Issues and Trends in HBI Ch 14
-
Upload
fallon-brewington -
Category
Technology
-
view
1.183 -
download
0
Transcript of Issues and Trends in HBI Ch 14
CHAPTER
© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.
14Patient Billing and
Collections
Learning Outcomes
When you finish this chapter, you will be able to:14.1 Explain the structure of a typical financial policy.
14.2 Describe the purpose and content of patients’ statements and the procedures for working with them.
14.3 Compare individual patient billing and guarantor billing.
14.4 Classify the responsibilities for each position that is typically part of billing and collections.
14-2
Learning Outcomes (continued)
When you finish this chapter, you will be able to:14.5 Describe the processes and methods used to
collect outstanding balances.
14.6 Name the two federal laws that govern credit arrangements.
14.7 Discuss the tools that can be used to locate unresponsive or missing patients.
14.8 Describe the procedures for clearing uncollectible balances.
14.9 Analyze the purpose of a retention schedule.
14-3
Key Terms
• bad debt• bankruptcy• collection agency• collection ratio• collections• collections specialist• credit bureaus• credit reporting• cycle billing• day sheet• embezzlement
14-4
• Equal Credit Opportunity Act (ECOA)
• Fair and Accurate Credit Transaction Act (FACTA)
• Fair Credit Reporting Act (FCRA)
• Fair Debt Collection Practices Act (FDCPA) of 1977
• guarantor billing
• means test
• nonsufficient fund (NSF) check
Key Terms (continued)
• patient aging report• patient refunds• patient statement• payment plan• prepayment plan• retention schedule• skip trace• Telephone Consumer
Protection Act of 1991
14-5
• Truth in Lending Act
• uncollectible accounts
14.1 Patient Financial Responsibility 14-6
• Effective patient billing begins with sound financial policies and procedures
• Medical practices use many methods to inform patients of their financial policies and procedures:– Payment policies are explained in brochures and on
signs in the reception area as well as orally by registration staff
– Patients are often asked to read and sign a statement that they understand and will comply with the payment policy
– Checks may be accepted but nonsufficient funds (NSF) check may not be honored if account is lacking
14.2 Working with Patients’ Statements 14-7
• The PMP uses information from an RA to update the patient ledger and the day sheet—report summarizing the business day’s charges and payments– These data are used to generate patient statements
—printed bills that show services provided to a patient, total payments made, total charges, adjustments, and balance due
• Patients may owe coinsurance, deductibles, and fees for noncovered services.
14.2 Working with Patients’ Statements (continued)
14-8
• Patient statements are designed to be direct and easy to read, clearly stating:– General information about the practice– Cost breakdown of all services provided– Balances owed– Date of the statement and sometimes the due date for
the payment– Accepted methods of payment (sometimes
necessary)
14.3 The Billing Cycle 14-9
• Cycle billing—type of billing which divides patients with current balances into groups to even out monthly statement printing and mailing– Spreads out the workload– If the billing cycle is weekly, for example, the patient
accounts are divided into four groups so that 25 percent of the bills go out each week
14.3 The Billing Cycle (continued) 14-10
• Patient billing:– Each patient who has a balance receives a mailed
patient statement
• Guarantor billing—grouping patient billing under the insurance policyholder– Statements are grouped by guarantor and cover all
patient accounts that are guaranteed by that individual
– Produces fewer bills to track but can become unwieldy when family members have various health plans and/or secondary plans
14.4 Organizing for Effective Collections 14-11
• The term collections refers to all the activities related to patient accounts and follow-up
• Large practices may have separate collections departments with these typical job functions:– Billing/collections manager—responsible for
establishing office policies and enabling collections specialists to successfully perform their jobs
– Bookkeeper—records funds coming into and going out of the practice
– Collections specialist—staff member with training in proper collections techniques
14.4 Organizing for Effective Collections (continued)
14-12
• Collections specialists:– Trained to work directly with the practice’s patients to
resolve overdue bills– Study aging reports and follow up on patient accounts
that are past due– Act ethically and professionally in contact with
patients
• Embezzlement—stealing of funds by an employee or contractor
14.5 Collection Regulations and Procedures
14-13
• Processes and methods used to collect outstanding balances:– Efforts to collect past-due balances are strictly
regulated by law and by office policy– Both collection letters and phone calls are integral
parts of the collections process– Collections specialists maintain a professional attitude
while being straightforward; they must be prepared for difficult situations and ready to work out credit arrangements and payment plans
14.5 Collection Regulations and Procedures (continued)
14-14
• Fair Debt Collection Practices Act of 1977 (FDCPA)—laws regulating collection practices
• Telephone Consumer Protection Act of 1991—law regulating consumer collections to ensure fair and ethical treatment of debtors
• Collection ratio – average number of days it takes a practice to convert its AR into cash
• Patient aging report—report grouping unpaid patients’ bills by the length of time they remain due– Divides information into categories based on each
statement’s beginning date
14.6 Credit Arrangements and PaymentPlans
14-15
• Two federal laws govern payment arrangements:– Equal Credit Opportunity Act (ECOA)—law that
prohibits credit discrimination on the basis of race, color, religion, national origin, sex, marital status, or age or because a person receives public assistance
– Truth in Lending Act—law requiring disclosure of finance charges and late fees for payment plans
14.6 Credit Arrangements and PaymentPlans (continued)
14-16
• Payment plan—patient’s agreement to pay medical bills according to a schedule– Practices have guidelines for appropriate timeframes
and minimum payment amounts for payment plans
• Prepayment plan—payment before medical services are provided– May be used when patients are scheduled to have
major, expensive procedures
14.7 Collection Agencies and Credit Reporting
14-17
• Practices use a variety of methods to collect funds from patients who have not paid:– Collection agency—outside firm hired to collect
overdue accounts– Credit reporting—analysis of a person’s credit
standing during the collections process– Credit bureaus—organizations that supply
information about consumers’ credit history– Skip trace—process of locating a patient who has an
outstanding balance
14.7 Collection Agencies and Credit Reporting (continued)
14-18
• Fair Credit Reporting Act (FCRA)—law requiring consumer reporting agencies to have reasonable and fair procedures
• Fair and Accurate Credit Transaction Act (FACTA)—law designed to protect the accuracy and privacy of credit reports
14.8 Writing Off Uncollectible Accounts 14-19
• Not all balances due to the practice will be paid• Practices must know when to write off an
account– Uncollectible accounts—monies that cannot be
collected and must be written off– Bad debt—account deemed uncollectible– Means test—process of fairly determining a patient’s
ability to pay– Bankruptcy—declaration that a person is unable to
pay his or her debts
14.8 Writing Off Uncollectible Accounts (continued)
14-20
• Patient refunds—money that needs to be returned to patients when the practice has overcharged a patient for a service– Patients’ refunds or credit balances are handled
differently than insurance overpayments, which must be refunded to the payer
14.9 Record Retention 14-21
• The retention of medical records follows office policy and is also regulated by law– Retention schedule—practice policy governing the
handling and storage of patients’ medical records
• Medical practices must be ready to answer patient requests for information and records and to defend claims that are questioned
• Financial records are generally saved according to federal business records retention requirements
Summary
Summary
Summary