Y khoa - Dược - Chapter 20: Patient billing and collection

20Patient Billing and CollectionLearning Outcomes (cont.)20.1 Describe accounts receivable and accounts payable and the common payment methods accepted in medical practices today.20.2 Identify the different types of documents used as statements to bill patients and how these documents are used in cycle billing.20.3 Compare open book, written-contract, and single- entry accounts, and purpose of creating an accounts receivable aging.Learning Outcomes (cont.)20.4 Explain the purposes of the following credit and collections acts: ECOA, FCRA, and FDCPA, and TLA. 20.5 Relate the required components of a Truth in Lending statement.20.6 Summarize two common types of problem collection accounts in the medical office.Introduction Payment arrangementsThird-party payers Balance billingPayment plansOutstanding balancesYou must understand and administer billing as well as payment collection methodsPatient Payments in the OfficeManagement ofAccounts receivable (A/R)Accounts payable (A/P)Billing and collections – vital tasksCopayment – immediate collectionAccepting Patient PaymentEnter charges for services provided Most practices acceptCashCheckCredit cardsInsurance For today’s visit, the total charge is $50. How would you like to pay?Accepting Patient Payment (cont.)CashCount money carefullyRecord payment Give patient a receiptCheck Check idCheck date and amountEndorse it immediatelyDebit cardImmediate transfer of fundsProcessed like credit cardAccepting Patient Payment (cont.)Credit cardCheck expiration date Keep signed receipt, give patient a copyTransaction fee ~ adjust patient accountOn-line paymentsPayment ResponsibilityGuarantorMinors Parents or person with legal custodyEmancipated minorDivorce Elderly patients and patients with disabilities ConsentProof of guardianshipPayment Responsibility (cont.)Professional courtesy Waived charges or accept amount that the insurance paysMust collect copaymentsApply Your KnowledgeWhat is the difference between accounts receivable and accounts payable?ANSWER: Accounts receivable is the money owed to the medical practice and accounts payable is the money owed by the medical practice.Good Job!Standard Billing ProceduresPreparing statements Practice contact informationPatient name and addressGuarantor’s nameBalanceItemized list of services and chargesPayments receivedTotal balance dueStandard Billing Procedures (cont.)Manual statementsLedger card Computer generated statementsIndependent billing serviceSuperbillManaging Billing CyclesCycle billing Bills each patient monthlyStaggers billing workloadMore even cash flowApply Your KnowledgeWhat is cycle billing?ANSWER: Cycle billing is a system in which each patient is billed only once a month but groups of patients are billed every few days. It spreads the work of billing over the month.Excellent!Standard Collection ProceduresCollection of payment is guided byLaws Professional standardsGuidelinesStatute of LimitationsStandard Collection Procedures (cont.)Statute of limitations and account typesOpen-book account ~ last payment date or charge for each illnessWritten-contract account Payment agreement stipulatedRegulated by Truth in Lending ActSingle-entry account ~ shorter time limitsUsing Collection TechniquesInitial telephone calls or lettersFriendly and sympatheticCall the patient at homeAssume the patient forgotAsk for full amountAcceptable amountExpected payment dateUsing Collection Techniques (cont.)Follow-up statements and collection letters60 days past due – friendly but firm90 days past due – stronger wording120 days or more past due Final letter Verify cutoff date on ledger cardSend certified/return receiptPreparing an Age AnalysisThe process of classifying and reviewing past-due accounts by age from the first date of billingUse patient ledger cards and color-coded tags to indicate the number of days past dueList all patients’ account balances and when the charges originatedPreparing an Age Analysis (cont.)True or False: An open-book account consists of only one charge. A written-contract account is regulated by the Truth in  Lending Act. A single-entry account might be used for a person who will not become a regular patient. The statute of limitations sets an amount limit on when  an account can be filed as past due. An age analysis is a process for reviewing past-due  accounts by age from the first date of billing.Apply Your KnowledgeANSWER:Correct!TTTFFsingle-entrytimeLaws That Govern Credit and CollectionFair Debt Collection Practices Act of 1977Governs collection of unpaid debtsGuidelines:Do not call before 8 A.M. or after 9 P.M.Do not make threats or use profane languageDo not discuss patient’s debt with anyone elseDo not use any form of deception or violence to collect a debtLaws That Govern Credit and Collection (cont.)Telephone Consumer Protection ActProtects against telemarketingProhibitsAutomated dialing to certain numbersPrerecorded calls to homesUnsolicited advertising via fax Most provisions do not apply to medical practicesLaws That Govern Credit and Collection (cont.)Professional guidelinesAMA ~ appropriate to assess finance charges or late charges on past-due accounts if the patient is notified in advanceThe physician must adhere to federal and state guidelinesUsing Outside Collection AgenciesAvoid those that use harsh or harassing collection practicesOnce agency has the accountNo further contact with the patientMaintain list of files sent for collectionPractice decides how best to deal with the accountInsuring Accounts ReceivableProtects the practice from lost income NonpaymentDestruction of A/R recordsProtects cash flow and ensures that the practice will have funds to cover expected expensesApply Your KnowledgeWhat law governs the methods that can be used to collect unpaid debts?ANSWER: The Fair Debt Collection Practices Act of 1977Right!Credit ArrangementsCredit – extended by physicianEqual Credit Opportunity ActReasons for not denying creditMust tell patient why credit was deniedPerform a credit checkCredit Arrangements (cont.)Performing a credit checkVerify employmentCredit bureau reportCreditworthiness of person seeking creditPayment historyFair Credit Reporting ActCredit Arrangements (cont.)Unilateral AgreementPhysician agrees to patient offer Not subject to Truth in Lending ActMutual AgreementBetween patient and physicianSubject to Truth in Lending ActFinance chargesMore than four paymentsTruth in Lending ActConsumer Credit Protection ActCredit agreements of more than four paymentsThe practice mustDiscuss agreement with patientSign and retain disclosure statementTruth in Lending Act (cont.)Disclosure statementTruth in Lending StatementAgreement on payment termsTotal amount of debtDown payment and payment amountFinal due date Interest rate and total finance chargesApply Your KnowledgeMatch: Credit cannot be denied based on  sex, race, religion, etc. Provides a credit history. Not regulated by the Truth in  Lending Act Bilateral agreement between the  patient and physician Covers credit agreements of more than four payments Description of agreed terms of  paymentDisclosure statementCredit bureauEqual Credit Opportunity ActUnilateral agreementTruth in Lending ActMutual agreementBCDFEAANSWER:Excellent! Common Collection ProblemsHardship cases ECOA – all patients in the same circumstances must be afforded the same considerationMay refer to clinics that provide free or reduced-fee servicesCommon Collection Problems (cont.)Patient relocation and address changesSkipsTelephone or e-mailAsk post office for forwarding addressKeep all returned statements and envelopes as proof of reasonable attempts to collectApply Your KnowledgeWhat is a “skip”?ANSWER: A patient who moves without leaving a forwarding address to which the office can sent a statement of unpaid charges.Yes!In Summary 20.1 Accounts Receivable refers to the money that is owed to the practice. Accounts Payable refers to the money that the practice owes other vendors. Common payment methods include cash, check, and debit and credit cards.20.2 Common statement documents include the use of superbills, typed or computer-produced itemized statements, and copies of ledger cards. In cycle billing the accounts are split in groups and statement mailing dates are staggered.In Summary (cont.)20.3 An open-book account consists of periodic charges and payments added as needed when patients are seen in the practice. A written-contract account is used when the physician and patient sign a contract for a specific service or procedure. A single-entry account is one used for patients when it is expected they will be seen only once, such as for a relative visiting the area on vacation. An age analysis is the process of classifying and reviewing past-due accounts by age from the first date of billing. In Summary (cont.)20.4 ECOA is the Equal Credit Opportunity Act. It prohibits discrimination against loan applicants. The Fair Credit Reporting Act (FCRA) requires credit bureaus supply correct and complete information to businesses to use in evaluating a person’s application for credit, insurance, or a job. The Fair Debt Collections Practices Act or FDCPA requires debt collectors to treat debtors fairly and prohibits certain collection tactics. The Truth in Lending Act requires creditors to provide applicants with accurate and complete credit costs and terms..In Summary (cont.)20.5 The Truth in Lending Statement must include the  following elements: amount of total debt, amount of the down payment, amount of each payment and date due, due date for the final payment, interest rate, expressed as an annual percentage rate, and total finance charges20.6 The two most common types of collection problems in the medical office are hardship cases, who simply cannot afford to pay their debt, and accounts known as skips, where the debtor moved and left no valid forwarding information so it is not possible to bill the patient..End of Chapter 20Remember that credit is money. ~ Benjamin Franklin