1. Daily Financial Practices
Chapter 19
Daily Financial Practices

2. Daily Financial Practices and the TPMS

3. Patient Fees A major part of managing the clinic’s business details
Informing patients of fees and financial arrangements falls to medical assisting staff
A positive attitude that anticipates that a majority of patients pay their medical bills is helpful

4. Helping Patients Who Cannot Pay
Recognize that there are patients who can have difficulty paying their bills
Those who cannot pay often have to make difficult choices—food or medicine

5. Determining Patient Fees
Usual, reasonable, and customary fees
Discussion of fees
Depends on type of medical facility
Establish fee schedule
Notify patients of fee policies
Medicare: Advanced Beneficiary Notification
Medicaid waiver
Usual, reasonable, and customary fees: see Chapter 17

6. Determining Patient Fees
Adjustment of fees
Medicare, Medicaid, Blue Shield, private health insurance adjustments
Limited-income patients’ “write-offs”
Pitfalls of adjusting fees

7. Determining Patient Fees
Refunds
May occur when insurance pays more than anticipated
Prepare a check for overdue amount to patient
Enter transaction on day sheet and patient account
Total the balance—may bring balance to zero

8. Credit Arrangements
Payment planning
Acceptance of credit/debit cards

9. The Bookkeeping Function
Managing patient accounts
For tax and legal purposes
Maintain account records for each patient
Accounts receivable records
Most common methods to track patient accounts are the manual (pegboard) and computerized accounting systems
Medical assistant should understand both systems

10. The Bookkeeping Function
The importance of good work habits
Always work with care and accuracy
The work must be kept current
Double-check entries for accuracy
List of other good habits for manual bookkeeping system noted in text

11. The Bookkeeping Function
The pegboard system
Write-it-once system
Identify pegboard components
Advantages
Provides up-to-date accounts receivable status
Relatively inexpensive

12. The Bookkeeping Function
Computerized financial systems
Used by the majority of ambulatory care settings
Advantages
Removes much of the “manual” application of bookkeeping process
Can be a part of a total practice management system
(Critical thinking Box in Text)

13. Recording Patient Transactions
Bookkeeping is an “exact” science
Accuracy is a must
Encounter form (charge slip, superbill, multipurpose billing form)

14. Encounter Form
Includes patient information, insurance data, previous balance, current services and charges
Often includes procedure and diagnosis codes
Includes patient’s ID number and provider’s NPI
Fits over pegs in pegboard system

15. Recording Patient Transactions
Patient account or ledger
Patient’s financial history recorded in accounts receivable ledger
Each adult in a family has her/his own ledger
Parent with custody is considered “guarantor” and responsible for a minor’s charges, no matter what a parenting plan states
(Procedure 19-1 – Manual; Procedure Computer)

16. Recording Patient Transactions
Patient account or ledger
Usually a minimum of three columns: debit, credit, balance
Some have space for another column for adjustments
Adjustment column is credit column
(Procedure 19-1 – Manual; Procedure Computer)
see the text for detail, Procedure 19-3 and 19-4 – Computer

17. Recording Patient Transactions
Day sheet
Posting of all financial transactions for professional services
Balanced at the end of the day; gives a complete picture of day’s activities
Come in many different styles; some provide a deposit portion and a section used for business analysis
(Procedure 19-5 – Manual)

18. Recording Patient Transactions
Day sheet
In the pegboard system
The ledger card and encounter form are placed on top of the day sheet
In a computer system
The same data is recorded
Computer database pulls up correct charge, posts to patient account and accounts receivable ledger
(Procedure 19-5 – Manual)

19. Recording Patient Transactions
Receipts
Used for payments on accounts when no services are rendered on that day
Can be created in both pegboard and computerized systems

20. Recording Patient Transactions
Month-end activities
Reconcile month-end figures on day sheet with patients’ ledgers
Time-consuming in manual system but is essential
Provides “checks and balances”

21. Recording Patient Transactions
Computerized patient accounts
Automatically creates encounter form
Calculates charges for monthly billing
Transfers data to produce insurance forms, statements, and deposits
Automatically ages all accounts

22. Recording Patient Transactions
Watch the video

23. Banking Procedures Types of accounts; online banking
Checking account is primary account
Selecting an account
Features are identified in text
Savings accounts
Money market
Interest generating checking/savings accounts
(see Critical Thinking in the text)

24. Banking Procedures Types of checks Cashier’s check Certified check
Money orders
Voucher check
Traveler’s checks or ATM machines when traveling

25. Banking Procedures Deposits Usually made daily Endorsements
Deposit slips
Procedure 19-6

26. Banking Procedures Cash on hand For change Receipts required
Balance daily

27. Banking Procedures Accepting checks
Inspect check for correct information
Do not accept a third-party check unless it is from insurance carrier
“Insufficient funds”
See the text on steps to take. (Procedure 19-9)

28. Banking Procedures Lost or stolen checks Report to bank
Stop payment order
Check signatures for possible forgery

29. Banking Procedures Writing and recording checks Purposes
To pay bills (accounts payable)
Refunds of overpayment
Replenish petty cash
Check components
Rules for writing checks
(Procedure 19-10)

30. Banking Procedures Reconciling a bank statement
Performed at least monthly
Ensures that accounts receivable is accurate for previous month
(Procedure 19-7)

31. Purchasing Supplies and Equipment
Ensure proper control over purchasing
Preparing a purchase order
Verifying goods received
Check against purchase order as unpacking items
Note discrepancies

32. Petty Cash Totally separate from cash on hand
Establishing a petty cash fund
Tracking, balancing, and replenishing petty cash
Track with petty cash vouchers
Balance and replenish when fund gets low