Patients Balances

[jyoung65]

Hello,

It is me again. Can someone please tell me what is the process of  patient balances? How many statements do you send them? How offten do you send them? If no response after you send the statements, what is the next step? Thanks!

[DMK]

There will be a lot of opinions on this.

IDEALLY you collect co-pays and deductibles at time of service but there will always be patients to bill.

I try to get my statements out (and I mean IN THE MAIL) on the 1st of the month.  My statements say "due on receipt" because by the time we've billed insurance, insurance responds, and statements are printed, a month has passed.  I have found that we get paid more timely when I get the bills out on the 1st because we have so many state workers who get paid on the 1st.  You may find that the 15th works better as less bills are due in the middle of the month and people generally get paid every 2 weeks. 

Our intake form let the patient know they have ONLY 90 days to pay balances.  Nowadays nobody cares when they pay their bill and the doctor is almost ALWAYS the last to get paid.  I don't stamp "PAST DUE" on the bill until the 3rd statement with no payment received.  If they're at least paying some, I'm grateful and not snotty about it.  I write "Thank You!" next to the payment on the statement.  If they come in for treatment I try to collect something while they're there.  We're very lucky that we have great patients who pay their bills.  I usually only have about 10 past due patients per month.  I will write a note explaining why they are receiving a bill (co-pay, deductible, non-covered) and send a copy of the EOB. 

I write off about 10 accounts per year.   They have a note in their file that they have to clear their balance prior to any further treatment.

I know that most offices will send to collections, but we are in a small town and the bad press isn't worth it.  It's not good business, but not worth the hassle (usually the balances aren't big, and they usually need the doctor at some point).

It's a sad truth that most people think if they have insurance they don't have to pay.  So new patients need to know what their portion will be (approximately) when they begin treatment.  So no surprises.

The next wave of trouble to hit the medical profession is going to be the concept of "Free Health Care".  It's not free and never will be free.  Neither to provide nor receive.  The public is badly misinformed about what's coming.

I will be very curious to see how others handle this topic!  I would love to have 100% collections, but somehow I don't see that happening.

[PMRNC]

DMK answered you so on the money I can't think of anything to add.. LOL

[jyoung65]

Thanks Linda!

[Michele]

I think most handle things like DMK does.  The only thing I would add is that we try to make sure the patient statements are very clear as to what they are being billed for and why.  They are more likely to pay if they understand the bill and can recognize that it is their responsibility, not still out to insurance.  Also, we send initial bill, then a "friendly reminder" then a final notice.  Many of our providers drop it prior to collections if it's a small balance (under $50 not worth the effort) or a concern about bad publicity.

[DMK]

And I'm going to hop on my soapbox over this issue again.  What other industry has to write off for services that WERE performed?  The doctor was there, performed the service, billed appropriately, and waits in good faith to get paid.  The patient thinks "Oh he's a rich doctor, he can write it off".  How is ANYBODY getting rich when they don't get paid for their work?

Most doctors are in the profession to help people.  Most doctors are very compassionate.  And most doctors don't get a salary from someone else, they are in business and their "salary" is when patient's pay their portion of the bill.  It may only be a $20 co-pay, but if 10 people don't pay that's $200.00 and that's the power bill for the month.  The average joe (and that's me as staff) can't afford a $200 hit every month, I still have to pay the power bill.

Whew!  Cranky much?  I think I will forego the 2nd cup of coffee and go put my head down for a minute!

[PMRNC]

There is one thing to remember when dealing with patient collections.. there are some states that will require a surety bond EVEN if your not collecting the payment. Some states require it for those services ACTING as a collection agency. Also you still have to follow FDCPA Fair Debt Collection Practices Act. For example, you are supposed to follow state guidelines with regards to interest, finance charges, etc and also statement (with initial communication) have to have the Mini Miranda present on them:  "This is attempt to collect a debt.....  this is section 800 / 11 found here:    http://www.debt-collection-laws.com/FDCPA/807.html

What I did was make sure that's on all my statements.  There is another biggie ..YOU cannot threaten collections or even vaguely say "we will be forced to seek further collection attempts"  If you threaten.. you must follow through. For example if you tell a patient that they have 10 days to send in the money or the account will be forwarded to a collection agency, that debt better be in the hands of a bonded collection agency on that 10th day!  At 90 days my client is given a report with all the accounts past due from patients and my recommendation. If they choose to send it to collection, I flag the account, set the date for it to be sent and the patient receives that 10 day notice at that point since I have the green light from the client.  The dunning message with the Mini Miranda is also on all of my statements.  A lot of billing companies don't know all this because they believe it only applies to collection services, and that's not true in many cases in some states. You have to know your state laws and remember that if the state law is stricter than the federal regs the state will supersede.

[DMK]

Perfect Linda!  Don't ever THREATEN collections if you have no intention of following through.

[Michele]

Yes very true.  Sorry I didn't mean to imply that it was ok to do that.  Just wanted to mention that you should take into consideration the size of the bill and if you will follow thru.  And DMK you can get on your soap box anytime, just move over to make room.  I'm not a dr or a dr's wife, but I know enough of them to know they work for their money and they get taken advantage of often because they are a "Dr". 

[PMRNC]

That's why I have a procedure in place for past balances and it's in place PRIOR to when we have to make that decision to send to collections, the provider gets a special report of all accounts coming up to "possible collection status" and he makes final decision on Yes to send it, no not to send it, or not send it and give extra time, offer payment plan, etc. Michele is correct the balance amount is taken into great consideration along with other factors such as costs to collect, feasibility of collection, regular visiting patient vs. not regularly seen, etc. The office should have a good financial policy IN place you can refer to and follow consistently and that helps avoid confusion, breaking of any FDCPA regs and it helps the provider stay fair to all patients and of course makes my job MUCH easier   When I sign on a client.. I REQUIRE the following aside from account setup:   Office policy, authorization to review all Policies & Procedures, compliance, financial policy, carrier fee schedules and contract copies when possible. I think all billing companies have to require these.. you can't do your job efficiently unless your clients office is running efficiently or it's a missing link and you end up with questions on how to do just about everything.