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Never assume third party rates are “cast in stone.”

At least ask for a different rate, especially if you can show your costs!


HCET Home > On-line Training > Money Matters > 7. Collections

7. Collections

Having large amounts of dollars in Accounts Receivable (A/R) for a long time can jeopardize your financial position by causing cash shortfalls. “Dollars in A/R” is how much money you are owed when bill payment is pending. Pending means waiting for payment.

Key steps to improving collections:

  • Develop a method for “aging” accounts
  • Pay attention to Accounts Receivable as soon as possible
  • Set a time to review outstanding bills to individuals and third party providers
  • Monitor A/R to enable you to determine which payers make timely payments, and react accordingly
  • Also track “unbilled visits”, (i.e., when you don’t have all the financial or health record information necessary to bill for patients awaiting coverage)
  • Set a policy of sending a bill within 48-72 hours of date-of-service

Registration is a critical time for gathering information and setting the tone for bill collection. When you schedule an appointment, collect as much patient information as possible.

At on-site registration:

  • Collect and verify outstanding patient demographic and insurance information
  • Verify coverage before the visit and on each occasion of a visit
  • Conduct financial screening, as necessary
  • Create or have patient health record available; and
  • Generate an encounter form

Steps for clinic staff through the clinic encounter:
  • The provider must complete an encounter form and health record, both of which go to coding to insure payment
  • The coder verifies the record notes, assigns appropriate code(s), completes encounter form, and forwards it to billing department
  • The billing department books appropriate service charge and produces a bill based on a completed encounter form

Bills are aggregated to form a claim that is submitted to a third party payer. Note that:
  • Different plans cover different things under different circumstances for different rates
  • Explanation of Benefits (EOB) codes are important
  • Request key (codes) from all payers with which you have a relationship
  • Rejection of bills need prompt attention
  • Being an “out of network” provider is not an admirable position to be in
  • Get a contract quickly to become a network provider

Using a collection agency must be done carefully as it is discourage by Title X. Instead::
  • Develop a plan to advise clients of outstanding bills
  • Place a copy in the chart and have a counselor discuss the outstanding amount at the next visit
  • While clients must not be denied service because of the inability to pay, they also have an obligation to settle any outstanding bills
  • Be willing to establish payment plans and to re-evaluate the patient’s position on the fee scale
  • DO NOT establish barriers by only giving one pack of pills or requiring clients to return based on finances rather than sound medical practice, as this is counter productive
  • Develop a business plan to increase all reimbursement.
  • Evaluate new programs and implementation plans.
  • Retool current operations, as needed.

Above all, KEEP TRYING!!
 
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URL: http://www.hcet.org/training/Mmatters/ModIII/7collect.htm
 Last update: 04/22/08