Wednesday, July 13, 2011

Patient Billing

Billing your patients for uncollected co-payments, deductibles, and self pay services is always a delicate matter.   Too much of a strong-arm approach can turn off patients and may prompt them to seek services elsewhere.  Allowing large uncollected patient debt can have a significant impact on your practice revenue.

Co-payments are automatically deducted from the physicians reimbursement and are required by the commercial insurers as part of the patient's participation in their health plan.  All co-payments should be collected at check-in rather than check-out.  Patients will avoid paying their co-payments whenever they have the opportunity and will duck out without even making a return appointment in order to avoid doing so.   Your policy should be that co-pays are made before services are rendered.  Your confirmation calls for appointments must remind your patients to bring their insurance cards and any applicable co-payments to their visit.  If you have a patient who does not bring their co-payment, they should be given a postage paid envelope addressed to your office and encouraged to write a co-payment check as soon as they arrive home.   Your daily data sheet should have a comments section that lists a clear reason for non-payment of the office co-pay and these listing should be reviewed by management each day.

Many practices find themselves sending out the statements for co-payments to the same patients month after month, with little or no response from the patient.  The mailing costs for sending multiple statements often end up exceeding the original co-payment amount and is clearly a waste of time and money.  Any patient who fails to reimburse the office after sixty days should receive a reminder phone call from the billing department reminding them of their co-payment obligation.   You may want to remind the patient that the co-payment is automatically deducted from the physicians reimbursement.

Unfortunately, sometimes even the best efforts cannot prompt a patient to fulfill their obligations.  At this point the billing manager must decide that this amount be declared as "bad debt."  You will want to make some notation in the patient's demographics or in the chart stating that this patient must be urged to present with their co-payment at all future visits.  Including a personal note with the monthly statement may also serve as an additional reminder.  In all cases, personal contact with patients regarding lapsed co-payments must be conducted in private with a sense of professionalism and courtesy.  Patients who do not respond in kind should be referred to the billing manager.  It will be up to you to decide if the patient who is chronically a non -payer should remain in your care.  You should speak to the patient to ascertain whether or not there is a legitimate hardship on a case by case basis.  Patients who claim hardship are required by CMS to have a letter on file stating the reasons they are not able to fulfill their obligations.  You will want to note "hardship" somewhere in the patient notes so that these patients are not asked for payment at future visits.

It is always a good idea to assign one member of your staff to act as a liaison to Medicare and to place them in charge of outstanding Medicare claims.  This staff member will also keep the practice current on any changes in Medicare billing and reimbursements as well as preparing appeals for rejected claims.  In cases where the practice has a limited number of Medicare patients, this employee may also be assigned to assist with commercial and patient account reconciliation.

Practices that have not yet converted to an EHS system will also require dedicated employees for charge entry and payment posting, including the downloading of any electronic payment transfers.  The billing manager can share responsibility for charge ad payment entry as well as making a careful examination of all explanation of benefits.   In most cases, practices that do utilize electronic records will have charges automatically entered into the system as the physician concludes his patient visit or at the end of daily office hours.  Charges will, however, still need to be checked for accuracy and to assure that each patient has the appropriate set of charges for services rendered.  As mentioned in previous chapters, practices utilizing electronic records must guard against having their systems choose the level of billing.  As with traditional charge entry, the employees in the billing department will have a different set of responsibilities but still remain an integral part of the practice service.   This is also true for traditional payment entry positions.  Although more practices are obtaining reimbursement via electronic fund transfers, the explanation of benefits for these payments will still need a thorough analysis.  The employee originally responsible for payment posting will not be responsible for downloading the transfers and assuring that patient ledgers are correctly credited.

Your billing manager will be responsible for the supervision and evaluation of your billing staff.  In addition, this employee will also oversee both the efficiency of the front desk in obtaining referrals and pre-certifications and as the tasks relate to the preparation of the daily billing packages.  They will also receive the completed billing package each day and assign the charge entry or electronic appraisal to the staff.  Having your billing manger also function as the oversight for the front office will guarantee that no charges will be entered without the necessary related paperwork and authorizations.

Centralize your billing department in an area away from the front desk, keeping HIPAA policies for privacy in mind.  All daily packages, including cash and checks should be returned to this location each day.  Multiple location practices may choose to utilize either a messenger service or a staff member who travels between locations to handle this responsibility.  Some physicians choose to make their bank deposits themselves, but this task is most often assigned to the administrator or billing manager.

Tomorrow :  Your Chain of Command

1 comment:

  1. Really impressive article. Thanks for sharing.

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    Medisoft

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