Chapter 10 Office and Insurance Collection Strategies Elsevier items and derived items © 2010, 2008...

Chapter 10Chapter 10

Office and Insurance Collection Office and Insurance Collection Strategies Strategies

Elsevier items and derived items © 2010, 2008 by Saunders, an imprint of Elsevier Inc.Elsevier items and derived items © 2010, 2008 by Saunders, an imprint of Elsevier Inc.

Elsevier items and derived items © 2010, 2008 by Saunders, an imprint of Elsevier Inc.Elsevier items and derived items © 2010, 2008 by Saunders, an imprint of Elsevier Inc. 22

Learning ObjectivesLearning Objectives Define credit and collection key words Define credit and collection key words

terminology and abbreviations.terminology and abbreviations. Define aging analysis.Define aging analysis. Define accounts receivable and explain how it Define accounts receivable and explain how it

is handled.is handled. Recite types of fee adjustments available to Recite types of fee adjustments available to

patients.patients. Name payment options available to patients.Name payment options available to patients. Perform oral and written communication Perform oral and written communication

collection techniques.collection techniques.


Learning Objectives (cont’d.)Learning Objectives (cont’d.)

List the names of the federal credit laws List the names of the federal credit laws applicable to a physician office setting. applicable to a physician office setting.

State the role of a billing service, collection State the role of a billing service, collection agency, and credit bureau in the collection agency, and credit bureau in the collection process.process.

Explain the purpose of small claims court in Explain the purpose of small claims court in the collection process.the collection process.

Name basic actions in tracing a debtor who Name basic actions in tracing a debtor who has moved and left no forwarding address.has moved and left no forwarding address.



Lesson 10.1 Lesson 10.1


Cash Flow CycleCash Flow Cycle

Physician revenue largely from Physician revenue largely from reimbursement by third-party payersreimbursement by third-party payers

Insurance contracts with payersInsurance contracts with payers Reimbursement provisionsReimbursement provisions Medical services not coveredMedical services not covered Patient responsibilitiesPatient responsibilities Reimbursement processReimbursement process


Reasons for Accounts Reasons for Accounts ReceivableReceivable

Increased healthcare expensesIncreased healthcare expenses Health care perceived as a rightHealth care perceived as a right Legal proceedingsLegal proceedings Insurance delaysInsurance delays


New Patient Confirmation LetterNew Patient Confirmation Letter


Signs of Potential Signs of Potential Nonpaying PatientNonpaying Patient

incomplete information on registration formincomplete information on registration form multiple changes of residencemultiple changes of residence questionable employment recordquestionable employment record no business or home telephoneno business or home telephone post office box listed with no street address; post office box listed with no street address;

or motel address listedor motel address listed incomplete insurance informationincomplete insurance information no referralno referral


Fee AdjustmentsFee Adjustments

discountdiscount cash discountscash discounts financial hardshipfinancial hardship write-offswrite-offs professional courtesyprofessional courtesy copayment waivercopayment waiver no chargeno charge reduced feereduced fee


Ledger CardLedger Card

Financial Accounting Record


Communicating FeesCommunicating Fees Be courteous at all times but express a firm, Be courteous at all times but express a firm,

businesslike approach that will not offend the businesslike approach that will not offend the patient.patient.

Never badger or intimidate a patient into paying; Never badger or intimidate a patient into paying; merely state the payment policy and educate the merely state the payment policy and educate the patient.patient.

Inform the patient of the fee and any deductible and Inform the patient of the fee and any deductible and balance due in a clear manner.balance due in a clear manner.

Verify the patient’s copayment listed on his or her Verify the patient’s copayment listed on his or her insurance card and collect this amount before the insurance card and collect this amount before the patient’s office visit.patient’s office visit.


Communicating Fees (cont’d.)Communicating Fees (cont’d.)

Make it easier for the patient to pay rather Make it easier for the patient to pay rather than leave without making payment.than leave without making payment.

Do not give the patient an option by asking if Do not give the patient an option by asking if he or she would like to pay now or have a he or she would like to pay now or have a bill sent.bill sent.

Motivate the patient to pay by appealing to Motivate the patient to pay by appealing to his or her honesty, integrity, and pride.his or her honesty, integrity, and pride.


Collecting FeesCollecting Fees

Payment at time of servicePayment at time of service Payment by checkPayment by check Itemized statementsItemized statements


Financial Agreement FormFinancial Agreement Form


Demand Letter for Returned Demand Letter for Returned CheckCheck


Itemized StatementItemized Statement


Collection Decision TreeCollection Decision Tree


Billing and Collection GuidelinesBilling and Collection Guidelines

First statement at time of serviceFirst statement at time of service Mail second itemized statementMail second itemized statement Third statement 30 days laterThird statement 30 days later First phone call/suspenseFirst phone call/suspense Second phone call with 5-day noticeSecond phone call with 5-day notice Written 10-day notice with next stepsWritten 10-day notice with next steps Take steps indicated in prior statementTake steps indicated in prior statement


Payment OptionsPayment Options

cashcash checkcheck credit cardcredit card online paymentonline payment debit carddebit card e-checkse-checks payment planspayment plans


Credit and Collection LawsCredit and Collection Laws

Equal Credit Opportunity ActEqual Credit Opportunity Act Fair Credit Reporting ActFair Credit Reporting Act Fair Credit Billing ActFair Credit Billing Act Truth in Lending ActTruth in Lending Act Truth in Lending Consumer Credit Cost Truth in Lending Consumer Credit Cost

DiscloserDiscloser Fair Debt Collection Practices ActFair Debt Collection Practices Act Statute of limitationsStatute of limitations



Lesson 10.2 Lesson 10.2


Telephone “Dont’s”Telephone “Dont’s”

Don’t raise your voice.Don’t raise your voice. Don’t accuse the patient of lying.Don’t accuse the patient of lying. Don’t act tough.Don’t act tough. Don’t consent to partial payment.Don’t consent to partial payment. Don’t debate.Don’t debate. Don’t report disputed accounts to collection Don’t report disputed accounts to collection

agency or bureau.agency or bureau.


Collection Form LetterCollection Form Letter


Multipurpose Collection LetterMultipurpose Collection Letter


Collection AbbreviationsCollection Abbreviations


Insurance PaymentsInsurance Payments

History of accountsHistory of accounts Coinsurance paymentsCoinsurance payments Insurance checks sent to patientsInsurance checks sent to patients Managed care organizationsManaged care organizations MedicareMedicare Medigap insuranceMedigap insurance Worker’s compensationWorker’s compensation Suing a third-party payerSuing a third-party payer


When to Use a Collection AgencyWhen to Use a Collection Agency

when patient says he/she won’t paywhen patient says he/she won’t pay when patient breaks promise to paywhen patient breaks promise to pay when partial payments, but 60-day lapsewhen partial payments, but 60-day lapse failure to respondfailure to respond returned checkreturned check insurance company payment not forwardedinsurance company payment not forwarded misinformationmisinformation can’t be locatedcan’t be located


Collection AgenciesCollection Agencies

Choosing an agencyChoosing an agency Types of agenciesTypes of agencies Agency operating techniquesAgency operating techniques Agency chargesAgency charges Agency assigned accountsAgency assigned accounts


Filing a Court ClaimFiling a Court Claim

Obtain claim of plaintiff form.Obtain claim of plaintiff form. File papers with the court.File papers with the court. Pay the filing fee.Pay the filing fee. Arrange to serve the defendant.Arrange to serve the defendant. Set trial date.Set trial date.


Tracing a Debtor (“Skip”)Tracing a Debtor (“Skip”)

Check the address on returned envelope.Check the address on returned envelope. Check the ZIP code.Check the ZIP code. File a request at the post office.File a request at the post office. Look in the phone book.Look in the phone book. Call the primary care physician.Call the primary care physician. Check with hospital accounts department.Check with hospital accounts department. Inquire at place of employment.Inquire at place of employment. Call contacts on patient’s registration form.Call contacts on patient’s registration form.


Special Collection IssuesSpecial Collection Issues

bankruptcybankruptcy terminally ill patientsterminally ill patients estate claims estate claims


Types of BankruptcyTypes of Bankruptcy

Chapter 7Chapter 7 Chapter 9Chapter 9 Chapter 11Chapter 11 Chapter 12Chapter 12 Chapter 13Chapter 13


Filing an Estate ClaimFiling an Estate Claim

Confirm death.Confirm death. Pursue payment from third parties.Pursue payment from third parties. Contact the county.Contact the county. File the claim.File the claim. Send itemized statement to the attorney.Send itemized statement to the attorney. Follow up as needed.Follow up as needed.


Patient ComplaintsPatient Complaints

Listen.Listen. Thank the person.Thank the person. Apologize.Apologize. Answer the complaint.Answer the complaint. Be professional, sincere.Be professional, sincere. Take it seriously.Take it seriously. Respond in letter form.Respond in letter form. Be cordial.Be cordial.


Other ConsiderationsOther Considerations

Collection controlsCollection controls EmbezzlementEmbezzlement Precautions for financial protectionPrecautions for financial protection BondingBonding

Chapter 10 Office and Insurance Collection Strategies Elsevier items and derived items © 2010, 2008...

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