Chapter 13 Fess, credit and collection

Quantum merit

"as much as he deserves" The promises by the patient to pay the doctor as much as he or she deserves for labor

What are some names used for the form that serves as a combination bill, insurance form, and routing document

Charge slip communicator encounter form fee ticket patient service slip routing form superbill transaction slip

CRA

Consumer Reporting Agencies CRA gather and assemble information on private individual to evaluate and determine the credit standing and credit capacity of consumer; They sell consumer report that detail the information for employers, insurers, etc

What does the court said about patient has a delinquent account?

Continued medical care implies an extension of credit, even if the old account remain unpaid The physician and MA should consider referring such patient else where for their care

what is the first important step in credit and collection?

To obtain a complete and accurate registration of the patient at the time of the first visit

Copayment Waiver

To reduce the cost of medical care for some patients, a physician might waive the copayment amount. Problem: physician could be accused of not treating everyone with the same insurance equally EXCEPTION: Medicare recognizes a credit adjustment for this purpose on a doctor-to-doctor basis

Electronic display calculator

10 key numerical keyboard with arithmetic function keys for entering values from 0 to 9

What should we do if an account has aged 120 days?

1. send another bill with a dun message 2. turn the account over the collection service 3. File a small-claim court

List 3 advantages of cycle billing?

1. Allow continuous cash flow throughout the month 2. relieve the pressure of having to mail all statements at one time 3. distributes patients telephone calls regarding account questions

Name two branches of credit bureaus

1. Consists of companies that issue noninvestigate consumer credit reports when someone applies for credit 2. Consists of companies that issue consumer investigative reports requested by insurance companies, employers, prospective employers.

Name 3 reasons why a patient registration ( information) form is valuable for collection process

1. Effectively collect on an account 2.Trace a patient who moves 3. Good flow information that will help in sending statement, billing insurance company and collecting

List 2 hardship discount regulation for low income person

1. Hill-Burton Act:Hospitals receive federal grants in exchange to care for indigents needing medical care 2. Health Care Reform: law that require hospitals to have written policies for providing free or discount for low income patient. It is expected that these programs no long exist

list 3 factors that would affect office policy for fee collection

1. Insured and fee-for-service contract in place 2. enrolled in a managed care plan with copayment requirements 3. not insured

Name two basic provision of garnishment law

1. It limits the amount of employee earnings withheld for garnishment in a workweek or pay period 2. It protects the employee from being dismissed if his or her pay is garnished regardless of the number of levies included in the garnishment

To increase the percentage of patients who pay their bills and for good public relations, how should a medical assistant approach a patient

1. MA may state fees and answer any questions about charges when making appointments by telephone 2. Tell patient when they call for appointments that the office policy is to collect the fee at the time services are given 3. Listen to patient's cc, but is prepare to discuss about the expense 4. Tactfully ask whether the patient has health insurance coverage 5. never assume anything about a patient's financial status

Name four advantages of using billing service

1. Patient understanding of statement is improved because all charges and payments are shown 2. Patient questions regarding charges are answer by the service 3. Collection calls to patients do no disrupt the practice, because they are handled by the billing service 4. Billing services save the medical office money because expensive billing equipment is not required and valuable space need not be allocated for billing supplies

Name two type of bankruptcy

1. Straight petition in bankruptcy 2. Wage earner's bankruptcy

What kind of information does MA should discuss with patient during the installment plan?

1. The amount of the total debt 2. The down payment 3. The amount and date of each installment 4. the date of final payment

Name four factors involved in establishing fees for a physician

1. what other physician in the same specialty receive for various services 2. The physician's education and experience 3. the geographic location of the practice 4. the overhead for maintaining the practice( rent, utility, insurance, taxes, etc.)

NSF

Nonsufficient Fund

Multipurpose billing form

A combination bill, insurance form, and routing document

Professional courtesy

A euphemism for a discount or a no-charge exemption extended to certain people by the physician

Bankruptcy

A patient becomes a ward of the federal court and is thereby protected by the court MA must not send monthly statements or make an attempt to collect

skip

A patient who owes a balance and moves, leaving the physician's office no forwarding address

Single-entry account

Account with only one charge listed and generally for small amount

A/R

Accounts Receivable A record of the total monies owed to the medical practice

Open-book account ( open account)

Accounts that are open to charges made from time to time. Record of business transactions on the books that represents an unsecured account receivable where credit has been extended without a formal written contract; payment is expected within a specified period

Written-contract account

Agreement a patient signs to pay the bill more than four installments under the Truth in Lending provisions

Defined straight petition in bankruptcy

Allow a person, family or small business to liquidate all debts and restart with a clean financial state Physician debt often go unpaid The person declare bankruptcy cannot do it again within 6 year

Federal Truth in Lending Act

Anyone who charges interest rates or agrees to more than four payment for a given service, the rates may be governed by state laws

When is the best time to call

Between 5:30 and 8:30 pm, Tuesdays and Thursday, and between 9:00am and 1pm on Sat

What is the most common type of consumer reporting agency?

Credit Bureaus

FCRA

Fair Credit Reporting Act

FDCPA

Fair Debt Collection Practices Act

FTC

Federal Trade Commission

List some information should contain in the collection letter?

How much is owed for a specific service What the patient should do about the delinquency When, where, and why patient should remit How the patient can facilitate payment

False Claims Act

If one physician does not bill another for services rendered, a result is that a third-party payer is relieved of its contractual obligation

Explain Aging Account and state why it is necessary

It is a system that analysis of accounts receivable indicating a breakdown of the length of time the account is over due

when is the ledger card is created?

It is created for each patient when he or she first receives medical services

Explain about Fair Credit Reporting Act

It is designed to promote accuracy and ensure the privacy of the information used in consumer report

Define wage garnishment

It means attaching a debtor's properties and wage by court order so monies can be obtained to pay debt

Truth in Lending Consumer Credit Cost Disclosure

It requires that providers disclose ALL costs including interest, late charges, and so on, PRIOR to the time of service

How often the multipurpose form should be reviewed and updated?

It should be reviewed and update every year including new or revised procedure All fees and payment should be posted daily to patient's account or ledger card day sheet

List some remedy for excuses non-payment

Keep early-pay envelopes, stamped and self-addressed within easy reach to give to patients with requested to mail a check on arrival at home Provide payment options such as paying online, credits, debit cards

What should MA do with an account remain delinquent for over 60 days?

Make personal contact by phone call by arrange the accounts according to aging parameters Prioritize the calls that need to be made according to the amount to be owned Take action on accounts that may be difficult to collect first

Name several things to look for in a deadbeat patient

Many unfilled blanks on the patient registration form Questionable employment record No business or home telephone Many moves of residence A motel address No referral No insurance

list two types of patient should not be generated by dull message

Medicare patient Worker's compensation programs

Fee-for-service

Method of payment; the patient or insurance company pays the physician for professional services according to a specific schedule of fees

If a physician asks you to file a claim in small-claim court, where would you go get the form and detailed information about the process?

Obtain the form from the clerk's office located at the municipal or justice court File the initiating paper Pay the filing fee Make arrangement to serve the defendant

Name 3 kinds of accounts

Open-book Account Written Contract account Single entry account

List three column in Medicare fee schedule

Participating fee Nonparticipating fee Limiting charge

Fair Credit Billing Act

Patient have 60 days from the date the statement is mailed to complain about an error The complaint must be acknowledge and documented within 30 days Provider have 30 days to correct the error

List 4 options of patient after served at small claim court

Pay the claim Ignore the claim Request a small claim hearing Demand a jury trial

Concierge fees ( retainer- based medicine)

Primary care physician opt out of insurance programs, decrease their patient load, and charge an annual fee for service Additional fees may be charged for tests and procedures as well as hospital care

Wage earner's bankruptcy

Protect the wage earner from bill collectors and to make arrangements for the wage earner to pay bills over time

What action MA should take when patient have credit refusal?

Provide patient with name and address of the agency even if a patient does not ask

What action should the doctor take once an account is assigned to collection agency?

Send patient a letter of discharge by certified mail for liability protection

For states that allow multiple fess schedules, a medical practice may have separate fee schedules for what type of programs or plans?

Separate fee schedules for Worker's compensation managed care contracts Medicare Private pay patients These fee schedule depend of the specialty of the practice and the type and number of signed contractual insurance and managed care plan agreements

The longer an account remain delinquent, ___________

The harder it will be to collect

what can determine the type of the calculator in the office?

The size of the practice

Dun message

The statement to promote payment

Fee Splitting

When one physician offer to pay another physician for the referral of patients Problem: This is considered unethical and a felony in several states

When does MA should sent out collection letter?

When regular statement have been sent, two or three months have been elapsed since the service, and patient cannot be reached by telephone or a promised payment have not been received

When is the best time to collect for an office visit and why?

When the service is rendered

If the patient is elderly and someone in the family responsible for the bill, who should MA discuss the bill to?

With both- the guarantor party and the patient

Is it legal for the practice keep sending bill to patient once the account have been turn over to collection agency?

Yes, it is legal. If the payment come to physician's office instead of collection agency, MA should contact the collection agency because a percentage of this payment may be due the agency

Ledger card

a record showing charges, payments, adjustments, and balance owed

credit

a trust in a person's integrity to meet financial obligation

Fee schedule

a typed list of the most common services the physician offers, including procedure code numbers , with a description of each service and its price

Check

a written order to pay a sum of money

charge

amounted billed( price) for professional services rendered; "fees" is the preferred term

deadbeat

one who evades paying bills

What is the average time frame for turning an account over to a collection agency?

at a maximum of 5 or 6 months after the debt has occurred

When is a managed care copayment usually collected?

at the time of the visit

Cycle billing

certain portions of the accounts receivable are billed at specific times during the month Enables the first patient statement to be in the mail within days of the first visit

List some specialties that collect for fee service as they are rendered while also requiring payment of small amount toward the performance of future services

elective surgery obstetric fee

Equal Credit Opportunity Act

if the physician agrees to extend credit to one patient, the same financial agreement must be extended to all patient who request it

Explain IRP

individual responsibility program physicians choose to opt-out of insurance programs and bill the patient directly; the patient then applies to the carrier or program for reimbursement

The job of discussing and collecting fees is usually relegated to the

medical assistant

Electronic printing calculator

print data on a paper tape

Nonparticipating fee

the amount paid to physician who do not have contracts

Participating fee

the amount paid to physician who have contracts with Medicare

Limiting charge

the highest amount a nonparticipating physician can charge a Medicare patient

collection ratio

the proportion of money owed compared to money collected on the accounts receivable

aging analysis

the statement usually shows a breakdown of the amounts that are due and how many days they are delinquent

Bill

using the same information found on the ledger, to be sent to the patient stating the fees owned