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Survey of Medical Insurance pp ch15
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  • Teaching Notes:   Have students define all key terms as an assignment. Then, in class, ask each student to define one key term aloud.   Optional assignment: Have students do an Internet search of one key term and write a short paragraph describing what they learned about that term from looking at a few websites.
  • Teaching Notes:   Have students define all key terms as an assignment. Then, in class, ask each student to define one key term aloud.   Optional assignment: Have students do an Internet search of one key term and write a short paragraph describing what they learned about that term from looking at a few websites.
  • Learning Outcome: 15.1 Discuss the ways practices explain their financial policies to patients. Pages: 562-565 Teaching Notes:   Have students explain the reasons why effective patient billing begins with sound financial policies and procedures, in their own words. Analyze the sample financial policy in Figure 15.1 as a class.
  • Learning Outcome: 15.2 Describe the purpose and content of patients’ statements and the procedures for working with them. Pages: 565-568 Teaching Notes:   Have students name the information from an RA/EOB that a PMP uses to update the day sheet. (The payer’s payment for each reported procedures is entered; the amount the patient owes for each reported procedure is calculated; if any part of a charge must be written off due to a payer’s required adjustment, this amount is also entered.)
  • Learning Outcome: 15.2 Describe the purpose and content of patients’ statements and the procedures for working with them. Pages: 565-568 Teaching Notes:   Examine the contents of the patient statement in Figure 15.3 (c) with your class.
  • Learning Outcome: 15.3 Compare individual patient billing and guarantor billing. Pages: 568-569 Teaching Notes:   Have your students debate the advantages of the different billing methods, and explain which one they would use.
  • Learning Outcome: 15.3 Compare individual patient billing and guarantor billing. Pages: 568-569 Teaching Notes:   Have your students debate the advantages of the different billing methods, and explain which one they would use.
  • Learning Outcome: 15.4 Discuss the responsibilities of a collections specialist, and describe other positions that are typically part of the billing and collections function. Pages: 569-570 Teaching Notes:   Ask your students to name some reasons why a patient may not have paid their bill. (Patient thinks bill is too high; patient thinks the care rendered was not appropriate or not effective; patient has personal financial problems; bill was sent to an incorrect address; there is a misunderstanding about the amount the patient’s insurance pays on the bill; etc.)
  • Learning Outcome: 15.4 Discuss the responsibilities of a collections specialist, and describe other positions that are typically part of the billing and collections function. Pages: 569-570 Teaching Notes:   Have your students create some examples of embezzlement that could occur in a medical practice.
  • Learning Outcome: 15.5 Describe the processes and methods used to collect outstanding balances due to the medical practice. Pages: 570-576 Teaching Notes:   Have your students practice making pretend phone calls to each other to try to collect an overdue bill.
  • Learning Outcome: 15.5 Describe the processes and methods used to collect outstanding balances due to the medical practice. Pages: 570-576 Teaching Notes:   Review the patient aging report in Figure 15.5 with your class.
  • Learning Outcome: 15.6 Name the two federal laws that govern credit arrangements. Pages: 576-577 Teaching Notes:   Ask your students to name some of the factors that are among the considerations lenders use to determine creditworthiness. (Income; expenses; debts; credit history.)
  • Learning Outcome: 15.6 Name the two federal laws that govern credit arrangements. Pages: 576-577 Teaching Notes:   Create some scenarios that require your students to devise a payment plan to address an overdue balance.
  • Learning Outcome: 15.7 Discuss the tools that can be used to locate unresponsive or missing patients. Pages: 577-581 Teaching Notes:   Have your class discuss the advantages and disadvantages of using a collection agency.
  • Learning Outcome: 15.7 Discuss the tools that can be used to locate unresponsive or missing patients. Pages: 577-581 Teaching Notes:   Ask your students to name the four main points that a written program must address under the Red Flags rule. (See the numbered list on page 580.)
  • Learning Outcome: 15.8 Describe the procedures for clearing uncollectible balances from the practice’s accounts receivable. Pages: 582-583 Teaching Notes:   Have your students name and explain some of the common types of uncollectible accounts.
  • Learning Outcome: 15.8 Describe the procedures for clearing uncollectible balances from the practice’s accounts receivable. Pages: 582-583 Teaching Notes:   Have your students name and explain some of the common types of uncollectible accounts.
  • Learning Outcome: 15.9 Explain the purpose of a retention schedule and the requirements for retaining patient information. Pages: 583-584 Teaching Notes:   Ask your students to describe the changes they think have come about in record retention as medical practices shift toward electronic record keeping.

Transcript

  • 1. 15 Patient Billing and Collections
  • 2. Learning Outcomes
    • When you finish this chapter, you will be able to:
    • 15.1 Discuss the ways practices explain their financial policies to patients.
    • 15.2 Describe the purpose and content of patients’ statements and the procedures for working with them.
    • 15.3 Compare individual patient billing and guarantor billing.
    • 15.4 Discuss the responsibilities of a collections specialist, and describe other positions that are typically part of the billing and collections function.
    15-2
  • 3. Learning Outcomes (Continued)
    • When you finish this chapter, you will be able to:
    • 15.5 Describe the processes and methods used to collect outstanding balances due to the medical practice.
    • 15.6 Name the two federal laws that govern credit arrangements.
    • 15.7 Discuss the tools that can be used to locate unresponsive or missing patients.
    • 15.8 Describe the procedures for clearing uncollectible balances from the practice’s accounts receivable.
    • 15.9 Explain the purpose of a retention schedule and the requirements for retaining patient information.
    15-3
  • 4. Key Terms
    • bad debt
    • bankruptcy
    • collection agency
    • collections
    • collections specialist
    • credit bureaus
    • credit reporting
    • cycle billing
    • day sheet
    • embezzlement
    15-4
    • 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
  • 5. Key Terms (Continued)
    • patient aging report
    • patient refunds
    • patient statement
    • payment plan
    • prepayment plan
    • Red Flags rule
    • retention schedule
    • skip trace
    • Telephone Consumer Protection Act of 1991
    15-5
    • Truth in Lending Act
    • uncollectible accounts
  • 6. 15.1 Patient Billing
    • 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
    15-6
  • 7. 15.2 Working with Patients’ Statements
    • The PMP uses information from an RA/EOB 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.
    15-7
  • 8. 15.2 Working with Patients’ Statements (Continued)
    • 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)
    15-8
  • 9. 15.3 The Billing Cycle
    • 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
    15-9
  • 10. 15.3 The Billing Cycle (Continued)
    • 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
    15-10
  • 11. 15.4 Organizing for Effective Collections
    • 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
    15-11
  • 12. 15.4 Organizing for Effective Collections (Continued)
    • 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
    15-12
  • 13. 15.5 Collection Regulations and Procedures
    • 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
    15-13
  • 14. 15.5 Collection Regulations and Procedures (Continued)
    • 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
    • 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
    15-14
  • 15. 15.6 Credit Arrangements and Payment Plans
    • 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, age, or because a person receives public assistance
      • Truth in Lending Act— law requiring disclosure of finance charges and late fees for payment plans
    15-15
  • 16. 15.6 Credit Arrangements and Payment Plans (Continued)
    • Payment plan— patient’s agreement to pay medical bills according to a schedule
      • Practices have guidelines for appropriate time frames 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
    15-16
  • 17. 15.7 Collection Agencies and Credit Reporting
    • 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
    15-17
  • 18. 15.7 Collection Agencies and Credit Reporting (Continued)
    • Fair Credit Reporting Act (FCRA)— law requiring consumer reporting agencies to have reasonable and fair procedures
    • Fair and Accurate Credit Transaction Act (FACTA)— laws designed to protect the accuracy and privacy of credit reports
    • Red Flags rule— law stating that health care entities must establish reasonable policies and procedures for implementing the identity theft guidelines
    15-18
  • 19. 15.8 Writing Off Uncollectible Accounts
    • 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
    15-19
  • 20. 15.8 Writing Off Uncollectible Accounts (Continued)
    • 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
    15-20
  • 21. 15.9 Record Retention
    • 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 any claims that are questioned
    • Financial records are generally saved according to federal business records retention requirements
    15-21