Medical Billing Ch. 15 Patient Billing and Collections Flashcards

9399778454	Account Ledger	Account Statement	0
9399778455	Accounts Receivable	Money that is flowing into a business	1
9399778456	Adjudication	A series of steps that determine whether a claim should be paid.	2
9399778457	Adjustment	Changes to a patients accounts that alter the amount charged or paid.	3
9399778458	Advisory Opinions	Opinion issued by CMS or OIG that becomes legal advice.	4
9399778459	Appellant	The person filing the appeal (provider or patient) aka claimant.	5
9399778460	Audit	A formal review designed to judge whether the practice complies with billing and coding regulations.	6
9399778461	Bad Debt	An account deemed uncollectible	7
9399778462	Balance Billing	Collecting the difference between a provider's usual fee and a payer's lower allowed charge from the insured.	8
9399778463	Bankruptsy	Legal declaration that a person is unable o pay his or her debts.	9
9399778464	Billing/Collections Manager	A physician, practice administrator, office manager, or collections manager that create and implement collections policies, and monitor results of collections activities.	10
9399778529	Bundled codes		11
9399778465	CCI Edits	Apply to medicare claims that bill for more than one procedure performed on the same patient; the same date of service.	12
9399778466	Claim Adjustment group code	Codes used by a payer on an RA to indicate the general type of reason code for an adjustment.	13
9399778467	Downcode	payer's review and reduction of a procedure code.	14
9399778468	bad debt	an account deemed uncollectible	15
9399778469	bankruptcy	legal declaration that a person is unable to pay his or her debts	16
9399778470	collection agency	outside firm hired by a practice or facility to collect overdue accounts from patients	17
9399778471	collections	the process of following up on overdue accounts	18
9399778472	collections specialist	administrative staff member with training in proper collections techniques	19
9399778473	credit bureau	organizations that supply information about consumers' credit history and relative standing	20
9399778474	credit reporting	analyzing a person's credit standing during the collections process	21
9399778475	cycle billing	type of billing in which patients with current balances are divided into groups to even out statement printing and mailing throughout a month, rather than mailing all statements once a month	22
9399778476	day sheet	in a medical office, a report that summarizes the business day's charges and payments, drawn from all the patient ledgers for the day	23
9399778477	embezzlement	stealing of funds by an employee or contractor	24
9399778478	Equal Credit Opportunity Act (ECOA)	law that prohibits credit discrimination on the basis of race, color, religion, national origin, sex, marital status, age, or because a person receives public assistance	25
9399778479	Fair and Accurate Credit Transaction Act (FACTA)	law designed to modify the Fair Credit Reporting Act to protect the accuracy and privacy of credit reports	26
9399778480	Fair Debt Collection Practices Act (FDCPA) of 1977	law regulating collection practices	27
9399778481	guarantor billing	billing system that groups patient bills under the insurance policyholder; the guarantor receives statements for all patients covered under the policy	28
9399778482	means test	process of fairly determining a patient's ability to pay	29
9399778483	nonsufficient fund (NSF) check	a check that is not honored by the bank because the account lacks funds to cover it; also called a "bounced", "returned", or "bad" check	30
9399778484	patient aging report	a report grouping unpaid patients' bills by the length of time that they remain due, such as 30, 60, 90, or 120 days	31
9399778485	patient refunds	monies that are owed to patients	32
9399778486	patient statement	a report that shows the services provided to a patient, total payments made, total charges, adjustments, and balance due	33
9399778487	payment plan	patient's agreement to pay medical bills over time according to an established schedule	34
9399778488	prepayment plan	payment before medical services are provided	35
9399778489	retention schedule	a practice policy that governs which information from patients' medical records is to be stored, for how long it is to be retained, and the storage medium to be used	36
9399778490	skip trace	the process of locating a patient who has not paid on an outstandingbalance	37
9399778491	Telephone Consumer Protection Act of 1991	federal that regulates consumer collections to ensure fair and ethical treatment of debtors; governs calling hours and methods	38
9399778492	Truth in Lending Act	federal law requiring disclosure of finance charges and late fees for payment plans	39
9399778493	uncollectible accounts	monies that can not be collected from the practice's payers or patients and must be written off	40
9399778494	The Financial Policy	A written document that both staff members and patients can follow: -Clear, thoroughly written -Explains pt responsibility -Signed by new pts -Explained to to employees & pts	41
9399778495	Financial Polices	Addresses all possible scenarios: -Financial arrangements and payment plans -Payments not covered by insurance -Various special circumstances	42
9399778496	Patient Financial Education	-Post signs -Hand outs (brochures/flyers) -Verbal discussions	43
9399778497	Patient Statements	Notices sent to patients explaining balance due via mail or email. -Automatically generated by PMP when insurance payments are done -Charges SHOULD be clearly itemized -Co-pay, deductible, co-insurance, non-covered services, fees (returned checks, missed appointments, forms)	44
9399778498	Cycle Billing	Type of billing that divides patients w/ current balances into groups to even out monthly statement printing & mailing.	45
9399778499	Guarantor Billing	Billing system that groups patients' bills according to the responsible party.	46
9399778500	Patient Accounts Receivable	Collections (Patient A/R) Balance = Nice (Patient Satisfaction) Mean (Cash Flow)	47
9399778501	Collections Specialists	Staff members trained in proper collections techniques. May receive bonuses for reducing patient A/R numbers.	48
9399778502	Reasons for Non-Payment	-Can't -Broke -Forgot / Don't feel like it -Dissatisfied -Misunderstand their obligations	49
9399778503	Embezzlement	Stealing by employees.	50
9399778504	Avoiding Embezzlement	-Divide up the work -Bond insurance against theft	51
9399778505	Consumer Collection Laws	The FTC enforces the FDCPA of 1977 and the TCPA of 1991. -NJ State / www.njconsumeraffairs.gov	52
9399778506	Fair Trade Commission	FTC	53
9399778507	Fair Debt Collection Practices Act	FDCPA (1977)	54
9399778508	Telephone Consumer Protection Act	TCPA (1991)	55
9399778509	FTC RULES	-1 Phone call per day -Between 8am - 9pm -No threats or profanity -3 voicemails per week (do not mention debt) -Identifiy the caller, practice & purpose of the call (no misleading patient) -Do not duscuss patient's debt w/ another person -If a patient requests no more calls, do not call (Instead, contact them via mail) -If a patient wants calls to be made to attorney, do not contact the patient directly again unless the attorney says to or can not be reached. -No Mail Postcards (duh)	56
9399778510	Collection Procedures	Medical office tracks overdue bills by reviewing the patient aging report. Each practice follows a different process for collections. -Current or up-to-date: 30 days (bill patient) -Past due: 31-60 days (reminder notice, phone calls) -Past due: 61-90 days (collection letters) -Past due: More than 90 days (turn over to collections)	57
9399778511	Patient Aging Report	Primary collections tool - Lists outstanding balances by length of time due	58
9399778512	Collection Ratio	Average number of days it takes to convert outstanding accounts to paid accounts. Lower = Better	59
9399778513	Phone Call Strategies	-Document all calls -Don't be robotic sounding -Don't use a script -Make calls in private -Maintain a positive & professional attitude -Never lose your cool	60
9399778514	Payment Plans	Patient's agreement to pay medical bills according to a schedule. Practices have guidelines for appropriate time frames and minimum payment amounts for payment plans. (Prepayment or past due balances)	61
9399778515	Equal Credit Opportunity Act	ECOA	62
9399778516	ECOA	Prohibits credit discrimination on the basis of: race, color, religion, national origin, sex, marital status, age, or because a person receives public assistance.	63
9399778517	Legal Reasons to Determine Credit Worthiness	-Income Amount -Expenses -Credit History	64
9399778518	Federal Truth in Lending Act	Applies to payment plans for over 4 installments or plans w/ finance charges/interest. Requires Signed disclosure -APR (annual percentage rate) -Finance Charge (in dollar amount) -Amount Finances -Total of Payments -Payment Schedule	65
9399778519	Collection Agencies	Outside firm (external company) hired to collect overdue accounts. Should be written into the financial policy. Cease all collection activities once collection agency takes over. -Most are paid a percentage of collected amounts. -Can buy unpaid accounts. -Credit Reporting	66
9399778520	Credit Reporting	Analysis of a person's credit standing during the collections process (3 bureaus who track debts)	67
9399778521	Skip Trace	Process of locating a patient who has an outstanding balance	68
9399778522	Tracing a Debtor	-Contact the post office -Search telephone directories for relatives -Search the web at one of the free person-finding services -Examine publicly available state & federal records for contact info.	69
9399778523	Uncollectible Accounts	Money that can not be collected and must be written off. -Small Balances -Old Balances -Very Poor Patients -Write Off Balances Classified as "Bad Debt" -Means Test It is fraud to write off balances for patients who do have the ability to pay	70
9399778524	Means Test	Process of fairly determining a patient's ability to pay.	71
9399778525	Patient Dismissals	Telling the patient they can no longer come to the practice. Dismissal Reason Examples: -Non-payment -Not Following Medical Instructions -Lying -Becomes Violent	72
9399778526	Patient Dismissal Requirements	-Send a certified letter -Give 30 day notice -Provide referrals to other doctors -Be Tactful	73
9399778527	Bankruptcy	A legal declaration of a person's inability to pay their debts.	74
9399778528	Fair Credit Reporting Act	FCRA	75
9399778530	Patient billing and collections, last step in billing and reimbursement process involves:	- Generating and mailing patient statements showing patient balances owed. - Posting patients' payment' - Examining aging reports for patients' accounts & handling collections	76
9399778531	Patient Financial Responsibility - defined in the Financial Policy of the Medical practice - they address all scenarios including:	- financial arrangements & payment plans - payments not covered by insurance - various special circumstances	77
9399778532	Policies should handle:	- collection of copayments, deductibles & past-due balances - financial arrangements for unpaid balances - charity care or use of sliding scale for those w/ low incomes - payments for services not covered by insurance - prepayment for services - day-of-service discounts/ discount to those in financial need - acceptance of cash, checks, money orders & credit or debit cards - special circumstances for auto accidents & nonassigned insurance	78
9399778533	Effective patient billing includes:	educating patinets from the start of the billing & reimbursement process.	79
9399778534	Patient Information Form	often presents a statement about payment responsibility (see pg 563)	80
9399778535	Encounter to Claim amount due process	Patient Encounter visit charges (transactions) entered in patient ledger patient's balance is updated claim is filed resulting payment from patient's insurance carrier is posted, based on the RA/EOB	81
9399778536	Resulting info. from RA/EOB	1. payer's payment for each procedure is entered 2. Amount patient owes for each reported procedure is calculated 3. If any part of a charge needs to be written off d/t payer's required adjustment, this amount is also entered.	82
9399778537	PMP uses the RA/EOB information to	update the day sheet and patient ledger	83
9399778538	Day sheet	report summarizing the business day's charges and payments (recorded in the PMP)	84
9399778539	Patient Statements	printed bills that show the amount each patient owes; computer generated from day sheet and patient ledger / both of these records have screens in the Practice's PMP	85
9399778540	Patient Ledger Cards	manually generated bills that show the amount each patient owes;	86
9399778541	Patient statements must be:	accurate and easy to read... clearly stating: - general info about the practice - cost breakdown of all services provided - date of statement & due date of payment (sometimes) - balances owed - Accepted methods of payment Clear and accuracy ensure patients pay on time	87
9399778542	payment Cards	accepted from patient at time of service... patient then receives a zero balance statement	88
9399778543	Guarantor Billing	grouping patient billing under the insurance policyholder. i.e. all of the family's recent charges can be categorized and sent together on one statement. (good for families w/ minor children)	89
9399778544	Cycle billing	used to assign patient accounts to a specific time of the month and to standardize the times when statements will be mailed and payments will be due. i.e. if cycle is weekly, the patient accounts are divided into four groups / 1/4 of the bills go out each week.	90
9399778545	Advantages/ Disadvantages of Guarantor Billing	- reduces amt. of time & $ spent on billing by reducing paper & mailing costs & reducing time spent on billing follow-up for those w/ overdue bills; fewer bills to track - Can become difficult & cumbersome when family members have various health plans and / or secondary plans	91
9399778546	Collections	all the activities related to patient accounts and follow-up; they should achieve a suitable balance between maintaining patinet satisfaction & generating cash flow	92
9399778547	Billing Collectors may have these job functions:	- Billing / collections manager - patient account representative (bookkepper) - Collections specialist	93
9399778548	Billing / Collections Manager	- responsible for establishing office policies & enabling collections specialists to successfully perform their jobs. Create, implement, monitor, organize & develop, assist with, train, supervise & evaluate all that has to do with collections.	94
9399778549	Collection Specialists	staff member with training in proper collections techniques, trained to work directly with the pratice's patients to resolve overdue bills. Must always act ethically, professionally... they represent the practice.	95
9399778550	Embezzlement	stealing of funds by an employee or contractor - Dividing collections tasks among several people with helps reduce chances of employee errors or embezzlement	96
9399778551	Avoiding opportunities for fraud	dividing tasks and responsibilities among several different people	97
9399778552	Fair debt Collection practices Act (FDCPA) of 1977	laws regulating collection practices Regulated by the Federal Trade Commission	98
9399778553	Telephone Consumer Protection Act of 1991	law regulating consumer collections to ensure fair and ethical treatment of debtors Regulated by the Federal Trade Commission	99
9399778554	Collections from patients are	1. classified as consmer collections 2. regulated by federal and state laws	100
9399778555	FTC Guidelines outlined in FDCPA and Telephone Consumer Protection Act:	- contact patients 1x/day only; leave no more than 3 messages per week - do not call before 8am or after 9pm - do not threaten or use foul language - identify the caller, practice & purpose of call; don't mislead the patient - don't discuss debt with anyone but patient - no messages or emails detailing the debt owed - contact via email if patient requests calls stop - make calls to attorney if patient wishes,	101
9399778556	patient aging reports	- contains patient's name - most recent payment - remaining balance DIVIDES information into categores based on each statement's beginning date: 1. Current or up to date (36 days) 2. Past Due (31-60 days) 3. Past Due: (61-90 days) 4. Past Due (90+ days)	102
9399778557	Claims Under Appeal	denied claim that's being appealed may not convert the account to 'past-due' status until the final appeal decision has been received.	103
9399778558	Each practice sets its own procedures for collections process.	30 days.............bill patient 45 days.............call patient regarding bill 60 days.............letter 1 75 days.............letter 2 & call 80 days ............letter 3 90 days..............turn over to collections	104
9399778559	Collections Letters	professional courteous, breif & to the point; Letter is first notice that their bill is past due. Gradually become more aggressive in wording.	105
9399778560	Methods of Collections	Collections Letter (s) Collections Calls Documentation (specialists use abbreviations for common call results & situations)	106
9399778561	Credit Arrangements & Payment Plans	Two federal laws govern payment arrangements: 1. Equal Credit Opportunity Act (ECOA) 2. Truth in Lending Act	107
9399778562	Equal Credit Opportunity Act (ECOA)	prohibits credit discrimination on the basis of race, color, religion, national oirgin, sex, marital status, age, or because a person receives public assistance. (enforced by FTC)	108
9399778563	Truth in Lending Act	law requiring disclosure of finance charges and late fees for payment plans;	109
9399778564	Payment Plan	A practice may decide to extend credit to patients thu a PAYMENT PLAN that lets patients pay bills over time, rather than in a single payment.... practices may charge interest on these plans... terms must be agreed on by both parties.	110
9399778565	Truth in Lending Act as it applies to Payment Plans	all terms must be disclosed and agreed upon before arragnement is finalized. If interest charged, or 4+ payments to be made plan is governed by TRUTH in LENDING ACT... part of the consumer Credit protection Act.	111
9399778566	Credit Counseling & Debt Management programs	nonprofit organizations that can assist patients who are struggling to pay their bills or who have a great number of different bills; they contact creditors to work out payment plans at reduced costs to patients.... only 1 monthly payment made & then divided among creditors as agreed.	112
9399778567	Payment Plan Design	practices have guidelines for appropriate time frames and minimum payment amounts for payment plans.	113
9399778568	prepayment Plans	payment before major expensive procedures are performed... downpayment made & then monthly postpayments set up.	114
9399778569	Collection Agencies and PHI	agencies must agree to follow practice's security & privacy policies to protect patients' PHI. - Employees of Coll. Agencies must sign confidentiality agreements regarding PHI	115
9399778570	When to Use a Collection Agency	- All attempts to contact patient have been unsuccessful & patient hasn't responded to letters or calls - patient says they won't pay a bill - bad check for lack of funds - defaults on payment plan - outdated patient contact info./ can't be located - patient receives payment for service from insurance company & hasn't paid provider	116
9399778571	Notice of Privacy Practices (NPP)- and Collections	explains practice's policy on when accounts are sent to an outside collector.	117
9399778572	Collection Agency....	be careful choosing... they represent the Practice. Choose a fair, ethical agency. ; Cost efficient way to retrieve some/all unpaid balances to cover some of practice's fees.	118
9399778573	Types of Collection Agencies	Local, regional or national scale; Local or regional understand patient's demographic surroundings National has more tools to locate/contact debtors, often at lower cost	119
9399778574	Credit Reporting	analysis of a person's credit standing during the collections process.... supplied by credit bureau for a cost.... shows record of unpaid bills/debt regulated by law under the Fair Credit Reporting Act (FCRA) and the Fair and Accurate Credit Transaction (FACTA)	120
9399778575	Credit Bureaus	organizations that supply information about consumers' credit history	121
9399778576	Fair Credit Reporting Act (FCRA)	law requiring consumer reporting agencies to have reasonable and fair procedures	122
9399778577	Fair and Accurate credit Transaction Act (FACTA)	laws designed to protect the accuracy and privacy of credit reports. Amended FCRA in 2003.	123
9399778578	FCRA and FACTA	designed to protect privacy of credit report information.	124
9399778579	Red Flags Rule	law stating that health care entitles must estabilsh reasonable policies and procedures for implementing the identity theft guidelines.	125
9399778580	Examples of red flags	alerts or warnings from consumer reporting agencies, suspicious personal identifying information and documents (photo ID),	126
9399778581	Skip Tracing	process of locating a patient who has an outsanding balance.	127
9399778582	Methods of Skip Tracing	Tracing a Debtor (practice searches) Professional Skip Tracing Assistance (for large practices) Computerized Skip Tracing (online directories & databases- less expensive) Effective Skip Tracing Calls	128
9399778583	Bad Debt	Patient Account deemed uncollectible...	129
9399778584	Uncollectible Account / Write-off account	monies that cannot be collected and must be written off / practice must determine which debts to write off in the PMP and whether to continue to treat the patients.	130
9399778585	Means Test	process of fairly determining a patient's ability to pay... patient fills out a form and their income tax forms are reviewed, along with credit reports.	131
9399778586	Bankruptcy	declaration that a person is unable to pay his or her debts / another reason for write-off.	132
9399778587	Dismissing patients who do not pay	physician has the right to terminate the physician-patient relationship for any reason under the regulations of each state.	133
9399778588	Patient Refunds	money that needs to be returned to patients when the practice has overcharged a patient for a service;	134
9399778589	Patients' refunds or credit balances	are handled differently than insurance overpayments, which must be refunded to the payer.	135
9399778590	Retention Schedule	protects both the provider & the patient; record must be available for anyone within or outside of the practice who is caring for the patient. - kept in case of legal proceedings	136
9399778591	Practice Briefs	American Health Info. Management Assoc. publishes guidelines called practice briefs on many topics including retention of health information.	137