Ch' 9 Office and Insurance Collections Strategies

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Ch. 9 Office and Insurance Collections Strategies

• Accounts receivable - unpaid balance due from
  patients for services that have been rendered.

2

• Goal of accounts receivable process collect the
  greatest amount from the insurance company and
  patient in the shortest time period

3

• Prioritize accounts based upon a combination of
  the following
• Balance due (highest to lowest)
• Aging of account - arranging A.R. By age, from
  the date of service
• Account type, payer type or insurance plan

4

• Financial responsibility (insurance vs. Patient)
• Date of claim submission or date of service

5

• Major goal - obtain payment consistently within
  30 - 45 days for all insurance claim forms filed.

6

• Time frames (suggested)
• Begin investigation when claims are 25 days old
  (phone call to insurance company and/or tracer
  claims)
• Call patient after 40 days
• Call insurance company again after 50 days

7

• Patient could become responsible for bill after
  60 days

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Other Collection Strategies

• Education during initial contact with patient
• welcome letter
• when co-payment is due
• whether office bills insurance company on behalf
  of patient

9

• Methods of payment
• Obtain detailed patient information on
  registration form
• Estimate medical cost for patient
• Review collecting fees, p. 294 - 302

10

• Credit arrangements
• credit card billing
• payment plans

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Credit and Collection Laws

• Statute of limitations maximum time during which
  a legal collection suit may be rendered against a
  debtor

12

• Equal Credit Opportunity Act prohibits
  discrimination in all areas of granting credit
• Fair Credit Reporting Act credit reporting
  agencies can only provide reports when

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• Court order is issued
• report is requested by consumer
• legitimate business need for the information

14

• Fair Credit Billing Act patient has 60 days from
  date of statement to complain about error.
• Creditor must acknowledge complaint within 30
  days
• Must correct any mistakes within 90 days max.

15

• Truth in Lending Act and Truth in Lending
  Consumer Credit Cost Disclosure must provide all
  details related to the cost of the credit
  granted, i.e., interest charges, late fees,
  payment amount, etc.

16

• Fair Debt Collection Practice Act - designed to
  protect consumers from unfair, harassing or
  deceptive collection practices.

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• The Collection Process
• Telephone
• Letters

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• Collection agencies
• Use only after all attempts have been made to
  collect in the physicians office
• Physician should approve prior to submitting to
  collection agency

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• Review text, p. 318 for guidelines on when to
  submit to collection agency
• Choosing an agency
• High standards of ethics
• Length of time in business

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• Collection rate
• Licensed, bonded, hold harmless
• References
• Small claims court
• garnishment, cars, bank and personal assets