medical practice. Prompt payment laws are state laws that mandate a time period within which clean claims must be paid; if they are not, financial penalties are levied against the payer. Timely filing is the requirement that claims must be submitted to payers within a specific number of days from the date of service.

© 2013 The McGraw-Hill Companies, Inc. All rights reserved The Importance of a Financial Policy 10-6 The collection process begins with a clear financial policy and effective communications with patients about their financial responsibilities. Most patients pay their bills, but every practice has some patients who do not. Patients’ reasons for not paying include: –Lack of insurance. –Lack of financial resources. –Significant medical costs. –Consumer-directed health plans with high out-of- pocket costs. –Lack of understanding that payment is their responsibility.

© 2013 The McGraw-Hill Companies, Inc. All rights reserved The Importance of a Financial Policy (continued) 10-7 It is important to have a written financial policy that spells out patients' responsibilities. Financial policies should tell patients how the practice handles: –Collecting copayments and past-due balances. –Setting up financial arrangements for unpaid balances. –Providing care for patients with low incomes. –Collecting payments for services not covered by insurance. –Collecting prepayments for services. –Accepted different methods of payment.

© 2013 The McGraw-Hill Companies, Inc. All rights reserved Laws Governing Patient Collections 10-8 Patient collections are consumer collections and are regulated by federal and state laws. Collections from insurance carriers are considered business collections. The Fair Debt Collection Practices Act of 1977 and the Telephone Consumer Protection Act of 1991 regulate debt collections, forbidding unfair practices.

© 2013 The McGraw-Hill Companies, Inc. All rights reserved Laws Governing Patient Collections (continued) 10-9 General guidelines forbidding unfair practices include the following: –No calls before 8 A.M. or after 9 P.M. –No threats or profane language –Respect for patient privacy –No deception or violence

© 2013 The McGraw-Hill Companies, Inc. All rights reserved Laws Governing Patient Collections (continued) A payment plan is an agreement between a patient and a practice in which the patient agrees to make regular monthly payments over a specified period of time. –The Truth in Lending Act applies if the practice adds finance charges and the payments are made in more than four installments.

© 2013 The McGraw-Hill Companies, Inc. All rights reserved Working with Collection Agencies A collection agency is an outside firm hired to collect on delinquent accounts. –The practice no longer contacts the patient if the account is turned over to a collection agency. –Collection agencies are often paid on the basis of the amount of money they collect. When payment is received from a collection agency, it must be posted to the patient’s account. –The agency provides a statement that shows which patient accounts have paid and the amounts of the payments.

© 2013 The McGraw-Hill Companies, Inc. All rights reserved Working with Collection Agencies (continued) Transaction Entry dialog box after collections payment is entered

© 2013 The McGraw-Hill Companies, Inc. All rights reserved Writing Off Uncollectible Accounts When all collection attempts are exhausted, the collection process is ended. An uncollectable account is an account that does not respond to collection efforts and is written off the practice’s expected accounts receivable. A write off is a balance that has been removed from a patient’s account.

© 2013 The McGraw-Hill Companies, Inc. All rights reserved Writing Off Uncollectible Accounts (continued) Transaction Entry dialog box after write-off is entered

© 2013 The McGraw-Hill Companies, Inc. All rights reserved Using a Patient Aging Report for Collections An aging report shows the patient’s chart number and name, and the amount of unpaid charges in each of these categories: –Current: Up to 30 days –Past: 31 to 60 days –Past: 61 to 90 days –Past: 91 to 120 days –Past: More than 121 days

© 2013 The McGraw-Hill Companies, Inc. All rights reserved Using a Patient Aging Report for Collections (continued) Sample patient aging report

© 2013 The McGraw-Hill Companies, Inc. All rights reserved Adding an Account to the Collection List Overdue accounts are added to a collection list. The Collection List is designed to track activities that need to be completed as part of the collection process. –Ticklers or collection reminders are displayed as collection list items. A tickler is a reminder to follow-up on an account that is entered on the collection list.

© 2013 The McGraw-Hill Companies, Inc. All rights reserved Adding an Account to the Collection List (continued) The Collection List dialog box displays ticklers that have been entered into the database.

© 2013 The McGraw-Hill Companies, Inc. All rights reserved Adding an Account to the Collection List (continued) Additional information available in the Patient field of the Collection List dialog box

© 2013 The McGraw-Hill Companies, Inc. All rights reserved Adding an Account to the Collection List (continued) Tickler Item dialog box Tickler tabOffice Notes tab

© 2013 The McGraw-Hill Companies, Inc. All rights reserved Creating Collection Letters Before collection letters can be sent in Medisoft: –A patient-responsible tickler item for the patient’s account must be entered in the collection list. –A collection letter report must be created. This report is generated when the Patient Collection Letters option is selected on the Collection Reports submenu of the Reports menu. When an account is added to the collection list, the current balance for the tickler is determined. Once recorded in the tickler, it is not updated when new transactions are entered in the program.

© 2013 The McGraw-Hill Companies, Inc. All rights reserved Creating Collection Letters (continued) Patient Collection Letters selected on the Collection Reports submenu

© 2013 The McGraw-Hill Companies, Inc. All rights reserved Creating Collection Letters (continued) The Patient Collection Report lists patients with overdue accounts to whom statements have been mailed.

© 2013 The McGraw-Hill Companies, Inc. All rights reserved Creating Collection Letters (continued) After printing collection letters, an account alert appears in the Transaction Entry, Quick Ledger, and Appointment Entry windows. There are three account alert abbreviations: –RB – remainder balance –DP – delinquent on payment plan –IC – in collections

© 2013 The McGraw-Hill Companies, Inc. All rights reserved Creating Collection Letters (continued) Transaction Entry dialog box with account alert message displayed

© 2013 The McGraw-Hill Companies, Inc. All rights reserved Creating a Collection Tracer Report A collection tracer report is a tool for keeping track of collection letters that were sent. The report lists: –Tickler item number –Responsible party –Chart number –Account balance –Date collection letter was sent –Reasons the account is in collections Created via the Collection Tracer Report feature on the Reports menu

© 2013 The McGraw-Hill Companies, Inc. All rights reserved Creating a Collection Tracer Report (continued) Collection Tracer Report