1. MD AAHAM Presented by: Mary Prendergast I.C. System, Inc.
Nice People Can Collect
Delinquent Patient Accounts
MD AAHAM
Presented by:
Mary Prendergast
I.C. System, Inc. .

2. AGENDA Policy formation Enforcement alternatives
Telephone pre-call plan
Collection laws
Objections
Urgency

3. Write Financial Policies OR Patients Will Write Them for You
Financial policies include both credit and collection
Most healthcare providers have a credit policy
Few have an effective collection policy

4. Patient Financial Form (sample 1)
PATIENT INFORMATION FORM Date______________________
Name________________________________________________________________Birth date________________Sex_____
Address________________________________________________City______________________State____Zip___________
Phone____________________________Work Phone________________________Cell Phone__________________________
Social Security #__________________________ Driver’s License # _________________________
FINANCIALLY RESPONSIBLE PARTY:
Name ______________________________________________________________________Relationship________________
Address________________________________________________City______________________State___Zip____________
Social Security #_______________________________Birth date______________________________
EMERGENCY CONTACT INFORMATION:
Employer____________________________________________________________Phone_____________________________
Name of Spouse_______________________________________________________Work Phone_______________________
Name of Relative______________________________________________________Phone_____________________________
Home Address__________________________________________ City______________________State____Zip___________
REFERRAL INFORMATION: How did you hear about us? _______________
Name of Referring Party________________________________________________Phone____________________________
INSURANCE INFORMATION:
Primary Carrier________________________________________________________________________________________
Address________________________________________________City______________________State____Zip__________
Phone_____________________________Policy #______________________Group #________________________________
Secondary Carrier______________________________________________________________________________________
Address_______________________________________________________________________________________________
FINANCIAL RESPONSIBILITY:
This information is accurate and true to the best of my knowledge. I understand I am responsible to pay for services
rendered, including reasonable attorney’s fees and costs of collection in the event of default.
Signature___________________________________________________________Date_______________________________
In a small business or practice, it is generally the owner who sets the attitude, but anyone can write your policy. If you have more than one owner, you need to decide whose attitude is dominant. “Pay if you can, and if you can’t don’t worry about it” – “We offer good services and are entitled to be paid fairly”. The collector’s attitude will mirror the business attitude, so it is important that the attitude be positive.

5. Financial Policy (sample 1)
Welcome
Thank you for choosing us as your healthcare provider.  We are committed to providing you with the best possible care and to your treatment being successful.  Your clear understanding of our financial policy is important to our professional relationship. Please understand that payment of your bill is considered part of your overall treatment.  In order to keep your cost of healthcare to an absolute minimum, we have adopted the following policies. 
Fees and Payments
Fees are standardized and are based on the complexity of your visit or procedure.  Payment of co-payments and any outstanding balance is required at the time of service.  We accept cash, personal checks, money orders, Visa or MasterCard.  While the filing of insurance claims is a courtesy that we extend to our patients, all charges are your responsibility from the date that services are rendered.   In order for us to file a claim, you must present a current copy of your insurance card at each visit and communicate any changes in your personal contact information.
Most insurance policies specify that some of the cost of the patient’s care is the patient’s responsibility.  This can be accomplished through any combination of co-payments, coinsurance, or deductibles.  Co-payments are due when you check in for your appointment.  Coinsurance and deductibles are determined by your insurance company and reported to us on your explanation of benefits.  Once we are notified, we will add the appropriate charge to your account and send you a statement.  This charge is payable upon receipt of the statement.  Once payments are received, they will be automatically applied to the oldest outstanding balance.  If you would like a payment to be applied to a specific charge, please notify our staff at the time of payment.
Insurance Plans
Your insurance coverage is a contract between you, your employer, and the insurance company; we are not a party to that contract.  We must emphasize that as healthcare providers, our relationship is with you, not with your insurance company.  Before your visit, please contact your insurance company to verify the physician that you are scheduled with participates with your plan and that the services that you intend to receive are covered.  In addition, because some insurance plans require either pre-certification and/or a referral from a primary care provider before you can be seen, please ask if these are required and obtain them if necessary.
Not all services are a covered benefit in all plans so it is very important that you understand the provisions of your individual policy.  Some insurance companies arbitrarily select certain services they will not cover and so we cannot guarantee payment of all claims by your insurance company.  If your insurance company pays only a portion of your claim or rejects your claim, they will notify you through an explanation of benefits.  Reduction or rejection of your claim by your insurance company does not relieve you of your financial obligation. Initials _________
In a small business or practice, it is generally the owner who sets the attitude, but anyone can write your policy. If you have more than one owner, you need to decide whose attitude is dominant. “Pay if you can, and if you can’t don’t worry about it” – “We offer good services and are entitled to be paid fairly”. The collector’s attitude will mirror the business attitude, so it is important that the attitude be positive.

6. Financial Policy (sample 1)
Screening Procedures
Insurance plans will only cover services that they determine to be medically reasonable or necessary.  It is important that you check with your insurance company to determine your colorectal screening benefits.  Please note that if you are scheduled for screening procedure and any condition or diagnosis is found both the screening diagnosis and the discovered condition are required to be reported.  Some insurance plans including Medicare have different coverage for screening versus diagnostic procedures so it is important that you understand your benefits carefully.
Procedure Charges
Patients undergoing procedures will receive two separate bills.  One bill is the physician’s fee and the other will be from the facility where your procedure was performed.  In addition, if a biopsy is done during a procedure, you may receive an additional bill from the lab facility that performs your biopsy.  Please contact the lab facility directly to discuss any questions with your lab bill.
Making and Keeping Appointments
If you need to cancel your appointment, please call at least 24 hours in advance. This allows us to accommodate other patients who need to be seen.  Excessive no shows may result in a charge being added to your account and you may also be dismissed from the practice. Initials __________
Non-Payment of Outstanding Accounts
Accounts that are not paid in a reasonable amount of time may be sent to an external collections agency and reported to the credit bureaus.  If this occurs, you may also be dismissed from the practice.  In addition to your outstanding balance, you may also be responsible for any fees or charges that we incur from the external collections agency while attempting to collect your balance. Initials ___________
Administrative Fees
Forms Charge – If your employer requires Family Medical Leave Act or Disability paperwork to be completed by your provider, the turnaround time is five business days and there is a $25 fee for this service, payable in advance. 
Medical Records Charge – If you would like a copy of your medical records sent to yourself or another physician, these copies are billed on a per page basis, payable in advance, in accordance with HIPAA and Ohio state law.  The per page fee schedule is available upon request.  If a collaborating physician (primary care or specialist) requests portions of your chart to assist in your care, there is no charge. Returned Check Charge – Non Sufficient Funds (NSF) checks are subject to a $30 fee (in addition to fees from your bank).
One reason for this slide is to let you know that many companies go even further to collect accounts, including adding fees, collection charges, interest, charging for no shows, etc.
The key is to remember that repetition is key to success: As you continue to reinforce your policies on a daily basis, your patient base understands it, asking for co-pays and payments at time of service is nothing more than a formality.

7. Updating Information Ideas on collecting more cash:
Call the day before and remind patient to bring insurance card and method to pay co-pay
Collect co-pays at time of service
One of the biggest excuses is “I don’t have it today”. Do we agree that people do not leave their house without a drivers license, checkbook, or credit cards?
A great one my Pediatrician uses: Add on the financial policy that if you have to bill them, a $5 billing fee will be added to the account – and the discharge staff asks that in a question format at time of dismissal.
Get new insurance information on every visit
Ask for insurance cards to copy on every visit. When the guarantor calls for the appointment, remind them not to forget the insurance card!
Require a new financial policy and patient financial form to be completed annually as a minimum
Outsource all areas of the A/R process that are redundant or cost inhibitive
Outstanding Insurance and Self Pay A/R at 30 or 60 days including calls, letters, both
Remind Patients of Standard Insurance Policies
As a reminder, most insurance plans do not cover all procedures and there may be a balance due in addition to your co-pay and will be shown on our statements. If you feel a procedure should be covered, notify our office immediately. Thank you!
Insurance: Most insurance companies provide wallet cards.

8. Keys to Remember When Writing Your Collection Policy
Write it when you are focused
Keep it simple
Talk through the policy with your staff
Tell your patients about it
Four elements of a policy…

9. Collection Policy Element One
Define, in writing, the hospital’s or practice’s attitude toward collecting delinquent patient accounts

10. Collection Policy Element Two
Identify people responsible for dealing with delinquent patients
Authorized to negotiate?
Allowed to make exceptions?

11. Collection Policy Element Three
Decide what techniques you will use internally
Statement messages
Letters
Phone calls
Personal contact inside
Termination of services
Discounts, charity care
Payment plans, charge interest

12. Collection Policy Element Four
Determine how far you will go to enforce patient collections
Legality
Ethics
Practice financial viability
Consistent with practice discount and charity care policies

13. Bona Fide Patient Payment Strategies
Internal
Termination of Services
Charge interest, fees
Third party
Impact credit
Court action
Small claims, attorney
Collection agency

14. Time is Money…Your Money!
SOURCE: ACA International’s Top Collection Market Survey
(percents rounded to nearest tenth)

15. When do Delinquent Patient Accounts go to Collection?
Decision-maker
Final Notice: “Contact us within ten days regarding your payment plans or we have no alternative but to allow this account to proceed to collections.”
Guarantees 100% “response”
Pay you
Contact you
Ignore you

16. Other Pre-collection Options
Send letters
Make phone calls
Face-to-face meetings
Know each patient’s issues
When enough is enough

17. Six Signals of Lost Communication
Patient tells you when to act
Ignores phone calls, letters
Lies, breaks promises
Displays bullying attitude
Uses loud, abusive language
Threats or wild accusations
Refuses to talk or hangs up

18. Collection Policy Timelines
Activity
Internal efforts
Letter services
Collection agency
Credit reporting
Litigation
Time to fulfill role
 60 to 90 days
 30 to 90 days
 6 to 24 months
 30 days to 7 years
 2 years average

19. Policy Review Compare credit and collection policies
Four elements of your collection policy
Bona fide collection strategies
Signals of lost communication
Collection policy timelines

20. Collection Laws Federal State
Tips to learn law, remember it, and avoid violations

21. FDCPA (1978) Purpose
Remove unfair competitive advantage by abusive third-party collectors
Stop abusive, deceptive, unfair practices by third-party collectors

22. FDCPA Coverage
Governs collection agencies and attorneys who collect for their clients

23. TCPA (1991) The TCPA is the Telephone Consumer Protection Act
States that an agency cannot call a cell phone on an auto-dialer without consent
Any guesses on the PENALTY ($_____) per dialed attempt IF the court finds the violation willful?

24. TCPA PENALTY
The PENALTY per dialed attempt IF the court finds the violation willful is… $1,500!

25. Maryland State Law
Maryland has in place financial assistance programs, regulations and laws that protect consumers from medical debt and medical debt collectors. The law, known as Senate Bill 776, requires that health care providers and collection agencies follow the policies below.
Health care providers and hospitals need to set up and adhere to policies that providing free and reduced cost health care services. In addition, they need to ensure patients are aware of these programs, and they must post notices about these assistance programs in areas throughout the facility that are accessible to patients.
Hospitals need to have standard applications for people to use when applying for financial assistance, and they must provide these applications to all uninsured and/or low income patients. Many also offer free health care.
If a hospital sends an paid bill to a medical debt collector who then proceeds to collect the balance on behalf of the hospital, the hospital must manage, follow up on, and actively oversee the debt collector’s practices and methods.

26. Maryland State Law (continued)
Per the Maryland law, a hospitals can’t sell outstanding medical debts to a debt collection agency. Selling unpaid bills to debt collectors had previously been a way for hospitals to get partial payment on the bill while letting go of their collection responsibilities. When this occurred in the past, this policy often resulted in aggressive, abusive, and sometimes illegal debt collection practices.
When a consumer receives a bill, the hospitals must also send an easy-to-read information sheet along with the hospital bill that explains who the patient can contact about the bill, how to apply for financial assistance and government programs such as Medicaid or other programs that might help, they need to advise them as to the patient’s rights with respect to the bill, and they need to notify them that they will receive separate medical bills for physician services or what may not be covered.
Charity care and financial assistance programs are required by Maryland law, and these programs need to provide free or low cost medically necessary care for low to moderate income families and patients. Free health care is provided to patients with family incomes that is at or below 150 percent of the federal government poverty level. Reduced costs must also be offered to other low income patients with total family incomes above percent of poverty levels.

27. Maryland State Law (continued)
Hospitals are prohibited from charging interest on medical bills and debts that are incurred by self-pay patients before a court judgment is obtained, so it must go through the legal process.
Another Maryland law (Health General §19-710) prohibits health care providers and hospitals from collecting from a patient money for any bills that are owed by a health maintenance organization (HMO) for a covered service, and this process is widely known as balanced billing
Unfortunately current Maryland laws and regulations still allows liens to be placed on patients’ homes to collect unpaid medical debt, and these liens can even result in foreclosure and the patient losing their home. However, this issue is currently under review by the state government.

28. Conforming to State and Federal Laws
General rules to protect yourself
Always tell the truth
Don’t pretend to be an attorney or collection agency
Be proud of who you are and what you do
Keep things confidential
Follow the golden rule
Stick to official debt collection and credit reporting channels
Record collection course participation; record of training

29. Collection Law Summary
Purpose of federal law
Who this law covers
Tips to help you understand, remember and avoid violations

30. Telephone Pre-call Plan
Preparation turns potential into reality
The pre-call plan
Gather facts and documents
Review history, potential objections
Know what you will/won’t accept
Call when patients are available

31. Handling Payment Objections (four-step system)
Purpose of a system
Increases chances in any situation
Get money vs. win arguments

32. Handling Objections Step 1
Acknowledge that you are listening
Words that say you are paying attention
I see
Yes
Uh huh
Really
I see…
Really…
Yes…
Uh huh…

33. Handling Objections Step 2
Agree with what the patient said as being reasonable
“I can see how you would feel that way”
“Others have said that”
“That must have been awful”
Stick with steps 1 and 2 as long as necessary

34. Handling Objections Step 3
Use a transitional word or phrase as a bridge to the answer
The best words
And
Furthermore
Likewise
Moreover

35. Handling Objections Step 3
Don’t blow up your bridge with the worst word to say at this point…
Any guesses on the worst word that you could say?
--Jeremy to give a MUG away---

36. BUT Handling Objections Step 3
Don’t blow up your bridge with the worst word to say at this point…
BUT

37. Handling Objections Step 4
Answer the objection if you can
Identify the most common patient payment objections
Write official answers to these objections
Practice the 4 steps with a partner
Use a turnabout question if you don’t have an answer

38. Turnabout Questions Are you refusing to pay?
What is preventing you from paying?
What has to happen to get this bill paid?
When can I expect a check in my office?

39. Create Urgency Through Word Choice
Any guesses on the best word that you could say to create urgency?

40. Create Urgency Through Word Choice
TODAY!

41. Create Urgency by Using TODAY
How much will you handle today?
Pay all today
Pay something today
Post-dated check today, credit card payment today
Commitment today
Make haste calmly
Important, vital, now, immediately, crucial, this morning,
this afternoon…
When today won’t work
Rush future results by assuming earliest action

42. Urgency to Rush Future Payments
Patient view: Practice view:
Next month = 29th, 30th, 31st  Next month = 1st
Next week = Friday  Next week = Monday
Tomorrow = pm  Tomorrow = am
Today = 5 pm  Today = 9 am

43. Urgency Through Deadlines
Deadlines must be meaningful to patient
Date of staff meeting to discuss which delinquent patients go to collection
Date of staff meeting to review patient requests for exceptions
Actual date the delinquent patient account goes to collection

44. Urgency for Bigger Payments
Don’t ask Do ask
How much per month?  How long to pay off?
How much you’ll send?  How much short?
Can you…  Will you...

45. REVIEW Policy formation Collection alternatives Collection laws
Telephone pre-call plan
Patient payment objections
Urgency

46. Nice People Can Collect Delinquent Patient Accounts
Thank you for attending!
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