1. Financial Administration
Unit 5
Financial Administration

2. Fees, Credit, and Collection
Chapter 13
Fees, Credit, and Collection

3. 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

4. Heart of the Health Care Professional
Service
Answering questions and explaining fees is a courtesy to the patient

5. History of Credit Credit Latin word credere To trust or to believe
Personal integrity
Ability to meet financial obligations

6. History of Credit The Great Depression Today
Start of credit for medical services
Today
Payment expected at time of service
Health insurance contract
Debit and credit cards used

7. 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

8. Fee Schedules “Quantum merit” Fee Schedule: List of Fees for Services
“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

9. Fee Schedules Every physician establishes fees Considerations:
Medical specialty
Education
Experience
Geographic location
Overhead costs

10. Fee Schedules Concierge Fees Medicare Fees Retainer-based medicine
Opt out of insurance programs
Medicare Fees
Participating fee
Nonparticipating fee
Limiting charge
See Example 13-1

11. 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

12. 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

13. 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 13-3

14. 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

15. 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

16. Billing Multipurpose Billing Form Combination bill Insurance form
Routing document
Receipt
May be computer-generated

17. Billing Multipurpose Billing Form Other names:
Charge slip, communicator, encounter form, fee ticket, patient service slip, routing form, superbill, transaction slip

18. Billing Monthly Itemized Statement Computerized bill sent to patient
Balance bill

19. Billing
Ledger card
Charges, payments, adjustments, balance owed
Explain Professional Fees in an Itemized Billing Statement
Procedure 13-1

20. Billing Cycle Billing Billing distributed throughout month
Account number
Insurance type
Date of first service

21. Billing Cycle Billing Allows continuous cash flow
Distributes related duties
Prepare and Post to a Patient’s Account
Procedure 13-3

22. Billing Credit Card Billing Debit Cards (Check Card)
Patient pays fee with credit card
Patient billed by credit card company
Debit Cards (Check Card)
Off-line (electronic check)
On-line (PIN)

23. Billing Smart Cards Individual Responsibility Program (IRP)
Like debit card; embedded with programmable microchip
Individual Responsibility Program (IRP)
Patient pays physician
Insurance reimburses patient

24. Billing Billing Services Prepare Monthly Itemized Billing Statements
Business that handles sending statements
Saves office money and time
Prepare Monthly Itemized Billing Statements
Procedure 13-4

25. Billing
1. Itemized fees for professional services with line-by-line description.
2. Insurance claim submitted showing dates or service billed.
3. Payment received on account from insurance, listing voucher number. United paid 80 percent.
4. Billed patient 20 percent copayment.
5. Patient’s payment check received, listing check number.

26. 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

27. 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 13-5

28. Credit and Collection Laws
Truth in Lending Consumer Credit Cost Disclosure
Disclose:
All costs
Interest, late fees
Prior to time of service

29. 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

30. 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

31. Collections Three Types of Accounts Aging Accounts Open-book account
Written-contract account
Single-entry account
Aging Accounts
Breakdown of days overdue
30, 60, 90, 120

32. Collections Office Collection Problem Solving Credit counseling
Verifying checks
Nonsufficient funds
Bad check preventive measures
Red Flags Rule

33. Collections Office Collection Problem Solving Dun messages
Dun: “to make a loud noise”
Payment reminder phrases

34. Collections Telephone Collections
Perform Debt Collection Using a Telephone
Procedure 13-6
Insurance check sent to patient
Assignment of benefits

35. Collections Collection Letters Form letter Letter with checklist
Personally composed letter
Solutions for payment excuses

36. 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 13-8

37. Collections Small Claims Court Inexpensive Judgment by court
Physician has to pursue payment
File an Uncollectible Account in Small Claims Court
Procedure 13-9

38. Collections Federal Wage Garnishment Law Estate Claims
Attaching debtor’s property or wage
Estate Claims
Claim on estate of deceased patient

39. Collections Bankruptcy Chapter 7: straight petition bankruptcy
Chapter 13: wage-earner’s bankruptcy
Debtor protected by court
Creditor cannot send further statements

40. Collections Tracing a Skip Search via Computer
Patient owes balance, moves, no forwarding address
Procedure 13-10
Search via Computer
Internet search using electronic databases

41. Stop and Think Case Scenarios
Review the scenario “Tackle Payment Obstacles”
Determine what your response should be

42. Stop and Think Case Scenarios
Review the scenario “Handle Collection Problems”
Formulate questions to ask the patient and state what action you will take