Copyright © 2008 Delmar Learning. All rights reserved. Unit 5 Financial Administration.

Copyright © 2008 Delmar Learning. All rights reserved.

Unit 5

Financial Administration


Chapter 13

Fees, Credit, and Collection


3

Objectives

• Review the learning and performance objectives for this chapter

• By the end of this chapter, demonstrate the procedures in the textbook and the job skills in the workbook


4

Heart of the Health Care Professional

• Service– Answering questions and explaining fees is a

courtesy to the patient.


5

History of Credit

• Credit– Latin word “credere”– To trust or to believe

• Personal integrity• Ability to meet financial obligations


6

History of Credit

• The Great Depression– Start of credit for medical services

• Today– Payment expected at time of service– Health insurance contract


7

History of Credit

• Credit and collection information– Complete, accurate Registration

• Personal information• Financial history• Employment information

– Includes insurance information• Used to bill insurance company


8

Fee Schedules

• Every physician establishes fees– Specialty– Education– Experience– Geographic location– Overhead costs


9

Fee Schedules

• Quantum merit– “As much as he deserves”

• Lists of fees for services– Required by federal regulations– Separate schedules

• Medicare• Managed care• Private pay


10

Fee Schedules

• Medicare fees– Participating fee– Nonparticipating fee– Limiting charge– Example 13-1


11

Fee Schedules

• Changes in fees and discounts– Hardship discounts

• Dependent on income level• Hill-Burton Act

– Professional courtesy– Copayment waiver

• Not recommended


12

Fee Schedules

• Discussing fees– Fee-for-service– Copayment collected at visit– Communicating fees

• Clear and accurate• Figure 13-1• Example 13-3


13

Fee Schedules

• Discussing fees– Signs of a “deadbeat”

• Questionable employment record• No business or home telephone• Many moves of residence• A motel address


14

Fee Schedules

• Discussing fees– Signs of a “deadbeat”

• Record of doctor hopping• No referral• No insurance• Incomplete registration form


15

Billing

• Payment at the time of service– Emphasize incentives to patient

• Example 13-4

– Meeting with the patient• Face-to-face• Discussion of outstanding balance


16

Billing

• Multipurpose billing form– Bill– Insurance form– Routing document– Receipt– Figure 13-3


17

Billing

• Monthly itemized statement– Sent to patients– Charges, payments, adjustments– Figure 13-5– Explain professional fees in an itemized billing

statement• Procedure 13-1


18

Billing

• Monthly itemized statement– Office calculator– Perform math functions using a calculator

• Procedure 13-2

– Prepare and post to patient’s ledger card• Procedure 13-3


19

Billing

• Cycle billing– Billing distributed throughout month

• Distributes related duties

– Prepare monthly itemized billing statement• Procedure 13-4


20

Billing

• Cycle billing– Credit card billing

• Patient pays fee with credit card

– Debit cards• Off-line• On-line


21

Billing

• Cycle billing– Individual responsibility program

• Patient pays physician• Insurance reimburses patient

– Billing services• Business that handles billing• Saves office money and time


22

Billing

1. Itemized fees for professional services with line-by-line description.

5. Patient’s payment check received, listing check number.

4. Billed patient 20 percent copayment.

3. Payment received on account from insurance, listing voucher number. United paid 80 percent.

2. Insurance claim submitted showing dates or service billed.


23

Credit and Collection Laws

• Fair Debit Collection Practices Act– Guidelines for collection practices

• Equal Credit Opportunity Act– If credit is extended to one patient, it must be

extended to all who request it


24


• Federal Truth in Lending Act– Disclosure form to detail interest– Figure 13-8– Establish financial agreement with patient

• Procedure 13-5


25


• Truth in lending consumer credit cost disclosure– Disclose all costs– Interest, late fees– Prior to time of service


26

Collections

• Three types of accounts– Open-book account– Written-contract account– Single-entry account

• Aging accounts– Breakdown of days overdue


27

Collections

• Office collection problem solving– Verifying checks

• Nonsufficient funds• Bad check preventive measures

– Dun messages• Dun = To make a loud noise• Payment reminder phrase


28

Collections

• Telephone collections– Perform debt collection by telephone

• Procedure 13-6

– Insurance check sent to patient• Assignment of Benefits

– Solutions for payment excuses


29

Collections

• Collection letters– Figures 13-11 and 13-12

• Collection agencies– Business that collects overdue accounts


30

Collections

• Take collection action– Write off an uncollectible account then post

money from a collection agency – Procedure 13-7


31

Collections

• Small claims court– Inexpensive– Judgment by court– Physician still has to pursue payment – File an uncollectible account in small claims

court • Procedure 13-8


32

Collections

• Estate claims– Claim on estate of deceased patient

• Bankruptcy– Debtor protected by court– Creditor cannot send further statements


33

Stop and Think

• Tackle payment obstacles– Review the scenario– Determine what your response would be


34

Stop and Think

• Handle collection problems– Review the scenario– Formulate questions to ask the patient and

state what action you would take

Copyright © 2008 Delmar Learning. All rights reserved. Unit 5 Financial Administration.

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