The Collection Process in Medical Billing

1
The Collection Process in Medical Billing

• Francie Walters
• Jennifer Randall

2
Alternate Title

• How to get the Most out of your Receivables!

3
What we will Cover

• Establishing a collection program at your lab
• The collection module in MB and how it works
• The aging reports in MB
• What the collection process looks like at
  Northeast Dermatopathology
• General Discussion about what works in your lab

4
Establish a Collection Plan

• Before you can begin the collection process in MB
  you should first determine your specific
  companies collection plan both for patient
  account balances and for insurance account
  balances.

5
Questions to answer in developing your patient
collection process.

• How much time will you give a patient to pay
  their bill before it enters the collection
  process?
• How many statements should a patient receive
  before entering the collection process?
• Will you allow the patient to make payments?
• Will you make any internal collection attempts,
  ie phone calls before you begin the MB collection
  process?
• What is the minimum balance you will attempt to
  collect?

6
What we do at NDI

• We allow 75 days from the date the patient
  received the first bill to pay the balance.
• We want the patient to receive a minimum of 2
  statements.
• The patient will not enter the collection process
  if they have made a payment in the last 30 days.
• We make no additional attempts to collect prior
  to the patient entering the collection process.

7
The Collection and Aging Module
8
Prepare the Aging Table
NOTE AGING YOUR RECEIVABLES HAS NO EFFECT ON
THE MEDICAL BILLING COLLECTION PROCESS!!!!
9
Aging based on Print Date vs Date of Service

• Aging based on Print Date will age your
  receivables based on the FIRST patient statement
  or the LAST claim generated
• Aging based on Service Date will age your
  receivables based solely on the number of days
  since the date of service

10
The 5 step collection process in Medical Billing

• The collection process in MB should be run
  monthly.
• Phase One or steps 1 and 2 are done at the start
  of the process
• Phase Two or steps 3 thru 5 are done
  approximately 15 to 20 days after Phase one.

11
A Possible Time Line

• June 1, 2014
• Age the receivable based on the Print Date
• Run the first two steps in the collection
  process, Generate the Pre-Collection Records and
  Print the Pre-Collection Letters
• June 20, 2014
• Run Steps 3 thru 5, Generate Collection Records,
  Send Accounts to Collection, Write off Overdue
  Accounts

12
Step 1Generate Pre-Collection Records
Sets Credit Status to 2 on the Patient
Demographics screen
13
The Credit Status Code

• The credit status field is updated as the account
  moves through the collection process. This field
  is stored in the patient demographics tab.

14
Pre-Collection Report

• Review For Medicare Patients
• Review for Full Balances

15
You can cease the collection process by
changing the credit status to none.
16
Generate the Pre-Collection Letters
Tip We print the pre-collection letters on
bright gold paper Credit Status Field advances
to 3 Phase One is Complete
17
Generate Collection Records
Credit Status Code Advances to 5
18
Send Accounts to Collections
Credit Status Code Advances to 6
19
Write off Overdue Accounts
Posts the Adjustment to the Service and Sets
Service to a 40 Changes the Credit Status Code
from 6 to 7 to none
20
What we do at NDI after the account is written off
21
(No Transcript)
22
NDI Timeline for September Collections

• Sept 2, 2014 we run the pre-collection program
  and send the precollection letters
• Sept 16, 2014 we run phase 2 of the collection
  process
• Oct 1, 2014 We make calls to all delinquent
  accounts where no payment has been made
• Oct 10, 2014 We send personalized letters to
  collection accounts.
• Oct 20, 2014, We send final collection letter
  (same letter to all accounts)
• Oct 31, 2014 we send any outstanding collection
  accounts to an outside agency.

23
Payer Aging Detail Report
24
Why is the claim still Open?

• There are only three reasons an insurance
• claim should be over 90 days old
• There was no response from the insurance company
  (happens a lot on secondary claims or paper
  claims)
• The claim was denied and never addressed
• There was a posting error on the account

25
Tools That assist in working our Aging Reports

• Scanning our Request Slips

26
Tools That assist in working our Aging Reports

• Websites we use daily
• Zirmed
• Promise (PA Medical Assistance Site)
• Navinet

27
Tools That assist in working our Aging Reports

• Zirmed
• Electronic Claims
• Credit Card Processing
• Electronic Payments
• Eligibility
• Medicare
• Blue Shield (Other than the local Blue
  Shield)
• Humana
• Miscellaneous Insurance

28
Tools That assist in working our Aging Reports

• Navinet
• Claims Status and Eligibility
• Local Blue Shield Plans
• Geisinger
• Aetna
• United Health Care
• Cigna

29
Tools That assist in working our Aging Reports

• PROMISE
• Pennsylvania Medical Assistance
• Claim Entry, Eligibility

30
In ClosingWhat I learned!!!!

• Aging has no bearing on the MB collection
  Process.
• 75 days is too long before they enter the
  collection process
• Our write off process is valuable and worth the
  time and effort
• The importance of alternating the aging of your
  receivables

31
QUESTIONS?