Collection Procedures

© DrFernandez.com 2008

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The Practice Starters® Program e-book

Collection Procedures©2008 Peter G. Fernandez

A Guide TO COLLECTION PROCEDURES FOR THE CHIROPRACTIC PRACTICE

By: PETER G. FERNANDEZ, DC

Copyright ©2008 by Peter G. Fernandez, DC

All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise without prior permission of the publisher. Notwithstanding the foregoing, purchasers of this book from established retail businesses may reproduce any clause recommended in this book without charge for the limited purpose of use in their business.

This book is designed to provide accurate and authoritative information with respect to the subject matter covered. It is sold with- the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice or other expert assistance is required, the services of an attorney in your state should be sought. While every attempt is made to provide accurate information, the author or publisher cannot be held accountable for errors or omissions.


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About The Author

Dr. Peter G. Fernandez (Dr. Pete) has been honored by the profession for of his remarkable and far-reaching work in - and for the practice of Chiropractic.A 1961 graduate of Logan College of Chiropractic, Dr. Fernandez, is a father of seven children, three of which are Chiropractors. It was because of his struggle entering practice as a new Chiropractor and witnessing the struggle his children had as they entered practice, that Dr. Fernandez created The Practice Starters Program.

Dr. Fernandez teaches new doctor’s what Chiropractic Colleges can’t - the business principles of chiropractic practice such as Personal Injury, adding Associate Doctors, Insurance Procedures, Practice Finance, Patient Retention, New Patient Acquisition, Advertising & Marketing, Legal Issues, Staff Training, Exam Procedures, etc.

The research, development, and anecdotal background for his teaching came from Dr. Fernandez’ experience practicing chiropractic in Florida from 1965 to present, examining and treating High School athletes (up to 200 per year), performing IME’s for insurance companies and other chiropractors; owning a chain of 12 chiropractic clinics, directing five associate doctors; as a professional football trainer; President of Central Florida Academy ofChiropractic Studies; Chairman of the Public Information Committee of the Florida Chiropractic Association; Board of Directors of the Florida Chiropractic Association; Member of the Florida Chiropractic Association Insurance Review & Peer Review Committees; President of the Pinellas County Chiropractic Society; Treasurer of the Florida Chiropractic Association; and President of the Florida Chiropractic Association.

Dr. Fernandez taught management procedures to over 10,000 Chiropractors and over 20,000 Chiropractic support personnel; consulted in opening over 3, 000 practices and 5, 000 in-practice doctors; authored 18 books on how to manage a chiropractic practice; and authored over 100 articles relating to athletic injuries; examination procedures; neurology and management procedures.

Dr. Fernandez has been honored for his entrepreneurial and management training skills by the states of Maine, Indiana, Florida, Tennessee, Missouri, Louisiana, Virginia, Indiana, Nebraska, Ohio, Kansas, Kentucky and was aAdjunct Professor at Texas Chiropractic College.


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The Practice Starters® Program

COLLECTION PROCEDURES©2008 Peter G. Fernandez

FINANCIAL RULES

The author of this text collected 98% of all his services rendered over a 20-year span of time. After twenty years, he wrote off $20,000. No, he was not a scrooge; he also has his share of welfare patients and people to whom he gave professional discounts. How he accomplished this collection percentage is described in this book.

HAVE A COLLECTION ATTITUDE ... AN “EVERYBODY PAYS” ATTITUDE

Develop a collection attitude. Money is a receipt for services rendered. Your attitude should be, “You will give the best service in the world to your patients and they will pay for your services.”

YOUR CAs MUST BE ABLE TO COLLECT

Weed out CAs with “Poor Boy” concepts. If your CAs can’t collect or they say they wouldn’t pay for your care, fire them!

DO IT RIGHT THE FIRST TIME

If you don’t create a problem by using sloppy or inadequate collection procedures, you won’t have to clean up a mess (a big bill) later. The following procedures should minimize any collection problems and enable your office to collect 98% of collectable services, i.e., your fees minus any insurance write-offs you have agreed to in advance, i.e., Medicare, PPOs, HMOs, etc.

POST A PAYMENT POLICY SIGN AT YOUR FRONT DESK

Place a sign at your front desk stating, “Services Are Payable the Day they Are Rendered.” The verbiage on this sign is not a suggestion...it is a policy.

HAVE A “PAY OR PAY” PROCEDURE


4Always give your patients a choice of “Pay or Pay.” In order to have a “Pay or Pay” policy, give your patients a choice of cash or check, counter check (if legal in your state), charge card, automatic deduction from their checking/savings account, insurance assignment, attorney lien, or Letter of Protection (LOP) from an attorney. Never give them a choice of “pay” or “charge.” Obviously, in this case, they’ll take the “charge” option.

DON’T LET BALANCES BUILD UP

When two people exchange something of equal value they both feel good about it. When there is not an equal exchange, the person not giving their portion of the equal exchange feels “guilty,” i.e., when someone receives twenty dollars worth of service and only gives you five dollars for your service.

The human being psychologically always wants to be “RIGHT” and doesn’t want to feel “GUILTY.” In order to feel “RIGHT” and not feel “GUILTY” people will justify a reason why they didn’t pay you, don’t have to pay you, or pay you less than they should have paid, thus making themselves feel “RIGHT”.

TO ACCOMPLISH A FEELING OF “BEING RIGHT”, A PATIENT WILL:1. Not follow your instructions.2. Not keep their appointments.3. Not get well.4. Gripe and complain.5. Find fault with you or your service.6. Bad-mouth or be-little you and your service.7. Avoid paying you.8. Sue you.THEY WILL DO SO TO JUSTIFY WHY THEY DIDN’T PAY YOU.

If you allow a person to build up a big bill ... you will cause the doctor-patient relationship to disintegrate. Remember, paying is part of healing.

HAVE A “NO BILLING” PROCEDURE

Tell your patients you have a no billing policy for patient balances under $250.

COLLECT ON THE CASH PATIENT’S FIRST OFFICE VISIT AND EVERY VISIT SERVICES ARE RENDERED

Have a policy of collecting for the initial diagnostic visit and every visit services are rendered. Start establishing the payment habit on the patient’s first visit. It’s easy to collect money when a patient is in pain, much more difficult later. People who intend to pay won’t be offended when


5asked to pay. Exceptions to this rule are:

1. If the patient has insurance that pays 100%.2. If the patient has insurance and the deductible has been met, then they’ll

receive a refund at the end of their care. 3. Major medical patients who must pay for their initial diagnostic visits; assignment

is accepted; and then pay 30% of subsequent visits.4. If a patient shows their willingness to pay by paying each visit for 8-10 visits, let

them charge and bill them once per month.5. HMO and PPO payment dictates.

MAKE DEFINITE FINANCIAL PLANS FOR THE PATIENT’S ENTIRE CARE DURING THEIR FIRST THREE VISITS

Most patients will feel insecure and quit care when financial arrangements are not finalized within three (3) days of starting care.

Trying to make financial arrangements with patients who owe balances is many times very unsuccessful.

ELIMINATE “FREELOADERS”

Don’t let “freeloader” patients build up a balance.

By following the collection procedures in this book, “Freeloader,” patients will discontinue care by no later than their second or third visit.

DO A CREDIT CHECK ON ALL CASH PATIENTS AND PATIENTS THAT WILL CHARGE THEIR SERVICES IN YOUR OFFICE

The only time a doctor should extend credit to a patient is when they have good credit and the doctor’s office has some form of payment protection, i.e., when a Major Medical insurance may be inadequate, or the patient has his/her fees guaranteed by an insurance company lien, attorney lien or an attorney Letter of Protection.

Also determine if any of the patient’s friends, relatives, or the person who referred them to your office, are patients in your office and check their payment records. If these people have a poor credit rating or a poor payment record in your office, the odds are the referred patient will also have a poor payment record in your office.

CHARGE FOR EVERY SERVICE YOU PERFORM


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Other than an offer of a free examination, etc., the doctor should charge for all the services he/she recommends, i.e.: Progress Exams, Progress X-rays, X-ray interpretation, calling another doctor, Spinal Care class, Back School class, Neck School class, etc. Fees for copying paperwork should be $1 per page, or whatever the local courthouse charges. P.I. fees for a narrative report should be 5 - 7 times your office visit fee. Depositions, courtroom testimony, pre-deposition conferences and pre-trial conferences fee should be $350 an hour (or whatever is customary in your area) or any part thereof, and portal to portal.

DON’T PAY ATTENTION TO SHOPPERS

Patients who look for the cheapest doctors are uncooperative patients because they think they are the doctors.

FREE IS FREE

Whenever a doctor advertises a free service, he/she should never charge an insurance company for the free service. To offer a service free to a cash patient and charge an insurance company for the same service is insurance fraud.

DON’T OFFER ONLY A FREE CONSULTATION

If you offer a “free consultation” and charge an insurance company for an examination using Code #90440, this is insurance fraud because this code designates a charge for the examination and the taking of a patient’s history.

WHEN A PATIENT CAN’T AFFORD YOUR CARE, REFER THEM TO THEIR FAMILY OR BANKER FOR FINANCING

Sometimes a patient will tell you they can’t afford to pay for their care. In this case, refer them to their relatives for assistance. Ask them, “Do you have any children? If so, call them. You took care of them all these years, now it’s their time to help you out. Tell them of the care you need, how much it’s going to cost and ask them for their help. They’ll help you.”

If the patient doesn’t have any relatives, tell them to go to their bank or credit union and borrow the money. You’re in the doctor business; you’re not in the banking business.

UTILIZE CHARGE CARDS

Utilizing a charge card to pay for health care is an additional method in which patients can pay for your services.


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For patients who pay cash, have deductibles, co-pays, or unknown balances that their insurance company may or may not pay for, get permission to charge their charge card for any unpaid balances. Use the “Authorization Agreement for Pre-Arranged Payments (Debits) by Credit Car of Bank Health Card” form for this purpose. (Exhibit #3). Remember, you’re in the doctor business; you’re not in the banking business. Let the banks that own the charge cards finance your patients, and not you.

UTILIZE HEALTH CHARGE CARDS

Follow the same scenario as recommended under charge cards. Health charge cards are simply a special charge card issued by banks that pay for health care, i.e., Medicredit, DenCare, etc.

THE DRFERNANDEZ.COM INSURANCE POLICY

DRFERNANDEZ.COM insurance policies are structured in such a way that the doctors take responsibility for verifying insurance coverage and determining what limitations and restrictions exist. As a courtesy to their patients, they also take the responsibility for billing the patient’s insurance carriers and, consequently, do not ask the patient to pay in full each visit for services rendered. They are willing to hold the carrier responsible for the percent they anticipate the insurance carrier will pay, until they know that they have exhausted all efforts to collect from that carrier. However, if after they have properly filed the claim and it is denied, the patient is responsible for the bill.

DEPOSIT ALL INSURANCE CHECKS (AND CASH PAYMENTS) IN YOUR OFFICE CHECKING ACCOUNT. REFUNDS AND OVERAGES ARE TO BE PAID OUT OF THIS SAME ACCOUNT.

Never endorse insurance checks over to patients, attorneys or anyone else. When the IRS audits you, they will have a record of all insurance payments that were sent to you. And, they consider all insurance checks sent to you as income to you, whether you actually deposited the check or endorsed it over to someone else. If your income records do not match the IRS’s, they will consider this situation fraud and you open yourself up to income tax fraud charges, costly fines, interest and penalties.

PATIENT RESPONSIBILITIES

Patients are responsible for the total cost of their care regardless of their insurance coverage.PROFESSIONAL COURTESIES


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There are occasional patients whom you will want to treat at a discount or free as a professional courtesy, i.e., doctors, nurses, policemen, firemen, emergency medical technicians or attorneys.

Be conscientious and responsible when deciding to treat someone as a professional courtesy. If the person to whom you extend professional courtesy has insurance coverage, your professional courtesy should only extend to their insurance deductible and co-pay.

RULES REGARDING FEES

CHARGE USUAL, CUSTOMARY, AND REASONABLE FEES

The doctor’s fees should always be in the usual, customary and reasonable range. Low fees ensure practice failure and/or doctor burnout. Some patients will gripe about the cost regardless of your fees.

RAISE YOUR FEES TO UP-TO-DATE LEVELS

Use the fee determination system described below to up-date your fees yearly. This procedure usually raises your fees up to the normal level, thus increasing your income 10-15%. Why charge less than necessary?

USE THE DRFERNANDEZ.COM FEE DETERMINATION SYSTEM

Don’t depend upon guesswork in determining your fees. And, don’t call other DCs to align your fees in relationship to their fees. This is a violation of Federal Anti-Trust law. The DRFERNANDEZ.COM fee determination service will give you accurate insurance, PPO and Medicare fees. Cash patients have the same fee schedule as insurance patients.

USE THE MEDICARE THREE-TIER FEE SYSTEM FOR ALL PATIENTS

If you adjust one or two segments, charge $24.90 for Code #98940.

If you adjust three or four segments, charge $34.47 for Code #98941.

If you adjust five or more segments, charge $44.75 for Code #98942.Note: These fees vary according to the area of the country the DC practices in. The previously described DRFERNANDEZ.COM Fee Determination System will let the DC know the


9appropriate fees for his/her area.

If you want to give a cash patient a financial break, only adjust one or two segments and charge for same.Caution: Never charge for adjusting segments you don’t adjust, or that you don’t have

subjective and objective findings to verify spinal problems in the areas you adjust, i.e., when adjusting C7 symptoms relating to this area must be written in the patient’s consultation and office visit notes, posture exam findings must be present in this area on the initial visit, daily visit notes and Progress exams. And, x-rays should always reveal a subluxation in this area.All vertebrae adjusted should have notes stating the above facts.

Exceptions to this rule are insurances that have a “pre-determined” and “agreed to” fee schedule.

DON’T INCLUDE THERAPY IN YOUR OFFICE VISIT FEE

When a doctor includes the charges of a therapy in his office visit fee, he/she is bound to lose the patient, i.e.: When a doctor charges $40 for an adjustment and therapy, the patient feels he/she is paying $20 for the adjustment and $20 for the therapy. When the doctor decides to discontinue the therapy, the patient will feel cheated because the doctor is now charging him/her $40 for an adjustment, which he/she formerly felt he/she paid $20.

This rule is especially important when dealing with Medicare, Medicaid or other federal insurance programs. The federal government considers the inclusion of therapy in an office visit fee, the negation of deductibles or co-pays, an illegal inducement to federally insured people and they will prosecute doctors if they find doctors doing so.

YOUR FEES SHOULD BE THE SAME FOR ALL PATIENTS

Another scenario that will backfire on you is charging one patient $40 a visit, and they refer a friend to your office, and you charge their friend $25. Because patients talk to each other, the patient who only pays $25 a visit will wonder why you are not giving him/her the “first class” service you are giving their friend ... after all you are charging their friend more for better care. The patient who pays $40 a visit will wonder why you are ripping him/her off because you are charging him/her more than his/her friend. You will lose both patients. Financial deals don’t work and always backfire!

An exception to this rule is when you have a contract with an insurance company, HMO/PPO, etc.


10DON’T HAVE A DUAL FEE SCHEDULE

Laws in most states now prevent doctors from “increasing fees” when billing insurance companies. In those states where there is no law on this subject, insurance carriers have argued that it is fraud for doctors to have dual fee schedules.

The new federal HIPAA law considers these dual fee schedules as illegal and federal law is always paramount!

DON’T DISCOUNT YOUR FEES

The average chiropractic practice has a 50%-60% overhead. If you discount your fees,the only thing you’re giving away is your net profit. This means you’ll end up being busy, but broke. Unfortunately, most chiropractors let the tail wag the dog. They have a number of people ask for a discounted fee. They think these people represent everybody; therefore, they discount their fees and go into a self-perpetuating financial atrophy from that point forward. Don’t think that all your patients want discounted fees.

When one of your relatives is very sick and needs an excellent medical physician, you will not call around town to find the cheapest specialist to take your relative to. Instead you, like everyone else, or everyone else that can think, will call around town to find the very best doctor for your relative. So will the public.

Dr. Clarence Gonstead, when he got into his late 60's, decided he wanted to cut down on his practice. He had excellent associates, who in their own right - had superb reputations. So in order to encourage his patients to discontinue with him and switch over to his associates who he trained for 20 years, he quadrupled his fees ... his practice tripled. People want the best and will pay for the best.

DON’T CHARGE LOW FEES

When you charge low fees, you are announcing to your community that your services are worthless and you will work harder and earn less.

DON’T OFFER FINANCIAL DEALS TO ANYONE

All financial deals blow up! They always end up with the loss of the patient.Family Plans

When you offer a family plan, i.e., $40 a visit for the patient, $30 for the spouse, and $15 for children, as long as all members of the family come to the office at the same time, you will


11eventually lose all members of the family with hard feelings. When the spouse or one of the children come to the office without the other spouse, and the doctor charges them his/her regular $40 office visit fee, the entire family will quit care. The same thing will occur when one of their children becomes an adult at age 18 or 21 and their fees are raised to adult fees. By offering a family plan, the D.C. will eventually lose the entire family.

CASH PATIENT COLLECTION RULES

DO A CREDIT CHECK ON ALL CASH PATIENTS

Join your local credit bureau so that you can run a credit check on every cash patient. This report will help you decide how to handle those patients who need, or would like, extended credit, i.e., a patient not able to pay you until he/she gets paid on Friday, or a regularly paying patient requesting they pay you once a month instead of every visit. If the patient’s credit report shows a history of not paying his/her bills, don’t kid yourself thinking that he/she will treat your bill any differently. People, who fail to pay others, will fail to pay you. Other companies/businesses do not extend credit to this type of person, why would you? And, a chiropractic office shouldn’t be in the banking business.Note: You must follow the procedures and regulations required by law in obtaining your

patient’s credit information. Your local credit bureau will be able to tell you what they are and how to abide by them.

“NO CHARGING” - BILLING POLICYDon’t allow patients to charge, other than patients with assignable insurance, an attorney lien, or an attorney’s letter of protection (L.O.P.). You have a 10% to 15% chance of collecting bills over 120 days old. Don’t let your practice income die of old age!

Don’t extend credit. Patients who owe you money, don’t follow through with care, usually don’t keep their appointments, become knockers instead of boosters, and many times will sue you for malpractice in order to avoid paying your bill.

And, patients who are paid up usually don’t sue!

ALLOW SELECTIVE CHARGING AFTER 8-10 VISITS

After your patient has paid their fees each visit for 8 to 10 visits in a row, let them charge and bill them once per month. They have proven their willingness to pay you.


12DON’T DISCOUNT FOR CASH PATIENTS

If you charge insurance patients $40 an adjustment, and cash patients $20 an adjustment, you will lose your patients. When the insurance company pays its portion of your patient’s bill and you bill the patient for their portion, and they or their attorney request you reduce your fees to cash fee prices, and you refuse, you will lose your patient. And, if you agree to do so, you are notifying the attorney and your patient that you ripped off the patient’s insurance company. Either way, you will lose.

DON’T TREAT THE PATIENTS POCKETBOOK

Never recommend less care than a patient needs because you ass-ume that the patient can’t afford your care. This type of action is immoral, unethical and could lead to malpractice.

The reverse is true as well. Never prescribe more care than a patient needs because you ass-ume the patient is wealthy.

COLLECT ON THE DAY SERVICES ARE RENDERED

Have the cash patient pay for their care every visit. As previously stated, patients will paywhen they are sick and will not pay when they are well. And, people who intend to pay won’t be offended when asked to pay.

FIRST VISIT SELECTIVE DISCOUNTING

If the first office visit is too expensive for a cash patient (someone living on a pension, etc.), you can selectively discount your fees. The CA should say:CA: “The doctor has extended to you a courtesy on your examination. Normally this

examination would be ______, but for you, Dr. Fernandez said your examination would only be ______.”

CASE FEES

You should charge case fees for cash patients, when patients have poor insurance coverage and Medicare insurance coverage. Patients are happiest when they know what is expected from them.

MAJOR MEDICAL INSURANCE PATIENT’S


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COLLECTION RULES

GET ALL FINANCIAL INFORMATION ON THE PATIENT’S FIRST VISIT

Trying to obtain insurance and financial information after the patient quits care, and has a balance, is many times impossible.

FIND OUT WHO IS RESPONSIBLE FOR THE PATIENT’S BILL ON THE FIRST VISIT

Many times a wife feels that her spouse’s (whether married or divorced) insurance is responsible for your payment. In other cases, whose insurance pays for a child’s care ... the mother, the stepfather, the divorced father? Find out all these facts on the first day. If the responsible party isn’t present during that office visit, the CA should call the anticipated responsible person and get their verbal and written authorization to pay for care. Have the patient, or the child’s mother, pay for the care until written authorization and insurance forms are received from the responsible party.

ASK THE PATIENT TO BRING THEIR INSURANCE POLICY IN WITH THEM ON THEIR NEXT VISIT

If the CA cannot contact the patient’s insurance company, or the patient’s insurance company won’t give the CA the in formation on the services that they are paid by the insurance company, limitations and exclusions, etc., have the patient bring their insurance policy to the office on their next visit.

Once the CA receives the patient’s insurance policy, she should review it to determine covered services, limitations and exclusions and then photocopy the pertinent pages of the patient’s insurance policy.

VERIFY THE PATIENT’S INSURANCE COVERAGE ON THEIR FIRST VISIT

On the patient’s first visit, the CA should call the patient’s insurance company to verify the patient’s insurance coverage, whether the deductible has been met, and its limitations and exclusions. If the CA is unable to contact the insurance company, or if the insurance company is unwilling to tell her what portion of the deductible is remaining, collect the total charges for the initial diagnostic visits and every treatment visit in full until the deductible is met and all verifications are accomplished.

DO A CREDIT CHECK ON ALL INSURANCE PATIENTS THAT WILL CHARGE THEIR SERVICES IN YOUR OFFICE


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The only time a doctor should extend credit to a patient is when they have good credit andthe doctor’s office has some form of payment protection, i.e., when Major Medical insurance may be inadequate, or the patient has his/her fees guaranteed by an insurance company lien, or have an “Authorization Agreement for Pre-Arranged Payment” from (Exhibit #3).

Also determine if any of the patient’s friends, relatives, or the person who referred them to your office, are patients in your office and check their payment records. If these patients have a poor credit rating or a poor payment record in your office, the odds are the referred patient will also have a poor payment record in your office.

COLLECT FOR THE INITIAL DIAGNOSTIC VISITS

Collect all fees due for the initial diagnostic visits (x-rays and exams). Exceptions would be insurances that pay 100% and attorney liens/Letters of Protection (LOP).

DO NOT ASK THE PATIENT TO PAY MORE THAN THE TOTAL AMOUNT OF THEIR INITIAL DIAGNOSTIC VISITS

If the total charges for the initial diagnostic visits are $195, and the amount of the patient’s deductible is $500, do not ask the patient to pay $500. In this case, have the patient totally pay for each visit until his total deductible is met.

COLLECT DEDUCTIBLES AND CO-PAYMENTS

Do not waive deductibles and co-payments. You are giving away your profit and possibly committing insurance fraud.

Legal Obligations Concerning Collection of Insurance Deductibles and Co-Pays

It is important that the doctor comply with all state and federal laws concerning insurance fraud. Federal HIPAA laws state that you can’t automatically collect deductibles and co-payments. While there are provisions in the laws for financial hardship, if you have a policy of blanketly waiving all deductibles or co-payments, you are violating the law and will get the reputation among your patients of ripping off insurance companies. Can you imagine your patient telling their friends/colleagues, “Dr. ___ is great, if you have insurance, he’ll stick it to your insurance company.” This is not the reputation you want to establish in your community.

You can selectively negate deductibles and co-payments if: 1) you can prove the patient is destitute, i.e., letter from a Priest/Minister/Rabbi stating the patient is destitute; 2) you have made a provable effort to collect from the patient.


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Failure to comply could result in your State Board of Professional Regulation or an insurance company charging you with insurance fraud.

WHEN DEDUCTIBLES ARE $500 OR LARGER

Collect for the initial diagnostic visits and all subsequent visits until the patient’s deductible is met. Then, if you accept assignment of the patient’s insurance, collect 30% of each visit thereafter. If you do not accept assignment of the patient’s insurance, collect the total amount due for each visit.

CHARGE FOR EXTENDED VISITS ON MORE INVOLVED CASES

President Abraham Lincoln said, “A doctor and attorney have only one thing to sell ... time.” When you devote extra time to a patient, i.e., adjusting extremities, taking prolonged histories, etc., you are entitled to charge for the extra time ... an extended visit.

DON’T TREAT INSURANCE COMPANIES

Too often, doctors tailor patient recommendations to the restrictions, or amount of payment they can get out of an insurance company. Both scenarios are wrong.

A doctor should prescribe the amount of care a patient needs based on the patient’s objective findings. To prescribe less than what the patient needs because of limitations of the patient’s insurance coverage is immoral and could lead to malpractice.

To prescribe more care than a patient needs because of unlimited insurance coverage is criminal.

MULTIPLE INSURANCE COVERAGE

Patients often pay for duplicate insurance coverage. Dig for all insurance coverage, accept assignments on all of them that may apply, notify all carriers that you “aren’t” sure which insurances will pay, therefore you accepted assignment on all of them and billed them all. Then ask the carriers to please advise you which carriers are responsible for your claim.

Insurances That Pay Chiropractic Claims:• Worker’s Compensation Insurance.• Major Medical Insurance (Group).• Major Medical Insurance (Private).• Spouse’s Private or Group Major Medical Insurance.


16• Ex-Spouse’s Private or Group Major Medical Insurance.• Preferred Provider Organization (PPO) Insurance.• Health Maintenance Organization (HMO) Insurance.• Liability Insurance (Homeowners or Commercial) if an accident.• Automobile Insurance.

S Med Pay.S No Fault.S Uninsured Motorist.S Underinsured Motorist.

• AAA Motor Club Accident Insurance.• Accident Insurance.• Fraternal Order Insurance.• Medicaid or Government Retirement Insurance.• Medicare.• Weekly Insurance Policies.• Insurance that covers time payments.• Investment Property Mortgage Payment Insurance.• Home Mortgage Payment Insurance.• Office Mortgage Payment Insurance.• Automobile Loan Payment Insurance.• Charge Card Payment Insurance (Sears, Wards, Penney’s, etc.).• Overhead Insurance Protection.• Disability Insurance.• Student Insurance.• School Athletic Insurance.

UP-DATE YOUR INSURANCE CODES

Every year there are revisions to the insurance codes utilized in a DC’s office. Current codes keep you out of trouble with insurance companies; gets your claims paid faster; and increases your income. Therefore, stay current with your insurance codes.

USE INSURANCE CODES PROPERLY

In order to get properly and adequately compensated by an insurance company, the doctor has to place the proper codes on the patient’s insurance (HCFA) form. For example, the doctor can charge for an adjustment, trigger point therapy, massage and supervised exercises on the same visit only if coded correctly, i.e.:• Chiropractic manipulation. (98940, 41 or 42)• Neuromuscular re-education (supervised exercises). (97112)• Massage. (97124)


17• Manual therapy (manual traction, trigger point therapy). (97140)

However, there are coding rules that must be applied when using these codes, i.e., the doctor must clearly state who performed these procedures; the time spent delivering the services and the area of the body to which the therapy is applied. The codes 97112, 97124 and 97140 describe procedures that must be applied to an area of the body different than the area adjusted (98940, 41, 0r 42), i.e.: An adjustment to the lumbar spine (98940) and supervised exercises (97112), massage therapy (97124) and trigger point therapy (97140) to the cervical spine.

Each of the services (97112, 97124, and 97140) must be at least 15 minutes in length. If less than 15 minutes in length, a -52 modifier must be added to these codes, and the charges for these procedures reduced.

Each of the services (97112, 97124, and 97140) must be applied by a licensed professional, i.e., a doctor giving the adjustment, a massage therapist, or physiotherapist. However, a CA or another DC applying these services will result in the services not being covered.

The procedures (97112, 97124, and 97140) can be applied to a patient on a second visit on the same day by the same DC giving the adjustment (98940), i.e., The doctor can adjust the patient in the morning (98940) and provide the services (97112, 97124 or 97140) at an afternoon appointment.

When the services (97112, 97124, and 97140) are applied to the patient on the same visit, the modifier -59 must be added to these codes.

UTILIZE A BILLING SERVICE

Billing services are recommended. It eliminates a lot of work in your office. However, a billing service does not eliminate the use of an insurance CA. You still need someone answering insurance carrier questions, but a billing service definitely frees up her time. A billing service also delays the hiring of an insurance CA, and once you have an insurance CA, it delays the hiring of her assistant.

Exception to Weekly Billing When Using a Billing Service

Usually a billing company will charge you a fee for each claim form. In this case, it is wise to only file claims when you treat a patient multiple times a week. If you bill weekly and only treat a patient once per week, you’re paying a high fee for only one visit per week. In this case, only bill monthly or bi-monthly and you’ll save a considerable amount of money, i.e., 40¢ per one visit when you bill weekly vs. 40¢ for four visits when you bill monthly.


18Some billing companies charge doctors a percentage of their collections. If you use this type billing company let them bill once per week.

For more information on billing services, contact Mr. Greg Barnes of Physician Servicesat 800-208-1009.

COMPUTERIZE YOUR OFFICE

All offices should be computerized. It makes for faster billing and quicker collections.

BILL WEEKLY

If you bill weekly, you will get your money quicker. The bills are smaller, therefore, the insurance companies will have a higher tendency to pay them faster and not object. The exception to billing weekly is when a patient is coming in once per week. In this case, it would be wise to bill once a month because there will only be four visits on your billing statement for that month, and your bill won’t be that big.

USE ELECTRONIC BILLING

Electronic billing will be mandated by Medicare in 2003. The Medicare electronic billing module is usually provided free. Soon all insurance companies will be switching over to electronic billing. When you use electronic billing, you will usually get paid within 14 days rather than waiting three or four months and putting up with a lot of hassles. If you don’t use electronic billing, you can depend upon insurance company hassles and a lot of waiting.

HAVE THE PATIENT FILL OUT AND SIGN THEIR OWN INSURANCE FORM AND BRING IT TO YOUR OFFICE FOR YOU TO MAIL

Many states and Major Medical, PPO or automobile insurance companies have a form that the patient has to fill out, sign and send to their insurance carrier to report their injury or claim. If the insurance carrier doesn’t receive this form, they will not pay for the patient’s professional services. This form is not the HCFA form the doctor sends to an insurance carrier.

If this procedure (the patient has to fill out their own insurance form, etc.) is necessary in your state, or with a certain insurance carrier, the DRFERNANDEZ.COM recommends that its doctors pre-print these forms and utilize them as part of their office procedures, i.e., If the patient states they have not filled out and sent in their form, the doctor’s office will have them fill out one of these forms, sign it and the doctor’s office will make a copy of it and mail the original to the patient’s insurance company.


19If the patient has filled out and mailed their form, the above procedure is not necessary.

HAVE THE PATIENT SIGN THE “ASSIGNMENT, LIEN AND AUTHORIZATION INSURANCE BENEFITS AND

ATTORNEY” FORM (EXHIBIT #1) ON THE INSIDE OF THE PATIENT’S FILE FOLDER

If a separate form is to be used, use the “Master Assignment, Lien and Authorization Insurance Benefits and Attorney” form (PGF71) (Exhibit #2). This form, when sent to the patient’s insurance carrier, usually protects the doctor’s bill.

HAVE THE PATIENT SIGN A “RELEASE OF MEDICAL INFORMATION” FORM (EXHIBIT #4)

HIPAA laws prohibit a doctor from sending information to anyone without the patient’s written authorization (release) to do so.

HAVE THE PATIENT SIGN AN “AUTHORIZATION AGREEMENT FOR PREARRANGED PAYMENTS (DEBITS) BY CREDIT CARD OR BANK HEALTH CARD” FORM (EXHIBIT #3)

Have all patients sign this “Authorization Agreement For Prearranged Payments (Debits) by Credit Card or Bank Health Card” form (Exhibit #3) for automatic debiting of their health credit cards, Visa, MasterCard, American Express, or an automatic deduction from their checking or savings account.

Do so in order to collect patient’s insurance deductibles, co-payments and non-payment of insurance cases.

HAVE CASH PATIENTS SIGN AN “AUTHORIZATION AGREEMENT FOR

ACCOUNT PAYMENT BY CREDIT CARD” FORM (EXHIBIT #7)

Have the patient sign the “Authorization Agreement for Account Payment by Credit Card” form in order to collect cash balances, i.e., either the cash patient didn’t pay you, or when an insurance company denies the patient’s insurance claim.

HAVE THE PATIENT SIGN A “POWER OF ATTORNEY TO ENDORSE CHECKS” FORM (EXHIBIT #5)

Have all insurance patients sign a “Power of Attorney to Endorse Checks” form (Exhibit #5). By using this form, whenever an insurance company sends you a check with your name and the patient’s name on it, you simply sign the patient’s name and your name to the back of the


20check, enclose a copy of this form, and deposit the check in your bank account. Your bank will honor your signing of your patient’s name.

MANAGED CARE (PPO, HMO, IPA) PATIENTS COLLECTION RULES


Trying to obtain the patient’s PPO and HMO financial information after the patient quits care, and has a balance, is many times impossible.

FIND OUT WHO IS RESPONSIBLE FOR THE PATIENT’S BILL ON THE FIRST VISIT

Many times a wife feels that her spouse’s (whether married or divorced) insurance is responsible for your payment. In other cases, whose insurance pays for a child’s care ... the mother, the stepfather, the divorced father? Find out all these facts on the first day. If the responsible party isn’t present during that office visit, the CA should call the anticipated responsible person and get their verbal and written authorization to pay for care. Have the patient, or the child’s mother, pay for your care until written authorization and insurance forms are received from the responsible party.




VERIFY THE PATIENT’S INSURANCE COVERAGE ON THEIR FIRST VISIT

On the patient’s first visit, the CA should call the patient’s PPO & HMO insurance company to verify the patient’s insurance coverage, whether the deductible has been met, if there is one,


21and its limitations and exclusions. If the CA is unable to contact the insurance company, collect the total charges for the initial diagnostic visits and every treatment visit in full until the deductible, if there is one, is met and all verifications are accomplished.

CAREFULLY SELECT THE PREFERRED PROVIDER ORGANIZATIONS (PPOs) & HEALTH MAINTENANCE ORGANIZATIONS (HMOs) IN WHICH YOU MAY WANT TO JOIN

Don’t join all PPOs and HMOs, some are good, most are terrible! Find a very knowledgeable, successful local DC. Ask him/her the following questions regarding each PPO and HMO.

1. How much do they pay per visit?2. How many visits do they willingly pay for?3. Are charges for therapy included in the allowable office visit fee?4. What therapies will they not pay for?5. Can you charge their insured patients for non-covered services?6. Can you treat their insured patients beyond their office visit restrictions and

charge their patients for those visits, i.e., If the plan authorizes 10 office visits and you treat the patient for 30 visits, can the patient pay you for the additional 20 visits?

7. How fast do they authorize or reject the patient’s initial care?8. How fast do they authorize or reject the patient’s additional care?9. How quickly do they pay?10. How much hassle (paperwork, etc.) do they give you?11. Are they a “Silent PPO,” i.e., They have a clause in their contract that allows

them to reduce the fees and services that you rendered to patients who had insurance coverage with other insurance companies down to their level of fees and care parameters.

When you ask these questions, you’ll be able to rule out the PPOs and HMOs you don’t want to accept. Also ask your DRFERNANDEZ.COM consultant his/her opinion regarding each PPO and HMO.Caution: Many PPOs and HMOs pay DCs through organizations called Independent ProviderAssociations (IPAs). Ask the same questions regarding the IPAs.

If the doctor has decided to sign a contract with an insurance companies PPO or HMO, he/she is considered an in-network provider. In this case, the doctor agrees to accept a lower fee for his/her services and usually to a limited number of visits. Most of the time an in-network patient doesn’t have to pay a deductible and usually pays a much lower co-payment each visit, i.e., $5 -$10.

If the doctor has decided not to sign a contract with an insurance companies PPO or HMO, he/she is considered an out-of-network provider. In this case, the insurance companies’


22patients will have to pay a deductible and a significantly higher co-payment on each visit, i.e., $20 - $30.

If you are able an in-network provider with a PPO or HMO, only charge their members (patients) the deductibles and fees you have agreed to and for the limitations you have agreed to when you signed the contract with that particular PPO or HMO. Please review the previous section, “Carefully Select the Preferred Provider Organization (PPO) and Health Maintenance Organization (HMO) in Which You May Want to Join” for clarification of covered services, limitations, exclusions, etc.

If you are an out-of-network provider with a managed care (HMO & PPO) provider, charge your normal fees, collect your patient’s deductible, collect their co-payments and collect for all non-covered services and non-covered patient visits.

PERSONAL INJURY PATIENTS COLLECTION RULES

Learn the important differences between the following systems and forms.

TORT AUTOMOBILE INSURANCE SYSTEM

In order to get paid in this system, the doctor must get paid by the patient’s automobile “medical payments” (Med-Pay) insurance. If a patient doesn’t have this provision in their automobile insurance coverage, they must have their bill guaranteed by an attorney lien or letter of Protection (LOP) or they must pay cash for their services each visit.

NO-FAULT AUTOMOBILE INSURANCE SYSTEM

In order to get paid in this system, the doctor bills the patient’s automobile insurance, if the patient has total coverage. If the patient has a deductible provision, the patient should pay for their initial diagnostic visit and every treatment visit until their deductible is met or have their bill guaranteed by an attorney lien or letter of Protection (LOP).

AUTHORIZATION FORMS

These forms authorizes (gives permission), but doesn’t instruct (demand) the patient’s insurance carrier pay the doctor.


23ASSIGNMENT FORMS

These forms demand the patient’s insurance carrier pay the doctor.

LIEN FORMS

These forms demand the patient’s insurance carrier to pay the doctor, and then places a freeze (a lien) on the portion of the insurance payments due the doctor.Note: All doctors are to check with a local Personal Injury attorney re: your State lawsregarding the wording of all forms you utilize.

THE DRFERNANDEZ.COM UTILIZES THREE DIFFERENT LIEN FORMS

The first form, “Assignment, Lien and Authorization Insurance Benefits and Attorney”(Exhibit #1) is printed inside the DRFERNANDEZ.COM’s file folders. The second form is the “Master Assignment, Lien and Authorization Insurance Benefits and Attorney” (Exhibit #2). These forms are signed by the patient and sent to their attorney and both insurance companies (the patient’s automobile insurance company and the insurance company of the person who hit your patient). The third form is an “Attorney Lien” form (Exhibit #__). The patient signs this form and takes it to their attorney for his/her signature and returns it to your office.


Trying to obtain insurance information and receive payment on a Personal Injury patient after the patient quits care and has a balance, is many times impossible.

VERIFY THE PATIENT’S PERSONAL INJURY INSURANCE COVERAGE ON THE PATIENT’S FIRST VISIT

On the Personal Injury patient’s first visit, the CA should call the patient’s automobile insurance company to verify the patient’s insurance coverage. If there is any, determine if their deductible has been met (if the patient’s insurance coverage has a deductible), and if the patient has Medical Payment (Med-Pay) insurance, has the Med-Pay been used up.

DETERMINE IF THE PATIENT’S MED-PAY INSURANCE COVERAGE IS USED UPThe CA should check with the patient’s insurance company to determine how much Med-Pay coverage is left. If the insurance company won’t give her the information, have the patient’s attorney do so.

GET A COPY OF THE PATIENT’S ACCIDENT REPORTDo so to make sure that your patient didn’t cause the accident. If your patient caused the


24accident, and doesn’t have no-fault or Medical Payments (Med-Pay) automobile insurance, and the only protection of your bill is an attorney lien or an attorney’s Letter of Protection (L.O.P.), the odds are the patient will lose their legal case and your bill will not be paid. In these type patients, also have the patient pay as much as they can on their bill and guarantee total payment by signing an “Authorization Agreement for Pre-Arranged Payment” form. (Exhibit #3.)

HAVE THE PATIENT FILL OUT AND SIGN THEIR OWN INSURANCE FORM AND BRING IT TO YOUR OFFICE FOR YOU TO MAIL

Many states or Major Medical, PPO or automobile insurance companies have a form that the patient has to fill out, sign and send to their insurance carrier to report their injury or claim. If the insurance carrier doesn’t receive this form, they will not pay for the patient’s professional services. This form is not the HCFA form the doctor sends to an insurance carrier.

If this procedure (the patient has to fill out their form, etc.) is necessary in your state, the DRFERNANDEZ.COM recommends that its doctors pre-print these forms and utilize them as part of their office procedures, i.e., If the patient states they have not filled out and sent in their form, the doctor’s office will have them fill out one of these forms, sign it and the doctor’s office will make a copy of it and mail the original to the patient’s insurance company. If the patient has filled out and mailed their form, the above procedure is not necessary.

HAVE THE PATIENT SIGN THE “ASSIGNMENT, LIEN AND AUTHORIZATION INSURANCE BENEFITS AND ATTORNEY” FORM (EXHIBIT #1) ON THE INSIDE OF THE PATIENT’S FILE FOLDERIf a separate form is to be used, use the “Master Assignment, Lien and Authorization Insurance Benefits and Attorney” form (PGF71) (Exhibit #2). These forms, when mailed to an insurance carrier - usually protects the doctor’s bill.

HAVE THE PATIENT SIGN A “RELEASE OF MEDICAL INFORMATION FORM” (EXHIBIT #4)HIPAA laws prohibit a doctor from sending information to anyone without the patient’s written authorization (release) to do so.

HAVE THE PATIENT SIGN AN “AUTHORIZATION AGREEMENT FOR PRE-ARRANGED PAYMENT” FORM(EXHIBIT #3)

Have all patients sign this “Authorization Agreement for Pre-arranged Payment” form (Exhibit #3) for automatically debiting health credit cards, Visa, MasterCard, American Express, or an automatic deduction from their checking or savings account. Do so in order to collect from cashpatients, insurance deductibles, co-payments and non-payment of insurance cases.

HAVE THE PATIENT SIGN A “POWER OF ATTORNEY TO ENDORSE CHECKS” FORM


25(EXHIBIT #5)

Have all insurance patients sign a “Power of Attorney to Endorse Checks” form (Exhibit #5). By using this form, whenever an insurance company sends you a check with your name and the patient’s name on it, you simply sign the patient’s name and your name to the back of the check, enclose a copy of this form, and deposit the check in your bank account. Your bank will honor your signing of your patient’s name.

HAVE THE PATIENT SIGN AN ATTORNEY LIEN FORM (EXHIBIT #11)

Send this form to the attorney for him to sign and send back to you, or better yet, have the patient take this form to their attorney and have him/her sign the form and return it to your office.Note: This form is different from the patient lien forms (Exhibits #1 & #2). Exhibits #1 and #2

are signed by the patient and sent to both insurance companies (the patient’s insurance company and the person who hit your patient’s insurance company), as well as to the patient’s attorney. The Attorney Lien form (Exhibit #11) is sent or taken to the patient’s attorney, signed by the attorney and returned to you.

LETTER OF PROTECTION

This is a letter from the patient’s attorney to you stating he/she will protect your bill from the proceeds of your patient’s insurance claim, or the patient’s lawsuit against the person that hit them. If the patient’s attorney sends you a L.O.P., you do not need to have him/her sign an “Attorney Lien” form (Exhibit #11).

DO NOT EXAMINE OR TREAT A PERSONAL INJURY PATIENT WITHOUT BEING PAID CASH, HAVE GUARANTEED PAYMENT BY THE PATIENT’S NO-FAULT, OR MEDICAL PAYMENTS (MED-PAY) INSURANCE, HAVE A SIGNED ATTORNEY LIEN OR LOP...AND A SIGNED “AUTHORIZATION AGREEMENT FOR PRE-ARRANGED PAYMENTS” FORM

If you examine or treat a personal injury patient without these protections, you are gambling you will be paid, and the odds are you will not be paid.

CHARGE FOR EXTENDED VISITS ON MORE INVOLVED CASESPresident Abraham Lincoln said, “A doctor and attorney have only one thing to sell ... time.” When you devote extra time to a patient adjusting extremities, taking prolonged histories, etc., you are entitled to charge for the extra time ... an extended visit.

COLLECT 100% FROM THE PATIENT’S NO-FAULT OR MEDICAL PAYMENTS (MED-PAY)


26INSURANCESCOLLECT FROM THE PATIENT’S AAA AUTOMOBILE INSURANCE COVERAGE Ask your patient if he/she is a member of AAA and if he/she has an AAA automobile accident insurance policy. This policy only pays $1000 - $1500. If they have this coverage, also accept assignment on this insurance coverage and send your bills to the AAA insurance company. There are no deductibles or co-pays with this insurance.

IF THE PATIENT’S MEDICAL PAYMENTS (MED-PAY) OR NO-FAULT INSURANCE DOESN’T PAY 100% OF THE PATIENT’S BILL

In some states, the patient’s Medical Payments (Med-Pay) or No-Fault insurance only pays 85% of the patient’s bill, or will only pay a certain amount per visit, i.e., $90. If so, have the patient pay the difference each visit. If the patient wants to pay a lesser amount per month, have your patient’s attorney give you a Letter of Protection (L.O.P.) or sign your Attorney Lien form and sign an “Authorization Agreement for Pre-Arranged Payments” form.

Some No-Fault insurances have $500, $1000, $2000 deductibles. If your patient has this type coverage, have your patient pay for all their services until their deductible is met, or have their attorney sign your attorney lien form or send you a Letter of Protection (L.O.P.) and have the patient sign “Authorization Agreement for Pre-Arranged Payments”.

IF THE PATIENT ONLY HAS A SIGNED ATTORNEY LIEN FORM OR AN ATTORNEY’S LETTER OF PROTECTION TO PROTECT YOUR BILL, HAVE THE PATIENT MAKE MONTHLY PAYMENTS TOWARDS THEIR BALANCE

If the patient has a L.O.P., or you have a signed attorney lien, or their Med-Pay is exhausted, a non-payment or non-collection effort shows that the D.C. will be biased when reporting the patient’s injuries to an insurance company, or testifying in court. Therefore, have the patient pay something on their bill each month.

CHARGE A $15 A WEEK ADMINISTRATION FEE

Some offices prefer to charge PI patients an administration fee of $15 per week and credit the patient’s account this amount. Doing so applies $60 a month to the patient’s balance.

IF THE PATIENT DOESN’T HAVE NO-FAULT, MEDICAL PAYMENTS (MED-PAY) INSURANCE, OR THEIR MED-PAY INSURANCE IS USED UP

Collect from their Major Medical insurance carrier. Caution: In some states the Major Medical PPO or HMO insurance will not pay if an auto

accident caused patient’s health problem. If unsure, have patient pay for their


27care until the Major Medical PPO or HMO insurance pays the bill.

IF THE PATIENT’S MAJOR MEDICAL INSURANCE HAS LIMITED COVERAGE

If the patient’s Major Medical insurance (a PPO or HMO) has limited coverage, i.e., only pays for 12 visits, once these twelve visits have been utilized, the patient then pays cash for each visit, or hires an attorney who signs your attorney lien form or sends you a Letter of Protection (LOP).

IF THE PATIENT’S MAJOR MEDICAL INSURANCE DOESN’T PAY 100% OF THE PATIENT’S BILL

If the patient has Major Medical insurance that has a deductible and limits on coverage, i.e., not paying for all services, limited fees, etc. Accept assignment on their Major Medical coverage and have the patient pay their deductible and 30% of each office visit.

If the patient doesn’t want to pay all their deductible and co-payments, have them have their attorney sign an Attorney Lien form or send you a Letter of Protection (L.O.P.). At the same time, have the patient pay a monthly amount on their bill.

If the patient doesn’t want to follow the above guidelines, have them pay cash for each office visit.

IF THE PATIENT DOESN’T HAVE NO-FAULT, MED-PAY OR MAJOR MEDICAL INSURANCE

Have the patient pay cash for each visit, or have the patient’s attorney send you a Letter of Protection (LOP) or sign an attorney lien form. These forms give your bills significant protection.

IF A PATIENT DOESN’T WANT TO USE THEIR AUTOMOBILE INSURANCE COVERAGE, OR SIGN A LIEN ON THEIR INSURANCE PROCEEDS BECAUSE THEY ARE CONCERNED THAT THEIR INSURANCE COMPANY WILL RAISE THEIR YEARLY PREMIUMS AND THEY DON’T HAVE ANY MAJOR MEDICAL INSURANCE COVERAGE

Call the insurance company of the person who hit your patient and ask if they will consider paying the patient’s bill in order to avoid having the patient hire an attorney.Many times the insurance company of the automobile who hit your patient’s vehicle will want topay for your patient’s care in order to avoid getting an attorney involved. To find out if this is true in any particular case, call the insurance adjuster of that insurance company who is in charge of that claim and tell him/her that the patient is concerned about their bill and is thinking about hiring an attorney. And, in order to avoid the patient hiring an attorney, would the


28insurance company consider paying their bill.CA: “The policy of this office is to collect for your initial diagnostic visits and 30% of

subsequent visits. We will accept assignment on your insurance coverage for the remaining 70% of your care. However, if there is any balance due after your insurance company pays, you will have to pay the balance. If there is any overage when the insurance pays, we’ll be happy to credit your account or give you a refund. Fair enough?”

DO A CREDIT CHECK ON ALL INSURANCE PERSONAL INJURY PATIENTS THAT WILL CHARGE THEIR SERVICES IN YOUR OFFICE, i.e.: UTILIZES A L.O.P. OR ATTORNEY LIEN

The only time a doctor should extend credit to a patient is when they have good credit andthe doctor’s office has some form of payment protection, i.e., when Med Pay or Major Medical insurance may be inadequate, or the patient has his/her fees guaranteed by an insurance company lien, Attorney Lien or an attorney Letter of Protection.

Also determine if any of the patient’s friends, relatives, or the person who referred them to your office, are patients in your office and check their payment records. If these patients have a poor credit rating or a poor payment record in your office, the odds are the referred patient will also have a poor payment record in your office.

NEVER DEPEND UPON THE INSURANCE COMPANY OF THE PERSON WHO HIT YOUR PATIENT TO PAY YOUR BILL

This insurance company is not responsible for paying your bill. However, an exception to this rule is if they write you and say they will pay your bill.

Note: If that insurance company says they will pay your bill when the case is settled, only take care of the patient when their Major Medical insurance pays you, you have a signed Attorney Lien or a L.O.P., a signed “Authorization Agreement for Pre-Arranged Payments” form, or if the patient pays cash for each visit.

CALL THE INSURANCE COMPANY OF THE PERSON WHO HIT YOUR PATIENT IN AN EFFORT TO PREVENT THE PATIENT FROM HIRING AN ATTORNEY

Many times the insurance company of the automobile who hit your patient’s vehicle will want to pay for your patient’s care in order to avoid getting an attorney involved. To find out if this is true in any particular case, call the insurance adjuster of that insurance company who is in charge of that claim and tell him/her that the patient is concerned about their bill and is thinking about hiring an attorney. And, in order to avoid the patient hiring an attorney, would theinsurance company consider paying their bill.


29

SEND ASSIGNMENT FORMS TO BOTH INSURANCE COMPANIES

Send a copy of the “Assignment, Lien and Authorization Insurance Benefits and Attorney” Form (Exhibit #1) or “Master Assignment, Lien and Authorization Insurance Benefits and Attorney” Form (PGF71) (Exhibit #2) to the patient’s insurance company and to the other insurance company (the one that insures the person that hit your patient). Stamp “Benefits Assigned” on the forms every time you submit a form or statement to any insurance company.

If the patient has hired an attorney, send a copy of this form to him/her too.

NEVER SEND YOUR INSURANCE CLAIMS TO AN ATTORNEY AND HE/SHE FORWARDS YOUR CLAIMS TO THE INSURANCE COMPANIES

What happens in this scenario is: The attorney will collect your bills from the insurance companies and place the funds in his/her Trust Account, accruing interest for him/her, and dole out small amounts to you, only when harassed.

When a patient’s case is about to be settled, after the attorney has collected all your bills, he/she will then demand you reduce your bill, even though he/she has collected all of it. By doing so, the attorney earns more money for himself/herself and the patient. Only you lose.

COLLECT FROM THE MOST AVAILABLE SOURCE ... NOT THE ATTORNEY

If the patient has Med-Pay or No Fault insurance, bill the patient’s automobile insurance company and get paid directly by their insurance company.

TREAT PERSONAL INJURY PATIENTS UNTIL THEY HAVE REACHED MAXIMUM MEDICAL IMPROVEMENT (MMI)

Do not let an insurance company or attorney bully you into giving a premature permanent impairment to a patient. Treat your patient until they are as well as you can get them (Maximum Medical/Chiropractic Improvement (MMI).

At this point, notify the attorney and/or the patient’s insurance company that the patient has reached MMI and you will have to continue treating the patient to keep the percentage of the patient’s permanent injury at a minimum and to keep the pain of the permanency at a minimum, if true.

Use the following verbiage when reporting MMI to an attorney or insurance company.“I recently performed a progress examination on Mrs. Patient. At this point, I feel that


30she has reached Maximum Medical Improvement (MMI). Unfortunately, the structural damage caused by the accident of (date), has resulted in a 10% permanent partial spinal impairment of the cervical spine, rated at 10% of the body as a whole. However, I am going to have to continue treating Mrs. Patient to keep her percentage of permanency from increasing and to keep the pain of the permanency at a minimum.”

WHEN AN INSURANCE COMPANY SENDS THE CHECK TO THE PATIENT

If you have followed all the DRFERNANDEZ.COM prescribed procedures, call the insurance adjuster of the patient’s insurance company and tell them to send you a check for the services you rendered and for them to recover the funds they sent to the patient. If they balk, ask the adjuster if he/she would like your attorney to call them to explain the law regarding assignment/liens.

Also, collect your bill from the patient’s credit card/bank using the “Authorization Agreement for Pre-Arranged Payment” form (Exhibit #3) the patient signed.Note: Some states don’t honor assignments/liens. Check with a local PI attorney regarding

this.

SEND THE ATTORNEY INQUIRY POST CARD (EXHIBIT #9) TO THE PATIENT’S ATTORNEY EACH MONTH

This card quickly up-dates your insurance department re: the disposition of each PI case.

WHEN A PATIENT FIRES AN ATTORNEY, OR IS DROPPED BY AN ATTORNEY

When either of the above scenarios occurs, your attorney lien or the attorney’s Letter of Protection (LOP) is canceled and you don’t have any protection of your bill. This is why it is very important to check with the patient’s attorney’s office on a monthly basis via the “Attorney Inquiry Post Card” or a telephone call to keep track of your patient’s case.

If you have followed DRFERNANDEZ.COM recommended procedures, you should be somewhat protected by the “Assignment, Lien and Authorization Insurance Benefits and Attorney” form (Exhibit #1) that you sent to both insurance companies and the “Authorization Agreement for Pre-Arranged Payment” form (Exhibit #3) to debit the patient’s credit card.

SLIP AND FALL ACCIDENTS

Get a signed attorney lien and/or a Letter of Protection from the patient’s attorney on these cases, or have the patient pay for each visit. Approximately 75% of these cases are lost. If you accept this type of case on an Attorney Lien, or a L.O.P., you are taking this case as a favor to


31the attorney. Tell the attorney, in a nice way, that you are taking care of this case as a favor to him/her.

Try to get the patient to sign an “Authorization Agreement for Pre-Arranged Payment” form (Exhibit #3) for additional protection of your bill.

WORKER’S COMPENSATION PATIENTS COLLECTION RULES

ALWAYS GET A WORKER’S COMPENSATION CARD (EXHIBIT #6) SIGNED BY THE EMPLOYER OR THE PATIENT’S FOREMAN TO GUARANTEE PAYMENT.

If the insurance company has to authorize this care, have them write you a written authorization to do so. Otherwise, have the patient pay for each visit.

MEDICARE PATIENTS COLLECTION RULES

REGISTER AS A NON-PARTICIPATING PROVIDER WITH MEDICARE

The DRFERNANDEZ.COM recommends that its doctors register with Medicare as a non-participating provider.

CHARGE PROPER MEDICARE FEES

If the doctor is a participating member of Medicare (see page ____ for definitions of participating and non-participating categories of Medicare membership) only charge the Medicare allowable fee for an adjustment (this fee is different in each area of the country). If you are a non-participating member, you can only charge the Medicare allowable fee in your area, plus 10%, for an adjustment.

USE THE MEDICARE “ADVANCE BENEFICIARY NOTICE” (ABN) FORM EACH VISIT

Make sure the Medicare patient signs an “Advance Beneficiary Notice” (ABN) form (Exhibit #8) each visit they come to your office.


32

This form tells the patient the services that will not be paid by Medicare. The patient then designates whether or not they want the unpaid for service and signs their form.

The only service that needs to be placed on the form is the chiropractic adjustment, because that is the only service that Medicare is concerned with. However, as a protective measure, DRFERNANDEZ.COM suggests the CA write in the proper space the extra services to be performed on that day, i.e., x-rays, examination, physiotherapy, etc. Regarding the chiropractic adjustment, the CA should write, “The doctor has recommended 30 office visits, of which 18 probably will not be paid by Medicare.”

The patient is to sign the ABN form with the described exclusions each office visit.

DON’T INCLUDE THERAPY, EXAMS, ETC. IN YOUR OFFICE VISIT FEE

Never include therapy, exams, etc. in your office fee on Medicare, Medicaid or other federal insurance programs. The federal government considers the inclusion of therapy and exams in an office visit fee, the negation of deductibles or co-pays, an illegal inducement to federally insured people and they will prosecute doctors if they find doctors doing so.

THE DOCTOR’S OFFICE IS TO FILE THE PATIENT’S MEDICARE FORM FOR THE PATIENT’S MEDICARE REQUIRES THAT ALL DOCTORS FILE THEIR PATIENT’S MEDICARE INSURANCE FORMS FOR THEM

MEDICAID/MEDI-CAL (CALIFORNIA’S VERSION OF MEDICAID) COLLECTION RULES

While Medicaid is a federal insurance program to care for the poor, it is administered by the individual states. Unfortunately, each state sets its office fee rates and parameters regarding number of allowable visits, reimbursement rates for office fees and covered services. In some states, Medicaid patients have better reimbursement rates for office visit fees than do Medicare and many managed care plans (HMO’s & PPO’s).

In many states, some patients have Medicaid and Medicare insurance. In this case, the doctor’s reimbursements are higher. However, the restrictions and limitations, i.e., number of visits, services allowable, etc. may be greater.


33The doctor should contact the insurance chairman of his state association for the above information regarding Medicaid in his/her state.

If the doctor accepts Medicaid, he/she should follow the collection rules regarding Major Medical insurance patients, yet only charging the fees and following the limitations allowed by his/her state’s Medicaid insurance.

COLLECTIONOFFICE PROCEDURES

DAILY VISIT COLLECTION DOCUMENTATION... FEE SLIP SYSTEM

The CA determines the patient’s new account balance from their fee slip and records it on the patient’s file, in the computer and on the patient’s account ledger (if one is used).

DISTRIBUTION OF FEE SLIPSINSURANCE PATIENT

In a multiple CA office, the front desk CA distributes the copies of the fee slip. The top copy (the original and most legible copy) goes to the insurance department, where the insurance CA posts the pertinent billing information for that visit.

PATIENT PAYING THAT DAY

Any patient paying that day is given the second copy of the fee slip as a receipt for payment.

PATIENT BILLING THEIR OWN INSURANCE

If a patient insists on billing their own insurance, they are considered a cash-paying patient and are required to pay cash for their services. This type of patient receives the second copy of the fee slip as a receipt for payment made (only after payment has actually been made) to be used in requesting reimbursement from his/her insurance company.

ONCE THE INSURANCE CA HAS POSTED THE PATIENT’S INFORMATION


34The insurance CA gathers all the white copies of the fee slip, staples them together and keeps them until the end of the week.

AT THE END OF THE WEEK

The insurance CA staples all the white copies of the fee slip together and writes in BOLD

LETTERS the week and year on the back of the outside fee slip. The insurance CA then places these fee slips in storage for future reference.

DAILY VISIT COLLECTION DOCUMENTATION ...PEGBOARD SYSTEM

The CA follows the same procedure as in using fee slips, with the exception of: • The “superbill” takes the place of the fee slip. (A “superbill” is Pegboard receipt that lists

all the doctor’s services.)• The insurance CA will post that day’s services into the computer from the daily control

sheet, and then save the daily control sheets.• The front desk CA posts the daily control sheet, the office deposit slip, the patient’s

ledger card, and the patient’s superbill at the same time.

FIRST VISIT COLLECTION PROCEDURES

FIRST VISIT CASH PATIENT’S COLLECTION PROCEDURES

AFTER THE EXAMINATION AND X-RAYS

THE DOCTOR REVIEWS THE PATIENT’S FEE SLIP AFTER THE PATIENT’S EXAMINATION AND X-RAYS


35The doctor reviews the patient’s fee slip (or super bill) describing the services he/she performed that day with the patient. However, he/she doesn’t go over the fees for these services unless asked by the patient. The doctor does this procedure by using:

THE “PLUS, IN ADDITION TO” VERBIAGEDR: “Today I performed a consultation, plus an orthopedic exam, a

neurological exam, a chiropractic exam, and physical exam.

IF X-RAYS HAVE BEEN TAKENThe doctor will include a brief description of the x-ray views taken:DR: In addition, I took two x-rays of your neck, one from the front, the other

from the side, and performed a urine test, etc.”

This procedure is necessary is to familiarize the patient with all the services that were rendered that day. Doing so will give the patient a total value to the doctor’s services, thus preventing the patient from being shocked when the CA presents the fees for the services that were rendered.

IF THE PATIENT RESPONDED TO AN OFFER OF FREE SERVICES

The doctor, using the “plus, in addition to” verbiage, explains all the services rendered that day that were free or discounted and then, again using the “plus, in addition to” verbiage explains the services in which there was a charge (x-ray, urine analysis, etc.).

WHEN THE PATIENT MAKES THEIR NEXT APPOINTMENT

THE CA COLLECTS THE TOTAL AMOUNT DUE

If the patient is a cash patient or a non 100% insurance patient, collect the entire fee for this visit. The CA will do so by also using:

THE “PLUS, IN ADDITION TO” VERBIAGE

The CA always starts her collection effort by reiterating to the patient all of the services he/she received that day, using the “plus, in addition to” verbiage and ends the sentence with the patient’s fees.

THE “PLUS, IN ADDITION TO” VERBIAGE CA: “Today Dr. ______ performed a consultation, plus an orthopedic exam, a



36

IF X-RAYS HAVE BEEN TAKEN

The CA will include a brief description of the x-ray views taken:CA: In addition, he/she took two x-rays of your neck, one from the front, the other


IF THE PATIENT HAS RESPONDED TO AN OFFER OF FREE SERVICES

The CA, using the “plus, in addition to” verbiage, will explain all the services rendered that day that were free or discounted and then explains the services in which there was a charge (x-ray, urine analysis, etc.).

THE CA ALWAYS STATES THE PATIENT’S FEES AS, “YOUR FEE”, NEVER “OUR FEES, OR OUR CHARGES, ETC. AND THE CA NEVER ADDS THE WORD, “DOLLARS” TO THE FEE

CA: “Today, Dr. Fernandez provided you with a consultation, an orthopedic examination, plus a neurological examination, and a chiropractic examination, in addition to, a urine analysis and two x-rays, one from the front, plus one from the side. Your fee for today is 185.”

The reason both the doctor and the CA review the services rendered to the patient prior tostating the fees using the “plus, in addition to” verbiage, is to remind the patient of, and to create an emphasis on, all the services that the patient received that day. By doing so, the patient will be far more acceptable of your fee.

THE CA THEN SAYS, “Is this to be paid by cash, check or credit card?”

IMMEDIATELY AFTER MAKING THE ABOVE STATEMENT, THE CA LOOKS DOWN AND STARTS WRITING THE RECEIPT

The CA, acting if she has no doubt the patient is expecting to pay and is prepared to do so, immediately looks down and begins writing the patient’s receipt. She doesn’t look up as if she expects the patient to object.

FIRST VISIT CASH PATIENT COLLECTION PROBLEM SOLVERS

NEVER ASK A PATIENT, “DO YOU WANT TO PAY?” They’ll answer, “Heck, no!”


37

NEVER ASK A PATIENT, “HOW DO YOU WANT TO PAY?” They’ll respond, “Bill me.”

PATIENT STATEMENTSScenario #1:PT: “I didn’t bring enough money with me today.”CA: “How much can you pay today?

PT: “I only have $40.” CA: “That’s ok. You can place your balance on a credit card ... we do accept them.”

If the patient doesn’t have a credit card, offer the patient the use of a counter check.

PT: “I don’t have a credit card.CA: “That’s okay, here’s a blank check that will help you out this time.

If The Patient Doesn’t Want to Use a Credit Card or a Counter Check, State Your “No Billing” Policy:

CA: “We have a policy of not sending statements for fees less than $250. This policy keeps our office visit fees down. When you come in tomorrow you can pay for the balance of today’s visit and tomorrow’s visit.”

Scenario #2:PT: “I forgot my checkbook.”CA: “If you have a credit card, we do accept them.”

PT: “I don’t have a credit card.”CA: “That’s okay, here’s a blank check that will help you out this time.”



Scenario #3:PT: “I didn’t bring any money or a check with me today.”


38CA: “If you have a credit card, we do accept them.”

If the patient doesn’t have a credit card or a check, offer them a counter check.

PT: “I don’t have a credit card.”CA: “That’s okay, here’s a blank check that will help you out this time, or, if you have

a credit card, we do accept them.”


CA: “We have a policy of not sending statements for fees less than $250. This policy keeps our office visit fees down. When you come in tomorrow you can pay for today’s visit and tomorrow’s visit.”

Scenario #4:If a New Patient Comes in on Monday, but Says He/She Cannot Pay until Friday:

PT: “I didn’t bring any money or a check with me today. I get paid on Friday and will pay you then.”

CA: “We have a policy of not billing for services under $250. This policy keeps our office visit fees down. Would you like to put your balance on a charge card...we do accept them?”

If the Patient Refuses, Then Offer Them the Use of a Credit Card or a Counter Check.

CA: “That’s okay, here’s a blank check that will help you out this time.

If the patient refuses to pay by credit card, check or counter check. The CA sets the patient’s next appointment for Friday and tells the patient that he/she can pay for today’s services along with Friday’s services on Friday. CA: “We have a policy of not sending statements for fees less than $250. This policy

keeps our office visit fees down. When you come in on Friday, you can pay for today’s visit and Friday’s visit.”

NOTE: Call your bank to find out about the legality of counter checks in your state.

FIRST VISIT MAJOR MEDICAL INSURANCE PATIENT’S


39

COLLECTION PROCEDURES

AT THE BEGINNING OF THE PATIENT’S FIRST VISIT

GET ALL PAYMENT INFORMATION ON THE PATIENT’S FIRST VISITCOPY THE PATIENT’S INSURANCE CARD

The CA is to photocopy the patient’s insurance card and staple it inside the patient’s file.

WHILE THE PATIENT IS IN CONSULTATION

WITH THE DOCTOR

The CA calls the insurance company for verification of coverage, limitations and exclusions.




AT THE END OF THE PATIENT’S CONSULTATION

The CA reports the insurance limitations and exclusions to the doctor. If the patientdoesn’t have insurance coverage, or very limited insurance coverage, the doctor will explain the CA’s findings regarding their insurance coverage to the patient so that they can make an informed consent whether or not to proceed with the recommended care.


40IF THE DOCTOR OFFERS A FREE EXAMINATION

The doctor performs the free examination, explains his/her findings to the patient andexplains the CA’s findings regarding the patient’s insurance coverage so that they can make and informed consent whether or not to proceed with the recommended care.

AFTER THE PATIENT’S EXAMINATION AND X-RAYSThe doctor reviews the patient’s fee slip with the patient. He does so by using:

THE “PLUS, IN ADDITION TO” VERBIAGE DR: “Today I performed a consultation, plus an orthopedic exam, a neurological exam,

a chiropractic exam, and physical exam.

IF X-RAYS HAVE BEEN TAKENThe doctor will include a brief description of the x-ray views taken:

DR: In addition, I took two x-rays of your neck, one from the front, the other from the side, and performed a urine test, etc.”


The doctor, using the “plus, in addition to” verbiage, will explain all the services rendered that day that were free or discounted and then explains the services in which there was a charge (x-ray, urine analysis, etc.).


THE CA REPORTS HER INSURANCE CONFIRMATION TO THE PATIENT

However, she does not explain in detail what the patient insurance company told her over the telephone, as this often changes. Insurance companies are notorious for saying one thing over the phone and then doing another thing once the patient is under care. In order to avoid creating any unnecessary patient anticipation, patient confusion or ill will, the CA simply tells the patient that his/her insurance will pay for chiropractic care (if true).

IF THE PATIENT IS COVERED BY INSURANCE THAT PAYS 100%

If the patient has accident insurance, medical payments, automobile insurance, No-Fault Automobile insurance, Workers’ Compensation insurance, etc. that pays 100% of the patient’s care, the amount due for the first visit is zero.


41Caution: Sometimes the medical payments automobile insurance has been exhausted or

the No-Fault automobile insurance doesn’t pay 100%. If so, use the scripts discussed under the “First Visit Personal Injury Patient’s Collection Procedures” section that follows.

CA:“YOUR INSURANCE WILL PAY FOR YOUR CARE 100%

IF THE PATIENT HAS GOOD ASSIGNABLE INSURANCE THAT DOESN’T PAY 100% OF THE PATIENT’S BILL

The CA will state the office fee policy for patients with insurance that pays less than 100% of the patient’s bill. CA: “The policy of this office is to collect for your initial diagnostic visits and 30% of


IF THE PATIENT HAS GOOD ASSIGNABLE INSURANCE WITH OVER A $200 DEDUCTIBLE WHICH HAS NOT YET BEEN PAID

The CA should collect for the total services rendered until the deductible is satisfied. After the full deductible has been paid, the CA would only need to collect 30% of the patient’s services.CA: “The policy of this office is to collect for your services until your deductible is

met, and at that point, you will pay 30% of the fees for your subsequent visits. We will accept assignment on your insurance coverage for the remaining 70% of your care. However, if there is any balance due after your insurance company pays, you will have to pay the balance. If there is any overage when the insurance pays,we’ll be happy to credit your account or give you a refund. Fair enough?”

NECESSARY DOCUMENTS

THE CA ASKS THE PATIENT TO BRING A COPY OF THEIR INSURANCE POLICY AND THEIR INSURANCE FORM, WITH THEIR PORTION FILLED OUT AND SIGNED, ON THEIR


42NEXT VISIT

THE CA HAS THE PATIENT SIGN THE AUTHORIZATION/ASSIGNMENT ON YOUR HCFA FORM AND THE “ASSIGNMENT, LIEN AND AUTHORIZATION INSURANCE BENEFITS AND ATTORNEY” FORM (EXHIBIT #1) ON THE INSIDE OF THE PATIENT’S FILE FOLDER

If the doctor doesn’t utilize the DRFERNANDEZ.COM file folder, have the patient sign the “Master Assignment Lien and Authorization Insurance Benefits and Attorney” form (PGF71). (Exhibit #2)

THE CA HAS THE PATIENT SIGN THE “AUTHORIZATION TO RELEASE HEALTH INFORMATION” FORM (EXHIBIT #4)

A doctor should never send patient information to anyone without the patient’s written authorization (release) to do so.

THE CA HAS THE PATIENT SIGN A “POWER OF ATTORNEY TO ENDORSE CHECKS” FORM (PGF131) (EXHIBIT #5)

This form allows the doctor to sign a patient’s name to an insurance check. When aninsurance company sends your office a check made out to your patient, or to the doctor and your patient, the CA simply attaches a copy of this form to the check, the doctor signs the patient’s name to the check, and deposits it. The bank will honor the doctor’s signature of the patient’s name.

THE CA HAS THE PATIENT SIGN AN “AUTHORIZATION AGREEMENT FOR PRE-ARRANGED PAYMENTS (DEBITS) BY CREDIT CARD OR BANK HEALTH CARD” FORM (PGF141) (EXHIBIT #3)This form authorizes you to charge the patient’s charge card for any balance the patient’s insurance company has not paid, i.e., If you have billed the patient’s insurance company $1000 and they pay $800, you can charge the patient’s charge card $200.

IF THE CA ENCOUNTERS PROBLEMS COLLECTING FROM A MEDICAL INSURANCE PATIENT, HE/SHE SHOULD FOLLOW THE FOLLOWING COLLECTION PROBLEM SOLVERS.


43

FIRST VISIT MAJOR MEDICAL PATIENT’S COLLECTION PROBLEM SOLVERS

IF AN INSURANCE PATIENT DOESN’T WANT TO USE THEIR INSURANCECA: “You can pay by cash, check or credit card for each office visit. We’ll give you a

receipt for the visit which you can send to your insurance company for reimbursement.”

Note: The patient does not receive a receipt for services rendered unless the service has been paid for.



PATIENT STATEMENTSScenario #1:

PT: “I didn’t bring enough money with me today.”CA: “How much can you pay today?






Scenario #2:


44

PT: “I forgot my checkbook.”CA: “If you have a credit card, we do accept them.”




Scenario #3:

PT: “I didn’t bring any money or a check with me today.”CA: “If you have a credit card, we do accept them.”








CA: “We have a policy of not billing for services under $250. This policy keeps our office visit fees down. Would you like to put your balance on a charge card...we do accept them?”If the Patient Refuses, Then Offer Them the Use of a Credit Card or a Counter Check.


45CA: “That’s okay, here’s a blank check that will help you out this time.

If the patient refuses to pay by credit card, check or counter check. The CA sets the patient’s next appointment for Friday and tells the patient that he/she can pay for today’s services along with Friday’s services on Friday.

CA: “We have a policy of not sending statements for fees less than $250. This policy keeps our office visit fees down. When you come in on Friday, you can pay for today’s visit and Friday’s visit.”


PREFERRED PROVIDER ORGANIZATIONS (PPO’s) AND INDEPENDENT PHYSICIANS ASSOCIATIONS (IPA’s) PATIENT’S

COLLECTION PROCEDURES

PPO’s and IPA’s are organizations in which a doctor may or may not have a contract to provide care to their members.

OUT OF NETWORK PROVIDERS

If the doctor has not signed a contract with a PPO or IPA he/she is considered a out-of-network provider. In this case, follow the collection scenario described for Major Medical patients.

IF THE DOCTOR OFFERS A FREE EXAMINATIONThe doctor reviews the patient’s fee slip with the patient. He/She does so by

using:THE “PLUS, IN ADDITION TO” VERBIAGE DR: “Today I performed a consultation, plus an orthopedic exam, a neurological exam,

a chiropractic exam, and physical exam.

IF X-RAYS HAVE BEEN TAKENThe doctor will include a brief description of the x-ray views taken:

CA: In addition, I took two x-rays of your neck, one from the front, the other from the side, and performed a urine test, etc.”


46IF THE PATIENT HAS RESPONDED TO AN OFFER OF FREE SERVICES

The doctor, using the “plus, in addition to” verbiage, will explain all the services rendered that day that were free or discounted and then explains the services in which there was a charge (x-ray, urine analysis, etc.).

IF THE PATIENT HAS GOOD ASSIGNABLE PPO INSURANCE THAT DOESN’T PAY 100% OF THE PATIENT’S BILL

The doctor will state the office fee policy for patients with insurance that pays less than 100% of the patient’s bill. DR: “The policy of this office is to collect for your initial diagnostic visits and 30% of


AFTER THE PATIENT’S EXAMINATION AND X-RAYSThe CA reviews the patient’s fee slip with the patient. He/She does so by using:

THE “PLUS, IN ADDITION TO” VERBIAGE CA: “Today Dr. ______ performed a consultation, plus an orthopedic exam, a


IF X-RAYS HAVE BEEN TAKENThe CA will include a brief description of the x-ray views taken:

CA: In addition, he/she took two x-rays of your neck, one from the front, the other from the side, and performed a urine test, etc.”


The CA, using the “plus, in addition to” verbiage, will explain all the services rendered that day that were free or discounted and then explains the services in which there was a charge (x-ray, urine analysis, etc.).

IF THE PATIENT HAS GOOD ASSIGNABLE PPO INSURANCE THAT DOESN’T PAY 100% OF THE PATIENT’S BILL

The CA will state the office fee policy for patients with insurance that pays less than 100% of the patient’s bill.


47CA: “The policy of this office is to collect for your initial diagnostic visits and 30% of


IN NETWORK PROVIDERS

If the doctor has signed a contract with a PPO or IPA he/she is considered an in-network provider. In this case, the doctor has agreed to be paid a lower fee for all or some of the doctors services, i.e., adjustments, physiotherapy, examinations, x-rays, limited number of visits etc. In some of these plans, the doctor is instructed to collect deductibles from these patients. However, most of the time a PPO or IPA patient doesn’t have to pay a deductible and the doctor is instructed to only collect a certain amount of co-pay usually $5 - $15, each time the patient comes to the doctors office.

AT THE BEGINNING OF THE PATIENT’S REPORT-OF-FINDINGS VISIT

When the doctor is an in-network provider follow with the collection procedures described below.

IF THERE IS A DEDUCTIBLE

Collect the deductible on the patient’s first visit and then collect the amount of co-pay they are required to pay each subsequent visit.

If the patient has a deductible and a co-pay provision in their contract:CA: We will accept assignment on your insurance coverage for their allowable care.

However, if there is any balance due after your insurance company pays, you will have to pay the balance. If there is any overage when the insurance pays, we’ll be happy to credit your account or give you a refund. Fair enough?”

IF THERE IS NO DEDUCTIBLE

Collect the co-pay amount due each visit.


48

IF THE PATIENT ONLY HAS TO PAY A CO-PAYMENT:

CA: “Your insurance company requires you to pay a $10.00 (or whatever) co-payment on each visit. We will accept assignment on your insurance coverage for their allowable care. However, if there is any balance due after your insurance company pays, you will have to pay the balance. If there is any overage when the insurance pays, we’ll be happy to credit your account or give you a refund. Fair enough?”

IF THE PATIENT HAS A PROBLEM PAYING FOR THEIR PORTION OF THEIR OFFICE VISIT, USE THE FOLLOWING PROBLEM SOLVERS

FIRST VISIT PPO AND HMO PATIENT’S COLLECTION PROBLEM SOLVERS

IF AN INSURANCE PATIENT DOESN’T WANT TO USE THEIR INSURANCECA: “You can pay by cash, check or credit card for each office visit. We’ll give you a

receipt for the visit which you can send to your insurance company for reimbursement.”








49If the patient doesn’t have a credit card, offer the patient the use of a counter check.




Scenario #2:





Scenario #3:







50CA: “We have a policy of not sending statements for fees less than $250. This policy

keeps our office visit fees down. When you come in tomorrow you can pay for today’s visit and tomorrow’s visit.”








It is wise for the doctor and CA to read each one of the PPO and IPA contracts in which he/she entered into to determine if they should collect a deductible. If so, how much, the amount of co-pay he/she should charge per visit, how many visits are allowed, what services are covered and what services are not covered etc. He/she should also check to see if he/she could charge additional for non-covered services because sometimes a PPO or IPA contract states that the doctor can only charge the patient a co-payment and not charge additional for non-covered services.

And, the doctor and CA should check if the PPO or IPA only pays for a limited amount of services or visits, i.e.: 12 visits or $25 dollars per visit and the doctor wants to treat the patientfor forty visits and use therapy etc., is there a prohibition against charging for the non-covered services? If so, the doctor should offer the patient a case fee, as described in the next section, for all services that are not covered by the PPO or IPA.


51

FIRST VISIT PERSONAL INJURY PATIENT’S COLLECTION PROCEDURES

NECESSARY PAPERWORK AT THE BEGINNING OF THE PATIENT’S FIRST VISIT:

THE CA IS TO GET THE PATIENT’S ATTORNEY’S NAME, ADDRESS AND TELEPHONE NUMBER

THE CA HAS THE PATIENT SIGN:• The “Assignment, Lien and Authorization Insurance Benefits and Attorney” form (Exhibit

#1). The Exhibit #1 form is printed on the inside of the patient’s file folder (PGF71). Have a local attorney verify this form is totally legal in your state. If it isn’t, have the attorney make a similar form that will be legal in your state.

• The “Master Assignment, Lien and Authorization Insurance Benefits and Attorney” form (Exhibit #2)

• The “Attorney Lien” form (Exhibit ___). The CA will ask the patient, after this first visit, to immediately take the “Attorney Lien” Form (Exhibit ___) to their attorney for him/her to sign and to bring this form back to your office on their next visit. Note: Dr. Pete: Get an Attorney Lien form.

• The “Power of Attorney to Endorse Checks” form (Exhibit #5).• The “Authorization Agreement for Pre-arranged Payments (Debits) by Credit Card or

Bank Health Card” form (Exhibit #3)

AFTER THE PATIENT’S EXAMINATION AND X-RAYS:


The doctor reviews the patient’s fee slip (or super bill) describing the services he/she performed that day with the patient. However, he/she doesn’t go over the fees for these services unless asked by the patient. The doctor does so by using:





52The doctor will include a brief description of the views taken:DR: “In addition, I took two x-rays of your neck, one from the front, the other




The doctor, using the “plus, in addition to” verbiage, explains all the services rendered that day that were free or discounted and then explains the services in which there was a charge (x-ray, urine analysis, etc.).

WHEN THE PATIENT MAKES THEIR NEXT APPOINTMENT:

IF THE PATIENT HAS NO-FAULT OR MEDICAL PAYMENTS (MED-PAY) INSURANCE THAT SHOULD PAY 100% OF THE PATIENT’S CLAIM

THE CA COLLECTS THE TOTAL AMOUNT DUE

If the patient is a cash patient or a non 100% insurance patient, collect the entire fee for this visit. The CA will do so by also using:


The CA always starts her collection effort by reiterating to the patient all of the services he/she received that day, using the “plus, in addition to” verbiage and ends the sentence with the patient’s fees. CA: “Your insurance should pay 100%. If there is a balance due after your insurance

pays, you will owe us the balance. If the insurance overpays, you will get a refund, or you can apply the overage to future care. Fair enough?”

IF THE NO-FAULT INSURANCE ONLY PAYS 85% OF THE PATIENT’S FEEUse the verbiage, previously described below and collect the 15% of each office fee.

DR: “I see you have automobile insurance coverage. We will accept assignment of your insurance coverage. However, your automobile insurance will only pay 85% of your services. Therefore, you will have to pay 15% of your fees each office


53visit. We will bill your insurance company and if there is a balance due after they pay us, you will owe us the remainder. If they pay us more than your balance due, the overage will be credited to your account or refunded to you. Fair enough?”

IF THE PATIENT’S MED-PAY INSURANCE HAS BEEN EXHAUSTEDFile a claim on the patient’s Major Medical insurance, if they have it. If they don’t have

Major Medical insurance, tell the patient he/she will need to pay cash for this visit and get his/her attorney to sign an attorney lien form (Exhibit #1), or send you a Letter of Protection (LOP).DR: “Mrs. Jones, unfortunately, in your case, you don’t have insurance coverage to

pay for your care. I recommend that you retain an attorney who specializes in automobile accidents in order to get your services paid for. I know several good attorneys that may be able to help you. Until we receive a Letter of Protection from your attorney, or he/she signs an Attorney Lien, which will be provided to you, you’ll have to pay for your services on the day the services are rendered.”

IF THE PATIENT HAS NO FAULT OR MEDICAL PAYMENTS AUTOMOBILE INSURANCE AND THE MEDICAL PAYMENTS INSURANCE HAS NOT BEEN USED UP:

The CA doesn’t need to cover the services rendered that day, nor mention the fees. She simply schedules the patient’s next appointment.

IF THE PATIENT DOESN’T HAVE AUTOMOBILE INSURANCE, PLACE THEIR SERVICES ON THEIR MAJOR MEDICAL INSURANCE COVERAGE WITH THE PATIENT PAYING FOR THE FEES NOT PAID BY THEIR MAJOR MEDICAL INSURANCE

IF THE PATIENT HAS GOOD ASSIGNABLE INSURANCE THAT DOESN’T PAY 100% OF THE PATIENT’S BILL

The CA will state the office fee policy for patients with insurance that pays less than 100% of the patient’s bill. CA: “The policy of this office is to collect for your initial diagnostic visits and 30% of


IF THE PATIENT DOESN’T HAVE NO-FAULT, MED-PAY, OR MAJOR MEDICAL


54INSURANCE

Tell the patient he/she will need to pay cash for each visit and get his/her attorney to sign an attorney lien form (Exhibit #1), or send you a Letter of Protection (LOP).DR: “Mrs. Jones, unfortunately, in your case, you don’t have insurance coverage to

pay for your care. I recommend that you retain an attorney who specializes in automobile accidents in order to get your services paid for. I know several good attorneys that may be able to help you. Until we receive a Letter of Protection from your attorney, or he/she signs an Attorney Lien, which will be provided to you, you’ll have to pay for your services on the day the services are rendered.”

IF THE PATIENT DOESN’T HAVE MEDICAL PAYMENTS OR NO-FAULT AUTOMOBILE INSURANCE, OR THEIR MEDICAL PAYMENTS INSURANCE HAS BEEN USED UP AND DOESN’T HAVE MAJOR MEDICAL INSURANCE AND A SIGNED ATTORNEY’S LETTER OF PROTECTION

The CA collects for today’s fees by using the following procedures.

Note: Some Personal Injury patients will bring an attorney’s Letter of Protection with them, or their attorney will have already sent a L.O.P. to your office.



THE CA ALWAYS STATES THE PATIENT’S FEES AS, “YOUR FEE”, NEVER “OUR FEES, OR OUR CHARGES, ETC. AND THE CA NEVER ADDS THE WORD, “DOLLARS” TO THE FEECA: “Today, Dr. Fernandez provided you with a consultation, an orthopedic

examination, plus a neurological examination, and a chiropractic examination, in addition to, a urine analysis and two x-rays, one from the front, plus one from the side. Your fee for today is 185.”

The reason both the doctor and the CA review the patient’s fee slip (services performed)using the “plus, in addition to” verbiage, is to remind the patient of, and to create an emphasis on, all the services that the patient received that day. By doing so, the patient will be far more acceptable of your fee.

THE CA THEN SAYS, “IS THIS TO BE PAID BY CASH, CHECK OR CREDIT CARD?”

AT THIS POINT THE CA LOOKS DOWN AND STARTS WRITING THE RECEIPT


55The CA, acting if she has no doubt the patient is expecting to pay and is prepared to do so, immediately looks down and begins writing the patient’s receipt. She doesn’t look up as if she expects the patient to object.

FIRST VISIT PERSONAL INJURY PATIENT’S COLLECTION PROBLEM SOLVERS

IF AN INSURANCE PATIENT DOESN’T WANT TO USE THEIR INSURANCE

CA: “You can pay by cash, check or credit card for each office visit. We’ll give you a receipt for the visit which you can send to your insurance company for reimbursement.”












56

Scenario #2:





Scenario #3:









CA: “We have a policy of not billing for services under $250. This policy keeps our office visit fees down. Would you like to put your balance on a charge card...we


57do accept them?”If the Patient Refuses, Then Offer Them the Use of a Credit Card or a Counter Check.


If the patient refuses to pay by credit card, check or counter check. The CA sets the patient’s next appointment for Friday and tells the patient that he/she can pay for today’s services along with Friday’s services on Friday. CA: “We have a policy of not sending statements for fees less than $250. This policy

keeps our office visit fees down. When you come in on Friday, you can pay for today’s visit and Friday’s visit.”


REMIND THE PATIENT TO BRING THE NECESSARY PAPERWORK TO YOUR OFFICE ON THEIR NEXT VISIT

The CA reminds the patient to bring their automobile insurance policy, their insurance form filled out and signed, and their signed attorney lien form to your office on their next appointment.

FIRST VISIT WORKER’S COMPENSATION PATIENT’S COLLECTION PROCEDURES

AFTER THE PATIENT’S EXAMINATION AND X-RAYS

THE DOCTOR REVIEWS THE PATIENT’S FEE SLIP (OR SUPERBILL) AFTER THE PATIENT’S EXAMINATION AND X-RAYS






58The doctor will include a brief description of the views taken:DR: “In addition, I took two x-rays of your neck, one from the front, the other

fromthe side, and performed a urine test, etc.”





CA: “Your insurance should pay 100% of your care.”

The CA uses the “plus, in addition to” verbiage, reiterating all the services the patient received, but doesn’t ask for payment as their insurance pays 100% of the patient’s claim. The CA then makes the patient’s next appointment. If the CA is not sure the patient is covered by Worker’s Compensation insurance, he/she has the patient pay cash for all office visits until she receives written authorization from the employer or insurance carrier. And, at the same time....

THE CA GIVES THE PATIENT A WORKER’S COMPENSATION TREATMENT AUTHORIZATION CARD (EXHIBIT #6)

The CA will give the patient a Worker’s Compensation Treatment Authorization card (PGF81) to take to his employer for authorization. Note: Verbal authorization does not replace written authorization. The patient is required to return the signed Worker’s Compensation Treatment Authorization card (PGF81) on their next visit.

FIRST VISIT MEDICARE PATIENT’S COLLECTION PROCEDURES


59AT THE BEGINNING OF THE MEDICARE PATIENT’S FIRST VISIT:

HAVE THE PATIENT SIGN A THE MEDICARE “ADVANCE BENEFICIARY NOTICE” (ABN) FORM EACH VISIT

Have the Medicare patient sign an “Advance Beneficiary Notice” (ABN) form (Exhibit #8) each visit they come to your office.


The only service that needs to be placed on the form is the chiropractic adjustment, because that is the only service that Medicare is concerned with. However, as a protective measure, DRFERNANDEZ.COM suggests the CA write in the proper space the extra services to be performed on that day, i.e., x-rays, examination, physiotherapy, etc.






The doctor will include a brief description of the views taken:DR: “In addition, I took two x-rays of your neck, one from the front, the other




The doctor, using the “plus, in addition to” verbiage, explains all the services rendered that day


60that were free or discounted and then explains the services in which there was a charge (x-ray, urine analysis, etc.).


The CA uses the “plus, in addition to” verbiage reiterating to the patient all the services the patient received and then makes their next appointment.



THE CA ALWAYS STATES THE PATIENT’S FEES AS, “YOUR FEE”, NEVER “OUR FEES, OR OUR CHARGES, ETC. AND THE CA NEVER ADDS THE WORD, “DOLLARS” TO THE FEE

MEDICARE NON-PARTICIPATING PROVIDER

The CA should collect for the patient’s care each visit or by case fee.

CA: Today, Dr. Fernandez provided you with a consultation, an orthopedicexamination, plus a neurological examination, and a chiropractic examination, in addition to, a urine analysis and two x-rays, one from the front, plus one from the side. Your fee for today is 85.”

MEDICARE PARTICIPATING PROVIDER

Collect for all non-covered services and bill Medicare for the service (adjustment) they will pay for.

CA: “Mrs. Jones, our office will bill Medicare for the adjustment, if any, you received today. You also received __________ (using the “plus, in addition to” verbiage to describe the non-covered services). Your fee for this service today is ________.”

The reason both the doctor and the CA review the services rendered to the patient prior tostating the fees using the “plus, in addition to” technique, is to remind the patient of, and to create an emphasis on, all the services that the patient received that day. By doing so, the


61patient will be far more acceptable of your fee.

THE DOCTOR’S OFFICE IS TO FILE THE PATIENT’S MEDICARE FORM FOR THE PATIENT

Medicare requires that all doctors file their patient’s Medicare insurance forms for them.

CA: “Mrs. Jones, you have agreed to pay for your recommended care each visit when your services are rendered. Today, Dr. _________ provided (use the “plus, in addition to” verbiage). Your fee for today is __________.”

IF THE CA HAS DIFFICULTY IN COLLECTING ANY OF THE ABOVE FEES, USE THE FOLLOWING PROBLEM SOLVERS FOR EACH TYPE MEDICARE PATIENT

FIRST VISIT MEDICARE PATIENT’S COLLECTION PROBLEM SOLVERS









62






Scenario #3:PT: “I didn’t bring any money or a check with me today.”CA: “If you have a credit card, we do accept them.”









63CA: “We have a policy of not billing for services under $250. This policy keeps our

office visit fees down. Would you like to put your balance on a charge card...we do accept them?”If the Patient Refuses, Then Offer Them the Use of a Credit Card or a Counter Check.

CA: “That’s okay, here’s a blank check that will help you out this time.If the patient refuses to pay by credit card, check or counter check. The CA sets the patient’s next appointment for Friday and tells the patient that he/she can pay for today’s services along with Friday’s services on Friday.



FIRST VISIT MEDICAID (MEDI-CAL) COLLECTION PROCEDURES

AT THE BEGINNING OF THE PATIENT’S FIRST VISIT:

As the rules regarding Medicaid vary in all states, the doctor’s office should check withthe insurance chairman of his/her state association regarding the specific rules that apply to each state.

GET AUTHORIZED TO TAKE CARE OF THE PATIENT

This procedure is usually accomplished by calling or getting electronic authorization from the Medicaid carrier in your state.

The patient may be a member of a Medicaid PPO or HMO and require your office to be authorized by the primary care doctor. If so, contact him/her for authorization.



The doctor reviews the patient’s fee slip (or super bill) describing the services he/she performed that day with the patient. However, he/she doesn’t go over the fees for these services unless


64asked by the patient. The doctor does so by using:



IF X-RAYS HAVE BEEN TAKENThe doctor will include a brief description of the views taken:

DR: “In addition, I took two x-rays of your neck, one from the front, the other from the side, and performed a urine test, etc.”

This procedure is necessary is to familiarize the patient with all the services that were rendered that day. Doing so will give the patient a total value to the doctor’s services.




The CA uses the “plus, in addition to” verbiage reiterating to the patient all the services the patient received and then makes their next appointment.



THE CA ALWAYS STATES THE PATIENT’S FEES AS, “YOUR FEE”, NEVER “OUR FEES, OR OUR CHARGES, ETC. AND THE CA NEVER ADDS THE WORD, “DOLLARS” TO THE FEECA: Today, Dr. Fernandez provided you with a consultation, an orthopedic

examination, plus a neurological examination, and a chiropractic examination, in addition to, a urine analysis and two x-rays, one from the front, plus one from the


65side.

CA: “Mrs. Jones, our office will bill Medicaid (Medi-Cal) for today’s visit. Your fee for today’s co-pay is _____. Will that be cash, check or credit card?”If the CA has a problem collecting the co-pay, use the following “problem solvers.”

FIRST VISIT MEDICAID PATIENT’S COLLECTION PROBLEM SOLVERS










PT: “I don’t have a credit card.”


66CA: “That’s okay, here’s a blank check that will help you out this time.”






a credit card, we do accept them.”If The Patient Doesn’t Want to Use a Credit Card or a Counter Check, State Your “No Billing” Policy:








67


REPORT-OF-FINDINGSVISIT FINANCIAL

AND COLLECTION PROCEDURES

Note: Using the DRFERNANDEZ.COM office procedure, the second visit is usually the report-of-findings visit. If the report-of-findings is given on the third visit, the CA is to collect for the charges of the second visit and for any balances or deductibles due.


86

REPORT-OF-FINDINGS VISIT CASH PATIENTS COLLECTION PROCEDURES

REPORT-OF-FINDINGS FINANCIAL ARRANGEMENTSFOR THE CASH PATIENT

Note: All financial arrangements can be presented by the CA or the doctor.

CASE FEE PRESENTATION

Case fees are preferred when a patient pays cash for their services because it shows they are committed to getting well ... paying is a part of healing. And, case fees give the patient an opportunity of a cash savings. 70% of cash patients will pay the case fee.

DON’T ATTEMPT TO MAKE YOUR CASE FEES FIT WITHIN A PATIENT’S BUDGET

Patients will usually not follow through with the doctor’s case fee recommendations if they have to pay for their care out of their weekly or monthly budget. When they try to do so, they will usually discontinue care when they have been relieved of pain. Therefore, don’t attempt to establish a payment plan that fits within a patient’s budget, i.e., $1,000 case fee to be paid $100 a month over 10 months. When these type payment plans are offered, the patients will usually receive one months care and then quit. This results in the patient not receiving the care they need.

When a case fee patient is required to pay for their care using a pre-payment plan (Option #1) or the 50% - 25% - 25% plan (Option #2), they’ll usually draw the money out of a savings account from their bank/credit union, or use a charge card ... thus getting their recommended care.

OPTION #1:PAY IN ADVANCE WITH 10-15% BOOKKEEPING SAVINGS USING THE “PLUS, IN ADDITION TO” VERBIAGE, THE DOCTOR OR CA SAYS:CA or DR: “The total cost of your three months corrective care program will include

spinal corrective adjustments and interferential therapy to reduce swelling and pain, plus intersegmental traction to accomplish __________, in addition to progress examinations to ___________, etc. Your fee for the care is 1,250.” (Have the financial figures compiled before the report-of-findings and use rounded figures for less confusion.) “If you wish to pay for these services at the beginning of your care, you will receive a 10% (or


8715%) bookkeeping savings of $125 — leaving the balance due of 1125.”

Never have the patient make three equal payments because most of your care will be givenin the first month and a portion of your patients will drop out of care at the end of that month. If you have an agreement that states, “If the patient drops out of care at any point, you will re-figure the patient’s balance and charge for all the services the patient received during the period of time they received care”. And, if you re-figure the patient’s balance and attempt to collect the difference, you will end up with a disgruntled patient, a knocker in your community and possibly a malpractice lawsuit.

DO NOT HAVE “ALL OR NON” ATTITUDE REGARDING CASE FEESIf you have a policy of only accepting pre-payments of the entire case fee, you will lose 30% of your patients.

OPTION #2:

IF THE PATIENT WANTS TO MAKE PAYMENTS ON THEIR HEALTH CARE PAY IN THREE PAYMENTS

CA or DR:“You may pay 50% now, 25% in 30 days and the balance in 60 days.”Note: There is no bookkeeping savings when the patient chooses this option.

OPTION #3:

PAY WITH A CREDIT CARDOffer the patient the option of paying for their care with a credit card.

OPTION #4:

OFFER AN AUTOMATIC DEDUCTION FROM THE PATIENT’S CHECKING/ SAVINGS ACCOUNTS OR AUTOMATED DEBITING OF THE PATIENT’S CHARGE CARD

If the patient choose this option, have them sign the “Authorization Agreement for Pre-Arranged Payments (Debits) by Credit Card or Bank Health Card” form (PGF141) (Exhibit #3)

OPTION #5:IF THE PATIENT WANTS TO PAY BY THE VISIT:


88If the cash patient does not accept the case fee, either in one payment or in three parts; the doctor or CA or doctor should recommend the pay-by-the-visit method.

PT: “Doctor, can I pay as I go along?”

CA or DR: “Yes, Mrs. Jones, you can. However, that is not what we recommend. Let me explain why. So many times when patients say they want to pay as they go, as soon as they start feeling better they stop coming in for treatment, making it impossible to properly take care of their health problem the way it should be. Now, is that what you have in mind Mrs. Jones?” (Wait for response.)

PT: “No, not at all. I just can’t come up with $1000 all at once, or even 50% of it. But I could pay for each office visit.”

CA or DR: “I believe you’re serious about getting well Mrs. Jones, so in your case you may pay for your service as it’s rendered.”

DO NOT CONFUSE THE PATIENT BY OFFERING TOO MANY OPTIONS AT ONE TIME

Offer the first two options and if the patient doesn’t choose either of the two options, move on to the next option.

DO NOT BEGIN TREATING THE PATIENT UNTIL ALL FINANCIAL ARRANGEMENTS HAVE BEEN MADE

WRITE THE PATIENT’S FINANCIAL ARRANGEMENTS ON THEIR FILE FOLDER IN FRONT OF THE PATIENT

Once the CA and patient have agreed on the financial arrangement, the CA will note the agreement in the financial box in the upper right hand corner of the DRFERNANDEZ.COM Patient File Folder (Regular: F1195 - Lateral: F1205). The CA does this in full view of the patient, then reads the financial arrangements to the patient, to verify that they understand their financial obligations. When there is a complete understanding there should be no misunderstanding.

ESCROW ACCOUNTS ARE SOMETIMES NECESSARY

If the patient pays by the Pre-Paid Method (Option #1) or by “50%, 25%, 25%” Plan (Option #2), some states require the doctor open a separate checking account, entitled an “Escrow Account” to deposit the patient’s payments.


89At the end of each month, the doctor then withdraws money from the escrow account to pay for the services provided to the patient that month.

The use of an Escrow Account is wise. In the event the doctor dies or is no longer able to provide the services prepaid for, his/her patients are due a refund and the money for the refund is available in the Escrow Account.

CASH PATIENT COLLECTION SCENARIOS AT THE END OF THE REPORT-OF-FINDINGS

CASE FEE PATIENT

OPTION #1: PREPAYMENT

CA: “Mrs. Jones, you have agreed to pre-pay for your entire recommended care and receive a 10 - 15% bookkeeping savings. That will be _________ today.”

OPTION #2: THREE MONTHLY PAYMENTSCA: “Mrs. Jones, you have agreed that you will pay for your recommended care in

three payments - 50% now, 25% in 30 days and 25% in 60 days. That will be _______ today.”OR,

BY-THE-VISIT PATIENT

CA: “Mrs. Jones, you have agreed to pay for your recommended care each visit when your services are rendered. Today, Dr. _________ provided (use the “plus, in addition to” verbiage). Your fee for today is __________.”

CASH PATIENT WHO OWES A BALANCEIf the patient has a balance due, the CA will address it now.

CA: “Mr. Jones, the fees for your services are due on the visit services are rendered. Your fee for today is 45, and you have a previous balance of 15 for a total of 60. Do you want to take care of that by cash, check or charge card?”

CASH PATIENT’S REPORT-OF-FINDINGS VISIT PROBLEM SOLVERS


90NEVER ASK A PATIENT, “DO YOU WANT TO PAY?”

They’ll answer, “Heck, no!”


PATIENT STATEMENTS

Scenario #1:







Scenario #2:






91

Scenario #3:
















92

Scenario #5:

IF THE PATIENT CAN ONLY PAY $40-50 A WEEK OR MONTH:

Only schedule them for one visit per week or per month, according to their ability to pay for your services. Find out the day that they get paid and schedule them for that day. Do not have the patient come in for three or four visits per week and only pay $40 per week or month towards those visits. They’ll end up with a big balance and will be resentful of you because of their big balance. They usually won’t pay their big bill and may possibly sue you for malpractice to avoid paying your bill.

WHEN THE PATIENT SAYS THEY CAN ONLY PAY YOU ON FRIDAY (WHEN THEY GET PAID): PATIENT STATEMENTS

Scenario #6:PT: “I know I need the treatments, but I can’t afford them.”DR or CA: “Mrs. Jones, you have two problems, one is your (health problem), and we

can help you with that because treating (health problem) is our specialty. Your second problem Mrs. Jones, is a financial problem. We cannot help you with that. However, we have several options that our patients can take advantage of to help them pay for their care. If you have a charge card, we do accept them.”Or suggest family assistance or a bank loan.

Scenario #7:

HAVE THE PATIENT GET ASSISTANCE FROM FAMILY, FRIENDS, CHURCH, ETC.Sometimes a patient will tell you that they can’t afford to pay for their care. Ask them:

DR: “Do you have any children? (If yes...), Call them; you took care of them all these years, now it’s their time to help you out. Tell your children the care that you need, how much it’s going to be and ask them for their help, and they will help you.”

HAVE THE PATIENT GET A BANK OR CREDIT UNION LOAN

If the patient doesn’t have any relatives that will help pay for their health care, tell them to go to their bank or Credit Union and borrow the money. You’re in the doctor business; you’re not in the banking business.


93PT: “Doctor, that seems like an awful lot of money!”DR: “Mrs. Jones, yes it is, but you have a lot of problems. I can assure you of

one thing, it will never cost less than it does right now. Had you come in sooner, it may have required less treatment, but if it is ignored for a longer period of time, it could cost much more.”

Scenario #8:IF THE PATIENT IS DESTITUTE

If a patient has fallen upon hard times and can’t afford health care, have them bring a letter from their minister/priest/rabbi stating they are destitute, and then treat the patient free.

REPORT-OF-FINDINGS VISIT MAJOR MEDICAL INSURANCE PATIENTS COLLECTION PROCEDURES

AT THE BEGINNING OF THE REPORT-OF-FINDINGS VISIT:

THE CA COLLECTS THE PATIENT’S INSURANCE POLICY AND THE FORMS THAT THE PATIENT SHOULD HAVE FILLED OUT AND SIGNED

The CA reads the patient’s insurance policy to determine if there are any limitations orexclusions that were not mentioned to the CA by the insurance company.

THE CA PHOTOCOPIES THE PERTINENT INFORMATION FOUND IN THE PATIENT’S INSURANCE POLICY, i.e., PAYMENT INFORMATION, LIMITATIONS AND EXCLUSIONS.

REPORT-OF-FINDINGS FINANCIAL ARRANGEMENTS FOR MAJOR MEDICAL PATIENTS

IF THE PATIENT HAS 100% INSURANCE COVERAGE (PERSONAL INJURY, WORKERS’ COMPENSATION, ACCIDENT INSURANCE, ETC.)DR: “Your insurance should cover your care 100%. So from this point forward we will

accept assignment of your insurance coverage. We will bill your insurance company and if there is a balance due after they pay us, you will owe us this


94balance. If they pay us more than your balance due, the overage will be credited to your account or refunded to you. Fair Enough?”

IF THE PATIENT HAS UP TO A $200 DEDUCTIBLE AND CO-PAY INSURANCE:DR: “I see you have insurance coverage. You have paid for your initial diagnostic

visit, so from this point forward we will accept assignment of your insurance coverage and you will only need to pay 30% of each office visit. We will bill your insurance company and if there is a balance due after they pay us, you will owe us the remainder. If they pay us more than your balance due, the overage will be credited to your account or refunded to you. Fair enough?”

IF THE PATIENT HAS OVER A $200 - $500 DEDUCTIBLE WHICH HASN’T BEEN MET WITH A CO-PAY:

The patient is to pay cash until their deductible is met. Then the patient pays 30% of each office visit.DR: “I see you have insurance coverage. You will have to pay for your services until

your deductible is met. Then we will accept assignment of your insurance coverage and you will only need to pay 30% of each office visit. We will bill your insurance company and if there is a balance due after they pay us, you will owe us the remainder. If they pay us more than your balance due, the overage will be credited to your account or refunded to you. Fair enough?”

IF A PATIENT HAS A $200 - $2000 DEDUCTIBLE INSURANCE

If a patient has a $500-2,000 deductible insurance, he/she is deemed a cash patient until their deductible has been met. In this case, the doctor should follow the previously described Cash Patient Report-of-Findings Financial Close and Collection Procedures.


IF THE PATIENT HAS 100% INSURANCE COVERAGE (PERSONAL INJURY, WORKERS’ COMPENSATION, ACCIDENT INSURANCE, ETC.)

CA: “Your insurance should cover your care 100%. So from this point forward we will accept assignment of your insurance coverage. We will bill your insurance company and if there is a balance due after they pay us, you will owe us this balance. If they pay us more than your balance due, the overage will be credited


95to your account or refunded to you. Fair Enough?”

IF THE PATIENT HAS UP TO A $200 DEDUCTIBLE AND CO-PAY INSURANCE:

CA: “I see you have insurance coverage. You have paid for your initial diagnostic visit, so from this point forward we will accept assignment of your insurance coverage and you will only need to pay 30% of each office visit. We will bill your insurance company and if there is a balance due after they pay us, you will owe us the remainder. If they pay us more than your balance due, the overage will be credited to your account or refunded to you. Fair enough?”

IF THE PATIENT HAS OVER A $200 - $500 DEDUCTIBLE WHICH HASN’T BEEN MET WITH A CO-PAY:

The patient is to pay cash until their deductible is met. Then the patient pays 30% of each office visit.

CA: “I see you have insurance coverage. You will have to pay for your services until your deductible is met. Then we will accept assignment of your insurance coverage and you will only need to pay 30% of each office visit. We will bill your insurance company and if there is a balance due after they pay us, you will owe us the remainder. If they pay us more than your balance due, the overage will be credited to your account or refunded to you. Fair enough?”

IF A PATIENT HAS A $200 - $2000 DEDUCTIBLE INSURANCE

If a patient has a $500-2,000 deductible insurance, he/she is deemed a cash patient until their deductible has been met. In this case, the CA should follow the previously described Cash Patient Report-of-Findings Financial Close and Collection Procedures.

COLLECT THE BALANCE DUE FROM THE PRIOR VISIT OR THE REMAINDER OF THE PATIENT’S DEDUCTIBLE AND 30% OF THIS DAY’S SERVICES

CA: “Mr. Jones, the fees for your services are due on the visit services are rendered. You have a previous balance of 15 and today Dr. Fernandez did (use the “plus, in addition to” verbiage) and your co-pay for today is 15, for a total of 30. Do you want to take care of that by cash, check or credit card?”

REPORT-OF-FINDINGS PROBLEM SOLVERS FOR


96MAJOR MEDICAL INSURANCE PATIENTS

PT: “Why do I have to pay 30% of each visit’s services? My insurance company pays 80%.

DR or CA: “Insurance companies usually don’t pay 80%. They pay 80% of the charges for services they approve, and at fees they want to pay. Realistically, they usually pay 70%. That’s why we ask you to pay 30%.”

IF THE PATIENT HAS DIFFICULTY IN PAYING THE CASH PORTION OF THEIR SERVICES



PATIENT STATEMENTS

Scenario #1:







Scenario #2:


97





Scenario #3:











98CA: “That’s okay, here’s a blank check that will help you out this time.



Note: Call your bank to find out about the legality of counter checks in your state.


DR: “Do you have any children? (If yes...), Call them; you took care of them all these years, now it’s their time to help you out. Tell your children the care that you need, how much it’s going to be and ask them for their help, and they will helpyou.”


If the patient doesn’t have any relatives that will help pay for their health care, tell them to go to their bank or Credit Union and borrow the money. You’re in the doctor business; you’re not inthe banking business.

REPORT-OF-FINDINGS VISIT HMO & PPO PATIENT’S COLLECTION PROCEDURES

REPORT-OF-FINDINGS FINANCIAL ARRANGEMENTS FOR HMO &PPO PATIENTS

If the patient has a deductible that has not been met..., if there is one, has not been met....DR: “I see you have insurance coverage. You will have to pay for your services until

your deductible is met. Then we will accept assignment of your insurance coverage and you will only need to pay your co-payment of $_____ each visit.”

If the patient has a deductible that has been met, or if there is no deductible...

AT THE BEGINNING OF THE PATIENT’S _______ VISIT:


99WHILE THE PATIENT IS IN CONSULTATION WITH THE DOCTOR:

AT THE END OF THE PATIENT’S CONSULTATION:



_______ VISIT _____ PATIENTS COLLECTION PROBLEM SOLVERS:

WHEN THE PATIENT MAKES THEIR NEXT APPOINTMENTIF THE PATIENT ONLY HAS TO PAY A CO-PAYMENTCA: “Your insurance company requires you to pay a $10.00 (or whatever) co-payment

on each visit. We will accept assignment on your insurance coverage for their allowable care. However, if there is any balance due after your insurance company pays, you will have to pay the balance. If there is any overage when the insurance pays, we’ll be happy to credit your account or give you a refund. Fair enough?”

HMO-PPO PATIENTS REPORT-OF-FINDINGS VISIT COLLECTION PROBLEM SOLVERS

IF THE PATIENT HAS DIFFICULTY IN PAYING THE CASH PORTION OF THEIR SERVICES





PT: “I only have $40.”


100CA: “That’s ok. You can place your balance on a credit card ... we do accept them.”





Scenario #2:





Scenario #3:





If The Patient Doesn’t Want to Use a Credit Card or a Counter Check, State Your “No


101Billing” Policy:





CA: “That’s okay, here’s a blank check that will help you out this time.If the patient refuses to pay by credit card, check or counter check. The CA sets the

patient’s next appointment for Friday and tells the patient that he/she can pay for today’s services along with Friday’s services on Friday.








102

SECOND VISIT REPORT-OF-FINDINGS VISIT PERSONAL INJURY PATIENTS COLLECTION PROCEDURES

AT THE BEGINNING OF THE PATIENT’S VISIT

COLLECT THE PATIENT’S INSURANCE POLICY FROM THE PATIENT

The CA reads the patient’s insurance policy to determine the amount of the patient’s Medical Payments (Med-Pay) and the limitations or exclusions.

THE CA PHOTOCOPIES THE PERTINENT INFORMATION FOUND IN THE PATIENT’S INSURANCE POLICY, i.e., PAYMENT INFORMATION, LIMITATIONS AND EXCLUSIONS.

COLLECT THE ATTORNEY LIEN FORM FROM THE PATIENT

If the patient hasn’t returned the Attorney Lien form, if requested, immediately tell thedoctor because the collection of his/her services is not protected.

REPORT-OF-FINDINGS FINANCIAL ARRANGEMENTS FOR THE PERSONAL INJURY PATIENTS

IF THE PATIENT HAS 100% COVERAGE

DR: “Your insurance company should pay 100% of your care.”

IF THE PATIENT DOESN’T HAVE 100% INSURANCE COVERAGE

DR: “I see you have automobile insurance coverage. We will accept assignment of your insurance coverage. However, your automobile insurance will only pay 85%


103of your services. Therefore, you will have to pay 15% of your fees each office visit. We will bill your insurance company and if there is a balance due after they pay us, you will owe us the remainder. If they pay us more than your balance due, the overage will be credited to your account or refunded to you. Fair enough?”

IF THE PATIENT DOESN’T HAVE NO-FAULT OR MED-PAY INSURANCE, OR IF THE PATIENT’S MED-PAY HAS BEEN EXHAUSTED

In this case, the doctor’s office should file a claim with the patient’s Major Medical insurance carrier. And, have the patient sign all appropriate forms and refer to an attorney to protect the doctor’s bill from any shortfalls.

DR: “Unfortunately, you don’t have automobile insurance (or inadequate automobile insurance). Therefore, we are going to accept assignment of your Major Medical insurance. However, in this case, you have two choices. 1) You will have to pay for your services until your deductible is met. Then you will only have to pay 30% of each office visit. We will bill your insurance company and if there is a balance due after they pay us, you will owe us the remainder. If they pay us more than your balance due, the overage will be credited to your account or refunded to you. Fair enough?”OR

2) We will accept assignment on your Major Medical insurance and recommend a competent Personal Injury attorney who will represent you and make sure the portion of our services not covered by your Major Medical insurance will be paid by the person who hit you.Which option do you choose?

IF THE PATIENT’S MED-PAY INSURANCE HAS BEEN EXHAUSTED:• FILE A CLAIM WITH THE PATIENT’S MAJOR MEDICAL INSURANCE CARRIER.• FOLLOW THE MAJOR MEDICAL FINANCIAL ARRANGEMENTS PREVIOUSLY

DESCRIBED.

IF THE PATIENT DOESN’T HAVE NO-FAULT, MED PAY OR MAJOR MEDICAL INSURANCE

The patient should have been referred to an attorney for him/her to sign an attorney lien or to send you a letter of protection (LOP). Until the attorney receives and returns your attorney lien, or sends you a Letter of Protection (LOP), the patient is to pay cash for their care.

DR or CA: “Mrs. Jones, unfortunately, in your case, you don’t have insurance


104coverage to pay for your care. I recommend that you retain an attorney who specializes in automobile accidents in order to get your services paid for. I know several good attorneys that may be able to help you. Until we receive a Letter of Protection from your attorney, or he/she signs an Attorney Lien, which will be provided to you, you’ll have to pay for your services on the day the services are rendered.”


IF THE PATIENT HAS NO-FAULT OR MED-PAY AUTOMOBILE INSURANCE COVERAGE

The CA doesn’t have to collect any money from the patient. He/she simply makes the next appointment.

IF THE PATIENT HAS NO-FAULT OR MED-PAY AUTOMOBILE INSURANCE COVERAGE THAT DOESN’T PAY 100% OF THE PATIENT’S BILL

The CA is to collect the amount not paid by the patient’s insurance carrier.

DR: “I see you have automobile insurance coverage. We will accept assignment of your insurance coverage. However, your automobile insurance will only pay 85% of your services. Therefore, you will have to pay 15% of your fees each office visit. We will bill your insurance company and if there is a balance due after they pay us, you will owe us the remainder. If they pay us more than your balance due, the overage will be credited to your account or refunded to you. Fair enough?”

IF THE PATIENT DOESN’T HAVE NO-FAULT OR MED-PAY INSURANCE, OR IF THE PATIENT’S MED-PAY HAS BEEN EXHAUSTED

In this case, the doctor’s office should file a claim with the patient’s Major Medical insurance carrier. And, have the patient sign all appropriate forms and refer to an attorney to protect the doctor’s bill from any shortfalls.

DR: “Unfortunately, you don’t have automobile insurance (or inadequate automobile insurance). Therefore, we are going to accept assignment of your Major Medical insurance. However, in this case, you have two choices. 1) You will have to pay for your services until your deductible is met. Then you will only have to pay 30% of each office visit. We will bill your insurance company and if there is a balance due after they pay us, you will owe us the


105remainder. If they pay us more than your balance due, the overage will be credited to your account or refunded to you. Fair enough?”OR2) We will accept assignment on your Major Medical insurance and recommend a competent Personal Injury attorney who will represent you and make sure the portion of our services not covered by your Major Medical insurance will be paid by the person who hit you.Which option do you choose?

IF THE PATIENT ONLY HAS A LETTER OF PROTECTION OR AN ATTORNEY LIEN TO PROTECT THE DOCTOR’S BILL

In this case, the CA is to tell the patient to pay a portion of their bill each month, as much as they can, or to pay a $15 a week administration fee.

CA: “Mrs. Jones, I see you have an attorney representing you. In these cases, we request our patients pay something on their bill each month, as much as they can afford. How much would you like to pay today?”

If the patient says they can’t pay anything today....

CA: “That’s okay Mrs. Jones. Just pay as much as you can each month.”ORCA: “Mrs. Jones, I see you have an attorney representing you. In these cases, we

have our patients pay an administration fee of $15 per week. The $15 per week is applied to your balance. How would you like to pay the $15 ... cash, check or credit card?”

IF THE PATIENT DOESN’T HAVE NO-FAULT, MED-PAY, MAJOR MEDICAL INSURANCE, AAN ATTORNEY LIEN OR L.O.P., OR DOESN’T WANT TO USE ANY OF THESE OPTIONS

The patient is considered a cash patient. Therefore the CA should collect for the patient’s entire office visit fee each visit.

CA: “Today, Dr. Fernandez provided you with a consultation, an orthopedic examination, plus a neurological examination, and a chiropractic examination, in addition to, a urine analysis and two x-rays, one from the front, plus one from theside. Your fee for today is 185.”


106PERSONAL INJURY PATIENTS REPORT-OF-FINDINGS VISIT

COLLECTION PROBLEM SOLVERS

IF THE PATIENT HAS AN OBJECTION TO PAYING THEIR PORTION OF THEIR OFFICE FEE



PATIENT STATEMENTS

Scenario #1:







Scenario #2:




107CA: “That’s okay, here’s a blank check that will help you out this time.”



Scenario #3:













108



REPORT-OF-FINDINGS VISIT WORKER’S COMPENSATION PATIENTS COLLECTION PROCEDURES

AT THE BEGINNING OF THE PATIENTS VISIT

MAKE SURE THE WORKER’S COMPENSATION CARD (EXHIBIT #6) IS SIGNED AND RETURNED ON THIS VISIT

The Worker’s Compensation Treatment Authorization card (PGF181) is to be returned by the patient with the necessary insurance information and the signature of their foreman/employer authorizing care on this visit.

WHEN THE PATIENTS MAKE THEIR NEXT APPOINTMENT

IF THE “WORKER’S COMPENSATION TREATMENT AUTHORIZATION” CARD (EXHIBIT ____) HAS BEEN SIGNED AND RETURNED

The CA is not to collect for the patient’s visit because the patient has 100% insurance coverage. He/she simply schedules the patient’s next office visit.

CA: “Mrs. Jones, your Worker’s Compensation insurance will take care of our fees. The doctor states he would like to see you on Monday. Would you like an appointment in the morning or afternoon?”

IF THE “WORKER’S COMPENSATION TREATMENT AUTHORIZATION” CARD HAS NOT BEEN SIGNED

In this case, the patient is a cash patient.


109

CA: “Mrs. Jones, unfortunately you have not been authorized by your employer (insurance company) as a Worker’s Compensation patient.”

CA: “Today, Dr. Fernandez provided you with a consultation, an orthopedic examination, plus a neurological examination, and a chiropractic examination, in addition to, a urine analysis and two x-rays, one from the front, plus one from the side. Your fee for today is 185.”

Note: If the patient is expected to get authorization under Worker’s Compensation, continue collecting for each visit until they are authorized. If it doesn’t look like authorization is forthcoming, ask the patient if they would like their Major Medical carrier to pay their bill, if they have Major Medical insurance.

CA: “Mrs. Jones, your employer (insurance carrier) has not authorized you care under Worker’s Compensation. Would you like us to bill your Major Medical carrier?”

If the patient says yes, have them sign all the necessary Major Medical forms described in the “First Visit Major Medical Insurance Patients” section in this manual. Then the CA should say:

CA: “We will accept assignment of your insurance coverage for their allowable care. However, if there is any balance due after your insurance company pays, you will have to pay the balance. If there is any overage when the insurance pays, we’ll be happy to credit your account or give you a refund. Fair enough?”

WORKER’S COMPENSATION PATIENTS REPORT-OF-FINDINGSVISIT COLLECTION PROBLEM SOLVERS

If the patient is deemed a cash patient, or a Major Medical patient in which they are expected to pay a deductible and 30% of their office visit fees, use the following Problem Solvers.



PATIENT STATEMENTS


110Scenario #1:PT: “I didn’t bring enough money with me today.”CA: “How much can you pay today?

PT: “I only have $40.”CA: “That’s ok. You can place your balance on a credit card ... we do accept them.”














111









REPORT-OF-FINDINGS FINANCIAL ARRANGEMENTS FOR THE WORKER’S COMPENSATION PATIENTS

DR or CA: “Your Worker’s Compensation Insurance should pay 100% of your care.”


112

REPORT-OF FINDINGS VISIT MEDICARE PATIENTS COLLECTION PROCEDURES






REPORT-OF-FINDINGS FINANCIAL ARRANGEMENTS FOR MEDICARE PATIENTS

IF THE DOCTOR IS A MEDICARE NON-PARTICIPATING PROVIDER:

If the doctor signed up with Medicare under this category, the doctor is to collect for all services rendered to Medicare patients and gives the patient a receipt for his/her services, (when the services are paid for.) The patients will then send the doctor’s receipts to Medicare for reimbursement.

OFFER A CASE FEE FOR ALL SERVICES NOT COVERED BY MEDICARE IS PREFERRED

70% of Medicare patients will pay for their care using this method.

DON’T ATTEMPT TO MAKE YOUR CASE FEES FIT WITHIN A PATIENT’S BUDGET

Patients will usually not follow through with the doctor’s case fee recommendations if they have to pay for their care out of their weekly or monthly budget. When they try to do so, they will


113usually discontinue care when they have been relieved of pain. Therefore, don’t attempt to establish a payment plan that fits within a patient’s budget, i.e., $1,000 case fee to be paid $100 a month for 10 months. When these type payment plans are offered, the patients will usually receive one months care and then quite. This results in the patient not receiving the necessary care that they need.

When a case fee patient is required to pay for their care using a pre-payment plan (Option #1) or the 50% - 25% - 25% plan (Option #2), they’ll usually draw the money out of a savings account from their bank, a credit union, or use a charge card ... thus getting their recommended care.

OPTION #1:

PAY IN ADVANCE WITH A 10 - 15% BOOKKEEPING SAVINGS USING THE “PLUS AND IN ADDITION TO” VERBIAGE, THE CA SAYS:CA: “The total cost of your three months corrective care program will include spinal

corrective adjustments and interferential therapy to reduce swelling and pain, plus intersegmental traction to accomplish __________, in addition to progress examinations to ___________, etc. Your fee for the care is 1,250. Medicare will pay 420 leaving you a balance of 820. (Have the financial figures compiled before the report-of-findings and use rounded figures for less confusion.) “If you wish to pay for your services at the beginning of your care, you will receive a 10% (or 15%) bookkeeping savings of $125 — leaving the balance due of 1125.”

OPTION #2:

IF THE PATIENT WANTS TO MAKE PAYMENTS ON THEIR CARE, OFFER A THREE PAYMENT PLAN

Have the patient pay 50% of their care in the beginning, 25% in thirty days and 25% at the end of the next 30 days. In this way, you will collect your entire fee in 60 days.

CA: “You may pay for 50% of your care now, 24% in 30 days and the balance in 60 days.”

There is no bookkeeping savings when the patient uses this option.

Never have the patient make three equal payments because most of your care will be in the first month and a portion of your patients will drop out of care at the end of that month. If you have an agreement that states, “If the patient drops out of care at any point, you will re-figure the patient’s balance and charge for all the services the patient received during the period of time they received care”. And, if you re-figure the patient’s balance and attempt to collect the


114difference, you will end up with a disgruntled patient, a knocker in your community and possibly a malpractice lawsuit.

DO NOT HAVE “ALL OR NON” ATTITUDE REGARDING CASE FEES

If you have a policy of only accepting pre-payments of the entire case fee, you will lose 30% of your patients.

OPTION #3:

WHEN THE PATIENT WANTS TO PAY BY THE VISIT

Tell the patient you will give them a receipt when they pay for your services. They can then send the receipts to Medicare for reimbursement.

MEDICARE PARTICIPATING PROVIDER:

If the doctor has signed up with Medicare under this category, he/she has agreed to accept assignment for the adjustments Medicare will pay for (some states pay for less than 12 visits, others pay for 12 visits, and in some states, Medicare pays for unlimited number of visits). The doctor is not to have his/her patient pay the entire fee for the Medicare allowable adjustments. However, the doctor is to have his/her patients pay for the co-pay on the fees for the adjustments and for non-covered Medicare services, i.e., the adjustments Medicare will not pay for x-rays, exams, physiotherapy and rehab.

Note: Federal law states that the doctor has to fill out the Medicare form for all Medicare patients and send it to Medicare.


OPTION #1:PAY IN ADVANCE WITH A 10 - 15% BOOKKEEPING SAVINGS USING THE “PLUS AND IN ADDITION TO” VERBIAGE, THE CA SAYS:CA: “The total cost of your three months corrective care program will include spinal

corrective adjustments and interferential therapy to reduce swelling and pain, plus intersegmental traction to accomplish __________, in addition to progress examinations to ___________, etc. Your fee for the care is 1,250. Medicare will pay 420 leaving you a balance of 820.” (Have the financial figures compiled before the report-of-findings and use rounded figures for less confusion.) “If you


115wish to pay for your services at the beginning of your care, you will receive a 10% (or 15%) bookkeeping savings of $125 — leaving the balance due of 1125.”

OPTION #2:IF THE PATIENT WANTS TO MAKE PAYMENTS ON THEIR CARE, OFFER A THREE PAYMENT PLAN

Have the patient pay 50% of their care in the beginning, 25% in thirty days and 25% at the end of the next 30 days. In this way, you will collect your entire fee in 60 days.

CA: “You may pay for 50% of your care now, 24% in 30 days and the balance in 60 days.”

There is no bookkeeping savings when the patient uses this option.

Never have the patient make three equal payments because most of your care will be in the first month and a portion of your patients will drop out of care at the end of that month. If you have an agreement that states, “If the patient drops out of care at any point, you will re-figure the patient’s balance and charge for all the services the patient received during the period of time they received care”. And, if you re-figure the patient’s balance and attempt to collect the difference, you will end up with a disgruntled patient, a knocker in your community and possibly a malpractice lawsuit.

DO NOT HAVE “ALL OR NON” ATTITUDE REGARDING CASE FEES

If you have a policy of only accepting pre-payments of the entire case fee, you will lose 30% of your patients.

OPTION #3:

WHEN THE PATIENT WANTS TO PAY BY THE VISIT

Tell the patient you will give them a receipt when they pay for your services. They can then send the receipts to Medicare for reimbursement.


116REPORT OF FINDINGS VISIT MEDICARE

PATIENT PROBLEM SOLVERS

PATIENT STATEMENTS

DR or CA: “Oh, I see you have Medicare insurance. I want you to know that Medicare is very good, inexpensive insurance. You can expect it to pay about 30% -40% of your bill, with you being responsible for the rest.”

PT: “Oh no, doctor, Medicare pays 80%.”DR or CA: “No, let me explain. Medicare pays 80% of the services they want to pay

for at prices that were charged back in the 70's. Realistically, they are only going to pay about 30% - 40% of your bill.”

PUT THE BLAME WHERE IT’S DUE - ON THE MEDICARE SYSTEM

DR or CA: “I don’t know why they treat our senior citizens this way. You have been putting money into the Medicare system your entire life, so that when you retire your healthcare needs will be taken care of. But every year, Medicare seems to pay less and less of patients’ bills. I don’t know why they treat our mothers and fathers this way. You deserve to have at least 80% of your bill paid. But, unfortunately, the government will only pay about 30% - 40%. Please don’t be shocked when they only pay 30% - 40%.”

THEN WHEN MEDICARE PAYS ONLY 30% - 40% OF THEIR BILL, THE PATIENT WILL SAYPT:“Doctor (or CA), you were right. Medicare only paid 40% of my bill. Why are they taking advantage of me?”

At this point, the patient will be angry with Medicare, not you, or your office.

If you do not follow this Medicare payment advice and verbiage when Medicare only pays 30% -40% of the patient’s bill, it will place nasty comments on their rejection slip like, “doctor is over-utilizing,” “doctor is over-treating,” “doctor is over-charging.” This will result in your patient beingupset with you, or your office and your office will lose your patient and their referrals.

WHEN A PATIENT IS UPSET OVER THEIR MEDICARE REIMBURSEMENT, REFER THEM TO THEIR CONGRESSMAN

Refer the Medicare patient to their Congressman. Have the patient ask him/her why Medicare only paid such a small amount. Usually a Congressman can motivate Medicare to pay a larger


117portion of the patient’s bill.

The patient needs to understand that Medicare is extremely good, inexpensive insurance, however, it is not designed to take care of non-life threatening problems. It is designed to take care of catastrophic problems, i.e., kidney transplants, heart surgery, extensive hospitalizations, etc. Unfortunately, patients have to pay a larger portion of their bill for less serious problems.

“I ONLY WANT TO COME FOR THE 12 VISITS THE GOVERNMENT PAYS FOR”IF YOU ARE A NON-PARTICIPATING MEDICARE PROVIDER

Have the patient pay for each visit as they receive their care. The patient is to fill out their Medicare form and mail it in. Give the patient a receipt for their fees (if they pay), then have the patient mail their receipts to Medicare. And, only treat the patient for 12 visits.

DR. or CA: “That’s perfectly fine Mrs. Jones. You can pay for your services when you come in each visit.”

IF YOU ARE A PARTICIPATING MEDICARE PROVIDER

Treat the patient for 12 visits, accept assignment, fill out their Medicare form, mail it in and wait for payment.

DR. or CA:“That’s perfectly fine Mrs. Jones. We’ll treat you for twelve visits and send the Medicare

form into Medicare for payment.”

“I ONLY WANT TO PAY FOR THE ADJUSTMENT, NOT THE THERAPY.”

Use the verbiage utilized for a participating or non-participating Medicare provider, and then treat the patient the way he/she requests and give the patient home care instructions to use instead of therapy.

IF THE PATIENT HAS A PROBLEM PAYING FOR THEIR CARE NEVER ASK A PATIENT, “DO YOU WANT TO PAY?” They’ll answer, “Heck, no!”


PATIENT STATEMENTS


118

Scenario #1:







Scenario #2:





Scenario #3:



119If the patient doesn’t have a credit card or a check, offer them a counter check.













120

REPORT OF FINDINGS VISIT MEDICAID PATIENTS COLLECTION PROCEDURES

REPORT OF FINDINGS FINANCIAL ARRANGEMENTS FOR THE MEDICAID PATIENTS

DR: “Mrs. Jones, I see you have Medicaid insurance. They will pay for (number of) visits and you will only have to pay your co-payment of ________ each visit.”

WHEN THE PATIENT MAKES THEIR NEXT APPOINTMENTCA: “Mrs. Jones, I see you have Medicaid insurance. They will pay for (number of)

visits and you will only have to pay your co-payment of ________ each visit.”

IF THE PATIENT HAS DIFFICULTY IN PAYING FOR THEIR CO-PAY, USE THE FOLLOWING PROBLEM SOLVERS.








121







Scenario #3:







Scenario #4:


122If a New Patient Comes in on Monday, but Says He/She Cannot Pay until Friday:







123

CA DAILY VISIT COLLECTION SCENARIOS

DAILY VISIT CASH PATIENT COLLECTION PROCEDURES

COLLECT FOR ALL SERVICES RENDERED EACH DAY

USE THE “PLUS, IN ADDITION TO” VERBIAGE.CA: “Today Dr. Jones performed an adjustment, plus supervised exercises, in

addition to an Interferential treatment.

USE “YOUR FEE” INSTEAD OF “OUR FEE” VERBIAGECA: “Your fee for today is ....”

NEVER ADD THE WORD, “DOLLARS” TO A PATIENT’S FEECA: “Your fee for today is 65. Will that be cash, check or charge card?”

THE CA LOOKS DOWN AND STARTS WRITING THE RECEIPT

CASH PATIENT WHO OWES A BALANCE

If the patient has a balance due, the CA will address it now.Note: In a multiple CA office, the insurance CA must notify the front desk CA to collect

insurance non-payments.

CA: “Mr. Jones, the fees for your services are due on the visit services are rendered. Your fee for today is 45, and you have a previous balance of 15 for a total of 60.


124Do you want to take care of that by cash or check? Or, do you want to put it on a charge card?”

CASE FEE PATIENT WHO OWES A MONTHLY INSTALLMENTThe CA collects the agreed upon amount for the monthly payment from a 50%-25%-25%

patient.CA: “Mrs. Jones, the second installment of your case fee, which is _______, is due

today. Will that be cash, check or charge card?”

CASH PATIENT COLLECTION PROBLEM SOLVERS



PATIENT STATEMENTS

Scenario #1:PT: “I didn’t bring enough money with me today.”CA: “How much can you pay today?







keeps our office visit fees down. When you come in tomorrow you can pay for the balance of today’s visit and tomorrow’s visit.”

Scenario #2:





Scenario #3:









126






Scenario #5:

Prior to Friday’s appointment, the CA reviews the patient’s credit report to determine what to do if the patient does not pay for all their services on Friday.

If the patient has an unfavorable credit report and does not pay all their balance on Friday, the CA tells the patient he/she will have to borrow the money and bring full payment in with him/her on their next visit.

The CA then tells the patient to call for an appointment as soon as they are ready for their next appointment.

CA:“Please call us for an appointment when you are ready for your next visit.”

If the patient has a good credit report and does not pay for all their services on Friday, the CA schedules their next appointment for the following Friday. All future visits correspond with the patient’s paydays.

Scenario #6:


127PT: “I can only pay $40 a week.”

Find out the day that they get paid and schedule them for that day. Do not have a patient come in for three or four visits per week and only pay $40 per week towards those visits. They’ll end up owing you a big balance, which will make your patients resent you. And, when patients resent their doctor, they won’t pay their bill and might possibly sue you for malpractice to avoid paying it.

Scenario #7:

PT:“Would it be okay for me to pay once a month instead of every visit?”

Your office policy is: Let your patients charge their services when they have proved theirwillingness to pay. However, remember, willingness and ability to pay are different.

If the patient has a good credit history with your office and has consistently paid for his/her services for at least eight consecutive office visits, and the office has had no prior problems collecting from this cash patient, the CA should approve this request.

CA: “Why sure, Mrs. Jones. We’ll be happy to bill you. This way you won’t have to write so many checks.”

Scenario #8:

IF THE PATIENT DOES NOT HAVE A PAYMENT HISTORY WITH YOUR OFFICE

The CA should explain that your office policy is that services are to be paid on the day they are rendered. The CA can also offer to allow the patient to pre-pay for ten visits at a time, thus providing the convenience that an honest patient is looking for.

CA: “Mrs. Jones, we have a policy that all services are to be paid the day services are rendered. This policy keeps our office fees down. However, you can pre-pay for ten visits at a time. And there is a 10% (or 15%) bookkeeping savings when you pre-pay for your care. Whenever a patient reduces our bookkeeping expenses, we pass the savings on to the patient. Therefore, when you pre-pay for 10 visits at a time, you will save $_______. Would you like to pre-pay for 10 visits now?

If the patient does not want to pre-pay, the CA maintains the “pay for services on the day that services are rendered” policy.

Scenario #9:


128IF THE PATIENT HAS A POOR PAYMENT HISTORY WITH YOUR OFFICE, OR HAS A BAD CREDIT REPORT.

CA: “Mrs. Jones, I’d like to help you, but I can’t. Our office policy is to collect for all services on the day that the services are rendered. This non-billing policy allows us to keep our office fees down.”Then offer the patient your pre-pay option.

CA: “However, you can pre-pay for 10 visits at a time and there is a 10% (or 15%) bookkeeping savings when you pre-pay for your care. Whenever a patient reduces our bookkeeping expenses, we pass the savings on to the patient. When you pre-pay for 10 visits at a time, you will save $______. Would you like to pre-pay for 10 visits now?”

If the patient doesn’t accept the pre-pay option, maintain your policy of your services areto be paid the day the services are rendered.

CA: “Your fee for today is ________. Will that be cash, check or credit card?”

DAILY VISIT MAJOR MEDICAL INSURANCE PATIENTS COLLECTION PROCEDURES


THE CA COLLECTS ANY BALANCES DUE ON THE PATIENT’S INSURANCE DEDUCTIBLES OR INITIAL DIAGNOSTIC VISITS AND 30% OF TODAY’S FEES

CA: “I see you have insurance coverage. You will have to pay for your services until your deductible is met. Then we will accept assignment of your insurance coverage and you will only need to pay 30% of each office visit. We will bill your


129insurance company and if there is a balance due after they pay us, you will owe us the remainder. If they pay us more than your balance due, the overage will be credited to your account or refunded to you. Fair enough?”

IF THE PATIENT’S INSURANCE DEDUCTIBLE OR INITIAL DIAGNOSTIC VISIT AND THEIR PREVIOUS 30% CO-PAYS HAVE BEEN PAID:

The CA collects 30% of the office visit fee if their insurance pays less than 100%.

CA: “I see you have insurance coverage. You have paid for your initial diagnosticvisit, so from this point forward we will accept assignment of your insurance coverage and you will only need to pay 30% of each office visit. We will bill your insurance company and if there is a balance due after they pay us, you will owe us the remainder. If they pay us more than your balance due, the overage will be credited to your account or refunded to you. Fair enough?”

The CA collects the total amount of the Major Medical insurance patient’s bill when:

1. The Patient’s Insurance Claim Is Not Paid by the Insurance Company.2. The Patient’s Insurance Claim Has Been Denied.3. The Insurance Company Has Paid All it Will Pay.

CA: “Unfortunately, your insurance has (not paid, refused to pay, pail all that it will). Therefore, the fee for your services are due the visit the services are performed. You have a previous balance of _______ and your fee for today’s services are ______. The total due today is ______. You can pay your fees by cash, check or charge card. Which would you prefer?”

DAILY VISIT MAJOR MEDICAL INSURANCE PATIENT’S PROBLEM SOLVERS




130








Scenario #2:





Scenario #3:



131












Scenario #5:

Prior to Friday’s appointment, the CA reviews the patient’s credit report to determine what to do if the patient does not pay for all their services on Friday.


132If the patient has an unfavorable credit report and does not pay all their balance on Friday, the CA tells the patient he/she will have to borrow the money and bring full payment in with him/her on their next visit.

The CA then tells the patient to call for an appointment as soon as they are ready for their next appointment.CA: “Please call us for an appointment when you are ready for your next visit.”

If the patient has a good credit report and does not pay for all their services on Friday, the CA schedules their next appointment for the following Friday. All future visits correspond with the patient’s paydays.

Scenario #6:

PT: “I can only pay $40 a week.”

Find out the day that they get paid and schedule them for that day. Do not have a patient come in for three or four visits per week and only pay $40 per week towards those visits. They’ll end up owing you a big balance, which will make your patients resent you. And, when patients resent their doctor, they won’t pay their bill and might possibly sue you for malpractice to avoid paying it.

Scenario #7:

PT:“Would it be okay for me to pay once a month instead of every visit?”

Your office policy is: Let your patients charge their services when they have proved theirwillingness to pay. However, remember, willingness and ability to pay are different.

If the patient has a good credit history with your office and has consistently paid for his/her services for at least eight consecutive office visits, and the office has had no prior problems collecting from this cash patient, the CA should approve this request.

CA: “Why sure, Mrs. Jones. We’ll be happy to bill you. This way you won’t have to write so many checks.”

Scenario #8:

IF THE PATIENT DOES NOT HAVE A PAYMENT HISTORY WITH YOUR OFFICE

The CA should explain that your office policy is that services are to be paid on the day they are


133rendered. The CA can also offer to allow the patient to pre-pay for ten visits at a time, thus providing the convenience that an honest patient is looking for.

CA: “Mrs. Jones, we have a policy that all services are to be paid the day services are rendered. This policy keeps our office fees down. However, you can pre-pay for ten visits at a time. And there is a 10% (or 15%) bookkeeping savings when you pre-pay for your care. Whenever a patient reduces our bookkeeping expenses, we pass the savings on to the patient. Therefore, when you pre-pay for 10 visits at a time, you will save $_______. Would you like to pre-pay for 10 visits now?

If the patient does not want to pre-pay, the CA maintains the “pay for services on the day that services are rendered” policy.

Scenario #9:

IF THE PATIENT HAS A POOR PAYMENT HISTORY WITH YOUR OFFICE, OR HAS A BAD CREDIT REPORT.

CA: “Mrs. Jones, I’d like to help you, but I can’t. Our office policy is to collect for all services on the day that the services are rendered. This non-billing policy allows us to keep our office fees down.”Then offer the patient your pre-pay option.

CA: “However, you can pre-pay for 10 visits at a time and there is a 10% (or 15%) bookkeeping savings when you pre-pay for your care. Whenever a patient reduces our bookkeeping expenses, we pass the savings on to the patient. When you pre-pay for 10 visits at a time, you will save $______. Would you like to pre-pay for 10 visits now?”

If the patient doesn’t accept the pre-pay option, maintain your policy of your services areto be paid the day the services are rendered.

CA: “Your fee for today is ________. Will that be cash, check or credit card?”

DAILY VISIT HMO & PPO PATIENTS COLLECTION PROCEDURES



134IF THE PATIENT HAS A DEDUCTIBLE THAT HAS NOT BEEN MET

CA: “I see you have insurance coverage. You will have to pay for your services until your deductible is met. Then we will accept assignment of your insurance coverage and you will only need to pay your co-payment of $_____ each visit.”

IF THE PATIENT HAS A DEDUCTIBLE THAT HAS BEEN MET, OR IF THERE IS NO DEDUCTIBLEDR: “I see you have PPO insurance coverage. You are only responsible for a co-

payment of _______ each visit.”

HMO-PPO PATIENTS COLLECTION PROBLEM SOLVERS



PATIENT STATEMENTS

Scenario #1:






CA: “We have a policy of not sending statements for fees less than $250. This policy keeps our office visit fees down. When you come in tomorrow you can pay for the


135balance of today’s visit and tomorrow’s visit.”

Scenario #2:



CA: “That’s okay, here’s a blank check that will help you out this time.”



Scenario #3:

PT: “I didn’t bring any money or a check with me today.”

CA: “If you have a credit card, we do accept them.”If the patient doesn’t have a credit card or a check, offer them a counter check.


CA: “That’s okay, here’s a blank check that will help you out this time, or, if you have a credit card, we do accept them.”




PT: “I didn’t bring any money or a check with me today. I get paid on Friday and will pay you


136then.”









DAILY VISIT PERSONAL INJURY PATIENTS COLLECTION PROCEDURES


IF THE PATIENT’S CARE IS GUARANTEED BY AN ATTORNEY LIEN OR LOP


137

Have the patient pay something on their account monthly, or charge them a $15 a weekadministration fee that will be applied to his/her balance.

CA: “Your monthly payment (or weekly administrative fee) is due today. That will be $15. Will that be paid by cash, check or charge card?”

IF THE PATIENT’S INSURANCE DOESN’T PAY 100%

CA: “Mrs. Jones, most of your fee for today’s services will be paid by your insurance company. Your co-payment of _____ is due the day your services are rendered. Will that be paid by cash, check or charge card?”

PERSONAL INJURY PATIENTS COLLECTION PROBLEM SOLVERS



PATIENT STATEMENTS

Scenario #1:

PT: “I didn’t bring enough money with me today.”

CA: “How much can you pay today?


CA: “That’s ok. You can place your balance on a credit card ... we do accept them.”


PT: “I don’t have a credit card.



138



Scenario #2:

PT: “I forgot my checkbook.”

CA: “If you have a credit card, we do accept them.”




Scenario #3:







CA: “We have a policy of not sending statements for fees less than $250. This policy


139keeps our office visit fees down. When you come in tomorrow you can pay for today’s visit and tomorrow’s visit.”













140

DAILY VISIT MEDICARE PATIENTS COLLECTION PROCEDURES







Collect for the patient’s visit, any previous balance, or the monthly fee of a “three-installment” case fee plan.Note: Remember, when collecting advanced payments, i.e., 50% - 25% - 25% or pre-pays of

10 visits or more, the money must be deposited into an “escrow” account and drawn out when the services are rendered.

MEDICARE NON-PARTICIPATING PROVIDER, OR IF THE PATIENT HAS A BALANCE

IF THE DOCTOR IS A MEDICARE NON-PARTICIPATING PROVIDER:

If the doctor signed up with Medicare under this category, the CA is to collect for all services rendered to Medicare patients and gives the patient a receipt for his/her services, (when the services are paid for.) The patients will then send the doctor’s receipts to Medicare for reimbursement.

CA: “Today, Dr. Fernandez provided you with a consultation, an orthopedic examination, plus a neurological examination, and a chiropractic examination, in


141addition to, a urine analysis and two x-rays, one from the front, plus one from the side. Your fee for today is 185.”

OR

CA: “Mrs. Jones, you have a balance due of ______, and today your fees are _____, for a total of _____. Will that be paid by cash, check or charge card?”

OR

IF THE PATIENT’S MONTHLY PAYMENT IS DUE

CA: “Mrs. Jones, your monthly payment of _______ is due today. Will that be paid by cash, check or charge card?”


MEDICARE PARTICIPATING PROVIDER:

If the doctor has signed up with Medicare under this category, he/she has agreed to accept assignment for the adjustments Medicare will pay for (some states pay for less than 12 visits, others pay for 12 visits, and in some states, Medicare pays for unlimited number of visits). The doctor is not to have his/her patient pay the entire fee for the Medicare allowable adjustments. However, the doctor is to have his/her patients pay for the co-pay on the fees for the adjustments and for non-covered Medicare services, i.e., the adjustments Medicare will not pay for x-rays, exams, physiotherapy and rehab.

Note: Federal law states that the doctor has to fill out the Medicare form for all Medicare patients and send it to Medicare.

Note: Federal law states it is against the law to blanketly forgive a Medicare of Medicaid patient’s co-payments.

CA: “Mrs. Jones, our office will bill Medicare for the adjustment, if any, you received today. You also received __________ (using the “plus, in addition to” verbiage to describe the non-covered services). Your fee for this service today is ________.”

IF THE PATIENT’S MONTHLY PAYMENT IS DUE

CA: “Mrs. Jones, your monthly payment of _______ is due today. Will that be paid by cash, check or charge card?”

OR


142CA: “Mrs. Jones, you have a balance due of _______ and the total of today’s co-

payment and non Medicare covered fees is ______. Will that be paid by cash, check or charge card?”

IF THE PATIENT’S MONTHLY INSTALLMENT FOR THEIR CASE FEE IS DUE

In this case, the patient’s case fee covers their non-Medicare covered services and their daily visit co-payments.

MEDICARE PATIENTS COLLECTION PROBLEM SOLVERS



PATIENT STATEMENTS

Scenario #1:








143Scenario #2:





Scenario #3:











144CA: “We have a policy of not billing for services under $250. This policy keeps our

office visit fees down. Would you like to put your balance on a charge card...we do accept them?”





DAILY VISIT MEDICAID/MEDI-CAL PATIENTS COLLECTION PROCEDURES


The CA is to make sure the Medicaid patient is authorized for care on this visit.


Collect the Medicaid (or Medi-Cal) patient’s co-payment.CA: “Your insurance will pay the majority of today’s visit. Your co-pay is _______.

Will that be paid by cash, check or charge card?”

MEDICAID PATIENT’S COLLECTION PROBLEM SOLVERS



145NEVER ASK A PATIENT, “HOW DO YOU WANT TO PAY?”

They’ll respond, “Bill me.”

PATIENT STATEMENTS

Scenario #1:

PT: “I didn’t bring enough money with me today.”

CA: “How much can you pay today?


CA: “That’s ok. You can place your balance on a credit card ... we do accept them.”


PT: “I don’t have a credit card.




Scenario #2:

PT: “I forgot my checkbook.”



CA: “That’s okay, here’s a blank check that will help you out this time.”




keeps our office visit fees down. When you come in tomorrow you can pay for the balance of today’s visit and tomorrow’s visit.”

Scenario #3:












CA: “We have a policy of not sending statements for fees less than $250. This policy


147keeps our office visit fees down. When you come in on Friday, you can pay for today’s visit and Friday’s visit.”


BILLING AND COLLECTING PATIENT

BALANCES

ESTABLISH NUMERICAL AND ALPHABETICAL FILES


148

PURCHASE A NUMERICAL FILE FOLDER

This is a numbered accordion file, large enough to place insurance paperwork in, and with slots numbered 1 through 31.

OR

MAKE YOUR OWN NUMERICAL FILE

If you cannot find an accordion file large enough, make your own numerical file “tickler” system, using 31 numbered file folders in their own designated and easy to maneuver file box or case.

PURCHASE AN ALPHABETICAL FILE

If you have a non-computerized office, purchase an alphabetical file folder (an accordion file with slots marked for each letter of the alphabet) large enough to place insurance paperwork in.

OR

MAKE YOUR OWN ALPHABETICAL FILE

If you cannot find an alphabetical accordion file large enough to place insurance information in, make your own alphabetical file by using alphabetically designated file folders placed in an easy to maneuver file box or case.

FOLLOW AN ALPHABETICAL BILLING CYCLE EACH MONTH

THE ALPHABETICAL BILLING CHART


149

The following alphabetical billing chart was designed for the non-computerized office to help eliminate billing oversights and avoid unnecessary payment delays. The chart is split into four weeks of five days (Monday through Friday) each. Each day is assigned letter(s) of the alphabet except one day which is designated “catch-up”. Following this chart, all patients with last names beginning with “A” will have their accounts billed out on the first Monday of the month, then all patients with last names beginning with “B” will have their accounts billed out on the first Tuesday of the month, etc.

A B B/C C D

E/F G H I/J/K L

M CATCH-UP M/N O/P Q/R

S S T/U/V W X/Y/Z

The billing of insurance should follow this alphabetical billing cycle after the first claim has been filed (the first billing is always done three days after the patient’s initial visit).

If the doctor’s office utilizes a computer to bill insurance companies, it should file claims weekly.

When billing patients for their cash balances, also follow this alphabetical billing cycle scenario.

CASH PATIENTS COLLECTION SCENARIO

CASH PATIENT’S BILLING SCENARIOS

Note: If the CA has done the proper job of collecting on the first three visits and on a daily visit basis, there should be no, or minimal, outstanding balances.

PAY-BY-THE-VISIT PATIENT

The patient’s first billing is a copy of his/her statement for services rendered and is sent out


150three days after the patient begins care.

Place a reminder notice that you have billed the patient for (whatever amount) in the alphabetical file under the letter of the alphabet that matches the first letter of the patient’s last name (i.e., Smith would go under the alphabet letter “S”). If you use a computer for billing, place the reminder notice in the computer’s reminder system. Make sure your statement format includes a very clear and precise “balance due” amount.

CASE FEE (50%-25%-25%) PATIENT

The CA is to place a notice in your office numerical file (or computer reminder system) to remind him/her to send a bill to the patient one week prior to the due date. Include a self-mailing envelope.

PURCHASE MAIL/RETURN WINDOW ENVELOPES

These envelopes can be found at NEBS 1-800-225-6380 (their item #13109-1). These envelopes allow you to insert the patient’s statement so that his/her name and address shows through a mailing window, plus there is an attached self addressed payment return envelope for the patient’s convenience.

NEVER USE “DUNNING” LETTERS OR “DUNNING” REMARKS ON THE OUTSIDE OR INSIDE OF BILLING ENVELOPES OR BILLING STATEMENTS

Patients who receive handwritten messages like, “You’re late,” or “Balance is past due,” are less apt to return for care than the patient who receives a late notice with the same message on a pre-printed label. The reason being is that the patient will be embarrassed to see the person who handwrote the dunning message, but pre-printed labels or professionally printed collection labels remove the “personal” aspect of the late notice, thereby removing the patient’s apprehension of facing someone who has had to “go after him/her” for payment.

NEVER SEND OUT NASTY COLLECTION LETTERS

Remember ... stern collection efforts usually result in malpractice suits. And, when a letter is personal, the patient will never return to the person who wrote the insulting letter.

NEVER SEND OUT COLLECTION POST CARDS

Whenever you send out collection post cards you are notifying someone other than the patient that the patient owes you money. Legally, this action negates their balance with you and may produce a lawsuit.


151

SECOND BILLING

If payment is not received by the next billing day for that patient, the day of the following month when all patients whose last names begin with the same letter as the patient are billed, i.e., if the patient’s name is Mr. Hill, the next billing day for him would be the second Wednesday of the following month, which is the day that all patients with the last name beginning with the letter “H” are billed. However, don’t send a second billing within 14 days of the first billing. If the alphabetical billing date is within 14 days of the patient’s first billing, place a note in the alphabetical file reminding your self not to send the second billing until the next month.

SEND ANOTHER COPY OF THE PATIENT’S ACCOUNT STATEMENT WITH A COLLECTION LABEL AFFIXED

Affix the following collection label (PGF221) so that it does not show on the outside of the envelope, but is obvious when the envelope is opened:

“We feel this balance is an oversight on your part. Thank you for sending payment today.”

Place a reminder notice that you have billed the patient for (whatever amount) in theAlphabetical file under the letter of the alphabet that matches the first letter of the patient’s last name (i.e., Smith would go under the alphabet letter “S”). Make sure your statement format includes a very clear and precise “balance due” amount.

THIRD BILLING

If payment is not received by the second alphabetical billing day, send another copy of the patient’s account statement with the following collection label (PGF231) affixed so that it does not show on the outside of the envelope, but is obvious when the envelope is opened:

“As previously requested, please let us hear from you regarding this account. We are preparing an in-house audit and your account must be paid within 10 days of this notice.”

Place a reminder notice that you have billed the patient for (whatever amount) in theAlphabetical file under the letter of the alphabet that matches the first letter of the patient’s last name (i.e., Smith would go under the alphabet letter “S”). Make sure your statement format includes a very clear and precise “balance due” amount.


152

COLLECTION TELEPHONE CALLS TO CASH PATIENTS

If payment is not received within 10 days of the third alphabetical billing date, an immediate telephone call is to be made to the patient.

The longer the CA waits to make collection calls, the less chance she has of collecting the doctor’s fees.

RULES REGARDING TELEPHONE COLLECTION EFFORTS

These rules are necessary to protect the patient’s privacy.

Don’t Talk to Anyone Other than the Patient.

Don’t Call the Patient at Work.

Never Leave a Collection Message on an Answering Machine or on a Voice Mail.

Don’t Let Others Hear Your Collection Calls.

ONLY CALL FROM 8 A.M. TO 8 P.M.

The best time to call is 5 p.m. to 8 p.m.

WHEN COLLECTION PATIENT BALANCES OVER 30 DAYS

DEVOTE ONE DAY A MONTH FOR COLLECTION CALLSRandom calling doesn’t work.

PRIORITIZE YOUR COLLECTION CALLS Collect the larger bills and newer bills first, then the oldest and smaller bills last.


153

ASK FOR THE ENTIRE BALANCE

FIRST SUGGEST THAT THEY PUT THEIR ENTIRE ACCOUNT BALANCE ON A CHARGE CARD

This step should not be necessary as the cash patient should have already signed an “Authorization Agreement for Account Payment by Credit Card” form (Exhibit #7) and the insurance patient should have signed an “Authorization Agreement for Pre-Arranged Payment (Debits) by Credit Card or Bank Health Card” form (Exhibit #3). These forms allow you to place their balance on a charge card. If the patients haven’t signed these forms and are receptive to placing their balances on a credit card, agree on the total payment to be added to their charge card. Send them the “Authorization Agreement for Account Payment by Credit Card” form (Exhibit #7) for their signature. Do so in your mail/return mail window-billing envelope.

SECONDLY, SUGGEST THAT THEY PUT $50 TO $100 A MONTH ON THEIR CHARGE CARD

If the patient hasn’t previously signed Exhibits #3 or #7, and they agree to placing their balance on a charge card, mail them an “Authorization Agreement for Account Payment by Credit Card” (PGF241) (Exhibit #7) filled out and ready to sign in your mail/return mail window-billing envelope. Once you receive the form back, charge their card $50 a month (or whatever amount has been agreed upon) until the balance is eliminated.

IF THE PATIENT DOESN’T WANT TO PLACE THEIR BALANCE ON THEIR CHARGE CARD AND REQUESTS TO MAKE PARTIAL PAYMENTS

Ask them how much they can send each month. Do not suggest an amount because your amount will usually be less than the patient will offer. If the patients offer is too low, suggest they pay $50-$100 a month.

HAVE THE PATIENT REPEAT THE FINANCIAL ARRANGEMENTS TO YOUWhen making telephone financial arrangements with a patient, suggest to the patient...

CA: “Mr. Smith, please write our payment arrangement down and read it back to me, so I can be sure I have not misunderstood anything.”

By doing this, you are actually getting the patient to affirm their financial arrangement, which strengthens the patient’s commitment to pay.


154MAKE A NOTATION ON THE PATIENT’S FILE EACH TIME ONE OF THE ABOVE STEPS IS UNDERTAKEN, I.E., 5/4/89, THIRD BILLING.

PLACE A NOTATION IN THE NUMERICAL FILE - RE: THE AMOUNT DUE EACH MONTH FOR SEVEN DAYS AFTER THE PAYMENT IS TO BE SENT

If the patient doesn’t make their payment as promised, call them again.

ALWAYS STAMP, “ADDRESS CORRECTION REQUESTED” ON BILLING ENVELOPES

This message can be pre-printed on your billing envelopes, or purchase a rubber stamp from your local office supply store. This is an easy way to maintain up-to-date mailing addresses on your patients.

THE USE OF COLLECTION AGENCIES

Only use a collection agency that sells you a series of collection letters. Remember, mostmalpractice cases are initiated because of a too stringent collection effort.

THE USE OF SMALL CLAIMS COURT

Many times taking a patient to small claims court is more effective than utilizing a collection agency. Check with a local attorney for your state’s Small Claims Court procedures.

INSURANCE PATIENTS BILLING SCENARIOS

MAJOR MEDICAL INSURANCE PATIENTS COLLECTION SCENARIOS

PLACE THE FOLLOWING PATIENT INSURANCE INFORMATION IN THE NUMERICAL FILE ON THE DATE THAT CORRESPONDS WITH THE THIRD DAY IMMEDIATELY FOLLOWING THE PATIENT’S INITIAL VISIT.

The patient’s insurance form (filled out and signed).HCFA Insurance form (F3200A) (filled out and signed).


155

Master Assignment Lien and Authorization Insurance Benefits and Attorney form (signed). (PGF71). (Exhibit #2)

If the “Assignment Lien and Authorization Insurance Benefits and Attorney” form (Exhibit #1) on the inside of the DRFERNANDEZ.COM file folder has been signed, having a patient sign a “Master Assignment Lien and Authorization Insurance Benefits and Attorney” form (Exhibit #2) is not necessary.

IN A NON-COMPUTERIZED BILLING OFFICE, BILL THE INSURANCE COMPANY ON THE THIRD DAY IMMEDIATELY FOLLOWING THE PATIENT’S INITIAL VISIT

In a non-computerized office, the first thing each morning, the CA pulls the information from the numeric slot that corresponds with that day’s date, i.e. on May 5th, the CA pulls the information from the #5 slot. This three-day period should be enough time to complete all initial diagnostic services, so that they are included in your first billing for that patient. (Please note: if the third day falls on a Saturday or Sunday, file the patient’s information in the number that corresponds with Monday’s date.)

IF YOUR OFFICE IS COMPUTERIZED, BILL THE INSURANCE COMPANIES EACH WEEK

Send a copy of the Assignment form, along with the updated HCFA form to the patientinsurance company.

AFTER THE FIRST BILLING HAS BEEN SENT TO THE PATIENT’S INSURANCE COMPANY:

In a non-computerized office, after you have billed the insurance company for the patient’s initial visit and diagnostic services (within three days after the patient starts care), place a copy of the patient’s insurance form in the lettered slot of the alphabetical file that corresponds with the first letter of the patient’s last name.

However, don’t send a second billing within 30 days of the first billing. If the alphabetical billing date is within 30 days of the patient’s first billing, place a note in the alphabetical file reminding your self not to send the second billing until the next month.

Following the alphabetical billing chart scenario, as the patient’s insurance form comes up each month for billing, update it and send it to the insurance company.

Following the numerical and alphabetical billing procedures as outlined above, a non-


156computerized billing system requires a review of two tickler files each day, one numeric and one alphabetical. A computerized office only needs to review their numerical file.

IN A NON-ELECTRONIC BILLING OFFICE, STAMP “BENEFITS ASSIGNED” ON ALL FORMS YOU SEND TO ALL INSURANCE COMPANIES

Stamp “Benefits Assigned” on a diagonal across each insurance form and assignment forms(Exhibit #1 or #2) you send to the insurance company.

Have a rubber stamp made up 1 inch high and 5 inches wide stating: “Benefits Assigned.”

HMO/PPO PATIENTS COLLECTION SCENARIOS

Follow the Major Medical patient’s insurance collection scenarios. If the patient owes for their deductible and co-payments, follow the “cash patient collection procedures” discussed in this chapter.

PERSONAL INJURY PATIENTS COLLECTION SCENARIOS

INITIALLY SEND BOTH INSURANCE COMPANIES (YOUR PATIENT’S INSURANCE COMPANY AND THE INSURANCE COMPANY OF THE PERSON THAT HIT YOUR PATIENT) AND THE PATIENT’S ATTORNEY A COPY OF THE:• “ASSIGNMENT, LIEN AND AUTHORIZATION INSURANCE BENEFITS AND

ATTORNEY” FORM (EXHIBIT #1).• OR, THE “MASTER ASSIGNMENT, LIEN AND AUTHORIZATION INSURANCE

BENEFITS AND ATTORNEY” FORM (EXHIBIT #2).

If you use the “Master Assignment Lien and Authorization Insurance Benefits and Attorney” form (Exhibit #2), keep the original in your file.

SEND A FILLED OUT HCFA FORM TO THE PATIENT’S INSURANCE COMPANY FOR PAYMENT WHEN YOU SEND THEM THE ASSIGNMENT FORMS.

IN A NON-ELECTRONIC BILLING OFFICE, STAMP “BENEFITS ASSIGNED” ON ALL FORMS YOU SEND TO ATTORNEYS


157Stamp “Benefits Assigned” on a diagonal across each insurance form and assignment forms (Exhibit #1 or #2) you send to the attorney.

Have a rubber stamp made up 1 inch high and 5 inches wide stating: “Benefits Assigned.”

FOLLOW-UP PI INSURANCE BILLINGS

Send a copy of the Assignment form and HCFA form to the patient’s insurance company and the patient’s attorney. Make sure “Benefits Assigned” is stamped on all forms.

Do not send this follow-up information to the insurance company of the person who hit your patient.

SEND OUT THE “ATTORNEY INQUIRY POST CARD” (EXHIBIT #9) TO THE PATIENT’S ATTORNEY EACH MONTH

Don’t call the patient’s attorney regarding the deposition of the patient’s claim. He/she probably doesn’t know the answer to these questions because his/her secretary or paralegal handles most of the details of the patient’s case except for conducting depositions and courtroom duties. And, don’t bother the attorney’s secretaries or paralegals each month with these questions because they are busy and will get irritated by monthly phone calls asking the same questions. Therefore, sending an “attorney Inquiry Postcard” gets all the information you need regarding your patient’s case, without aggravating the attorney, or his/her staff.Remember: The attorney’s secretary or paralegal are usually the individuals that refer

patients to doctor’s offices. Always stay in their “good graces” and never aggravate them.

CALL THE ATTORNEY OR ATTORNEY’S SECRETARY IF YOU HAVEN’T RECEIVED AN ANSWER TO THE “ATTORNEY INQUIRY POST CARD” BY RETURN MAIL WITHIN 14 DAYS OF SENDING IT

Ask the attorney or his/her secretary the questions that are printed on the post card.

Never miss this step because the attorney may settle the case and send the check to the patient.

MEDICARE PATIENTS COLLECTION SCENARIOS



158

Bill the patient for any balances due on their co-pays and non-Medicare covered services using the “cash patient” billing scenarios described in this chapter.

MEDICARE NON-PARTICIPATING PROVIDER

Bill the Medicare patient for all balances by using the “cash patient” billing scenarios previously described in this chapter.

MEDICAID/MEDI-CAL PATIENTS COLLECTION SCENARIOS

Bill the patient for their unpaid co-pay by using the “cash patient” collection scenarios previously described in this chapter.

ALL INSURANCE CLAIMS ARE TO BE FILED USING THE PREVIOUSLY DESCRIBED GUIDELINES, EXCEPT IN THE

FOLLOWING CIRCUMSTANCES

THE INSURANCE CASES HAVE BEEN DENIED.

When this happens, the patient becomes a cash patient. If so, follow the cash patient billing procedure.

AN ADDITIONAL INSURANCE COVERED CLAIM OCCURS

If so, file the new claim using the alphabetical and numerical file scenario previously described, or file by computer. When a second claim occurs, follow the guidelines for the multiple insurance coverage, as previously described.

ANYONE DISCHARGING THEMSELVES FROM CARE

If so, send a final bill to the patient’s insurance company immediately and bill the patient for any balance due from the patient.

ANYONE THE DOCTOR HAS DISCHARGED FROM CARE

If so, send a final bill to the patient’s insurance company immediately and bill the patient for any


159balance due from the patient.

BALANCES EXCEEDING $300 TO $400 IN A NON-COMPUTERIZED OFFICE

If so, bill their insurance company immediately.

INSURANCE TELEPHONE COLLECTION PROCEDURE

Insurance companies “reign” over the money you’ve earned in providing services to their clients ... they decide what you will be paid and they can easily manipulate “when” you will be paid. There are specific procedures that you can incorporate into your practice that will assure your patient insurance claims are paid in the timeliest manner. One of the most vital of those procedures is this insurance telephone collection procedure. The following information explains the two most common insurance telephone collection scenarios and the corresponding telephone procedure that is the most productive and effective in getting the “king” to pay.

When attempting to collect prior insurance balances, start with your larger unpaid insurance claims first, then collect your smaller balances. After that, your telephone collection procedures should be initiated by your insurance collection CA on each patient’s claim that is not paid within 30 days of billing.

The following collection procedure requires the CA to set up and use the previously described numerical file system for follow up activity.

IF THE PATIENT’S CLAIM IS NOT PAID WITHIN 30 DAYS:

Place an insurance tracer phone call to the insurance company.

EACH OF THE FOLLOWING TWO TELEPHONE INSURANCE COLLECTION SCENARIOS BEGIN WITH THE FOLLOWING STEPS:

Locate the Patient’s Insurance File Number and Policy Number

The CA first looks up the insurance company’s file number as found on anycorrespondence received from them in regards to that particular case, or the patient’s policy number as found on the patient’s insurance card.

INSURANCE COLLECTION SCENARIO #1:


160THE C.A. CALLS THE INSURANCE ADJUSTER AND STATES IN A VERY PLEASANT VOICE:

CA: “Hi, this is Sally from Dr. Fernandez’ office. I am calling you in reference to your insured, Mrs. Mary Jones, your file #MJ2384 (or, your policy #123456). Normally your insurance company pays us very quickly. However, on Mrs. Jones’ claim, we have not received any payment.”

Then the CA asks:CA: “Is there a problem with the claim? Are there any questions that I can answer for

you?”THE INSURANCE ADJUSTER LOCATES THE CLAIM FORM AND HAS SOME QUESTIONS

The CA answers those questions and then asks the adjuster if he/she has any more questions.

A. WHEN ALL THE ADJUSTER’S QUESTIONS HAVE BEEN ANSWERED, THE CA ASKS:

CA: “Is there anything else I can do to help you with the claim?”

The CA continues to ask this question and provide the requested information until theinsurance adjuster tells her there is nothing else needed.

A. THE CA WILL THEN END THE TELEPHONE CONVERSATION WITH:

CA: “When can I expect the check?”

Typically, insurance claims are paid on the 1st and 15th of each month, but the insurance adjuster will be able to tell you when your particular claim is scheduled for payment.

C. THE CA WRITES UP A DETAILED ACCOUNT OF THE CONVERSATION

The conversation notes should include the date, name of adjuster, what problems occurred with the claim, questions asked and their answers, and month and day of expected payment.

The CA highlights the month and day that the payment is expected to be made, initials this written account, and places it along with the patient’s insurance information in the numerical file slot that corresponds with a date that is seven days after the promised payment date (this allows for mail transit time). For example, if the insurance adjuster told the CA the payment should be sent on May 15th, the insurance CA would highlight the payment expected date (May


16115th) and then file her conversation documentation in the numerical slot #22.

If the insurance information comes up in the numerical file number but the highlighted month is actually for the month following the present one, the insurance CA would simply make sure that the payment has not by chance been received, and then leave the insurance information in the numerical “tickler” file, to be followed up on the same date of the next month. For example, if the insurance CA calls the insurance company on the 6th of May and is promised payment on June 1st, he/she will tickle this information for the 8th. When he/she pulls his/her #8 file on May 8th for follow up, this June 8th document will be in the file, but because he/she has highlighted the month of June, he/she will know at a glance not to call the insurance company yet. In this case, the CA will simply check to make sure payment has not been received and then leave the document in the #8 file for follow up next month, on June 8th.

If by chance, the insurance company has paid the patient’s bill, the CA removes the reminder notice from the numerical tickler file.

SAMPLE OF CONVERSATION DOCUMENTATION:

“3/18/02 - Spoke to Nationwide Insurance adjuster, Mark Smith (765-432-2145, ext. 586). He asked (note the actual questions) and I told him (note your answers). Mr. Smith said that my answer should satisfy everything they need and the check for Betty Jones’ bill of $234.05 should be paid on 4/01/02. VMC (CA’s initials)”

A. IF THE INSURANCE CHECK IS NOT RECEIVED BY THE DAY THAT YOUR FOLLOW UP REMINDER POPS UP IN YOUR NUMERICAL FILE SYSTEM

The CA calls the insurance adjuster and follows the same question, answer and numerical filing of documentation procedures as detailed in the previously described steps “A”, “B” and “C”. Again, it is extremely important that the CA maintain a pleasant tone of voice and a “what can I do to help you” attitude when he/she speaks with the insurance adjuster.

INSURANCE COLLECTION SCENARIO #2:

THE C.A. CALLS THE INSURANCE ADJUSTER AND STATES IN A VERY PLEASANT VOICE:

CA: “Hi, this is Sally from Dr. Fernandez’ office. I am calling you in reference to your insured, Mrs. Mary Jones, your file #MJ2384 (or, your policy #123456). Normally your insurance company pays us very quickly. However, on Mrs. Jones’ claim, we have not received any payment.”


162Then the CA asks:

CA: “Is there a problem with the claim? Are there any questions that I can answer for you?”

THE INSURANCE ADJUSTER LOCATES THE CLAIM FORM AND ASKS FOR ADDITIONAL INFORMATIONThe insurance adjuster locates the claim form and tells the CA that additionalinformation is needed in order to process the claim, i.e., didn’t receive the doctor’s bill, need soap notes, etc. The CA writes down what the adjuster needs and repeats it back to him/her so that there is no misunderstanding. He/she also verifies the address or fax number to which the insurance adjuster would like the information sent. The CA then tells the adjuster the information will be sent immediately and thanks the adjuster for his/her help.

THE CA IMMEDIATELY SENDS THE ADDITIONAL INFORMATION TO THE ADJUSTER:

By mail: The CA sends the requested information via certified, return receipt mail.

In addition to the CA’s written detailed account of the conversation, including date, name of adjuster and what was discussed, the CA also places a “follow-up” note of what was mailed, including the sender’s copy of the certified mail receipt along with the patient’s insurance information in the numerical file slot that corresponds with the seventh day from the day that the information was mailed, i.e., if the mail receipt is for June 9th, the CA will file the information in the numerical file #16 (this allows time for the information to reach the insurance company and then the adjuster’s desk). If the seventh day falls on a Saturday or Sunday, the information will be placed in the numbered file that corresponds to Monday’s date.

By Fax: If the insurance adjuster has requested or approved that the additionalinformation be faxed to him/her, the CA would immediately do so.

In addition to the CA’s written detailed account of the conversation, including date,name of adjuster and what was discussed, the CA also places a copy of the fax and fax receipt along with the patient’s insurance information in the tickler file number that corresponds with the seventh day from the day that the information was faxed (this allows time for the information to reach the adjuster’s desk).

By e-mail: Under no circumstance is patient information to be e-mailed. The Health Insurance Portability and Accountability Act (HIPAA) consider it a violation of patient privacy and clearly prohibit it.


163WHEN THE “FOLLOW-UP” NOTICE OR THE “FAX” APPEARS IN THE CA’S NUMERICAL FILE SEVEN DAYS AFTER THE ADDITIONAL INFORMATION HAS BEEN SENT, HE/SHE TELEPHONES THE INSURANCE ADJUSTER TO VERIFY THAT HE/SHE HAS RECEIVED THE REQUESTED INFORMATION

If the insurance adjuster has not received the information seven days after it was sent, the CA reconfirms the mailing address or fax number and immediately re-sends the information. The CA would follow the same send, documentation, follow-up notice/fax, patient’s insurance information and numerical file procedure as detailed above.

It is important that the CA maintain a pleasant, “how can I help you” attitude when speaking with the insurance adjuster. In no way should the CA’s words or tone of voice reflect or insinuate to the adjuster that he/she must have received the information and is probably just stalling for time (this is most often true, but if you want to get paid, you don’t upset or insult the adjuster. However, if the information was mailed by certified mail and the CA has the name of the person who signed for it, the C.A. can kindly suggest that the insurance adjuster check with that person to see if he/she still has it.

If the insurance adjuster has received the information, the CA follows the procedures as detailed in Steps “A”, “B”, “C” and “D”.

Note: It is imperative that all communications with insurance adjusters be well documented. Without this documentation, and regardless of what the CA may say, the doctor must assume that no communication was made.

INSURANCE COMPANY CA TELEPHONE COLLECTION DO’S AND DON’TS

The most effective and productive collection telephone calls are made with the following goals in mind:

DO Make a FriendDO Answer QuestionsDO Get a Promise for PaymentDON’T Upset The Person Who Controls The Checkbook”

No matter how frustrated or angry you feel about an insurance adjuster’s attitude or lack of action, if you want to get paid, you must never argue with the insurance adjuster, never insult the adjuster, and never use “smart-mouth” terminology, sarcasm or arrogance when


164communicating with the adjuster, whether over the telephone or in written correspondence.

DO thoroughly and immediately document all conversations with the insurance adjuster.

DON’T let the insurance adjuster know you are frustrated or irate with whatseems to be intentional payment delays.

DO thank the insurance adjuster for his/her time and assistance.

DO immediately put your conversation documentation in the appropriatenumerical file slot.

DO follow up on the day that follow up is due.

DON’T give up!

Remember: Computers Bill Insurance Companies — They Don’t Collect Your Money. Collection Telephone Calls Are What Collect Your Money.

BILLING PATIENTS FOR THEIR PORTIONOF INSURANCE CLAIMS

The easiest and most effective way of billing patients for those services, or portion of their services, that are not covered by their insurance carrier, is by using professionally printed labels.

As previously stated, by appropriately using pre-printed labels, you are clearly communicating your message, while saving time and keeping your collection efforts on a more business and less personal level.

WHEN THE INSURANCE COMPANY HAS ONLY PAID A PORTION OF A PATIENT’S CLAIM

The following label (PGF222) should be affixed to a copy of the patient’s statement that clearly reflects the “patient balance due”. This statement should then be mailed to the patient in a


165mail/return window envelope like those found at NEBS 1-800-225-6380 (their item #13109-1):

“Your insurance company has paid its share of your bill. The balance due is the portion to be paid by you. Please call us if you should have any questions.”

WHEN THE INSURANCE COMPANY DOESN’T PAY THE PATIENT’S INSURANCE CLAIM

Affix the following label (PGF223) to a copy of the patient’s statement that clearly reflects the “balance due”. This statement should then be mailed to the patient in a mail/return window envelope like those found at NEBS 1-800-225-6380 (their item #13109-1):

“We have filed your insurance claim for you, but have received no payment. Please remit your payment for the balance now due and payable.”

WHEN THE INSURANCE COMPANY REJECTS A PATIENT’S CLAIM


“REJECTED. Your insurance company has rejected your claim for benefits; therefore, this balance due is your responsibility. Please send your payment today.”

WHEN THE INSURANCE COMPANY HAS PAID THE PATIENT DIRECT, INSTEAD OF YOUR OFFICE


“Your insurance company has paid you directly for this bill. Your account is now due and payable, please send payment today.”

In each of the above cases, the insurance CA will follow the alphabetical billing sequence procedures as previously outlined, until the patient has paid for his/her portion of the charges due.


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IF THE PATIENT DOESN’T PAY THEIR BILL WITHIN 30 DAYS OF THE SECOND BILLING

If the patient does not respond within 30 days of the second billing, the following letter may be sent:

Dear _______:

Your bill with us in the amount of $_______ , dated __________, 2003 is still unpaid.

Before closing our file on this, you should know the following:

S Since you have not paid on this bill, it is not a deductible medical expense on your tax return.S The Internal Revenue Service will consider any payment you receive from the insurance

company as reportable income, rather than reimbursement for a medical expense.

If the IRS should audit your return, we will be required to substantiate the uncollected amount. Payment in full before that date will eliminate this problem.

Sincerely,

____________________________

Collection Procedures

Documents