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Account
A statement of transaction during a fiscal period and the resulting balance.
Account receivable ledger
A record of the charges and payment posted on an account
Disbursements
funds paid out
Fiscal agent
an organization under contract to the government ( as well as some private plans) to act as financial representatives in handling insurance claims; also known as fiscal intermediary
Payable
Balances due to a creditor on an account
Receipts
Amounts paid on pt accounts
Receivables
Total monies received on accounts
Transaction
An exchange or transfer of goods, services, or funds
The MA is responsible for informing the pt about what type of info
Financial matters, billing insurance companies or other third-party payers, and making payment arrangements
What are the three commodities the physician should sell
Time
Judgement
Service
What does a physician agree to under a managed care contracts
to accept predetermined fees for specific procedures and services instead of the fee for service method.
What determines a physician’s fees
The economic level of the community
What drives pt away
interestingly, fees that are too low
Defined the Usual of the UCR
the physicians usual fee for a given service; the fee most frequently charged for the service
Defined the Customary of the UCR
A range of the usual fees charged for the same service by physicians with similar trianing and experience
Defined the Reasonable of the UCR
The fee for an exceptionally difficult or complicated service or procedure that requires extraordinary time or effort by the physician
When working under a managed care plan doctors agree to what??
– Fee setting by thrid-party payers
– Physician’s fee profile
– Insurance Allowance
A third-party payer may provide what??
A schedule of predetermined fees
Some third-party payers require _______ of the fee vefore service is renderedm and some require _______ before paying for certain services.
preapproval, precertification
How does the physician fee profile is established??
when the fiscal agent keeps a continuous record of the usual charges been averaged over a given period, usually a year thats been complied
When should you charge the full fee??
Always first, with the understanding that after the insurance allowance has been received, the balance may be discounted or adjust
If a smaller fee is quoted and charged at a discount, what can happen??
– the lower fee can alter the physician’s fee profile
– The insurance allowance may be reduced
– Reducing fees and adustments for professional courtesy may violate the physician’s agreement with the third-party payer and could be considered fraudulent.
The first step in discussing financial issues is to make sure the conversation is held
Out of hearing range of other pts
Never sidestep payment issues by saying
Dont worry about the bill; lets just get you well first
Have stated policies for the office
so each pt is the same
How should the estimate slip be prepared??
in duplicate so that the patient has a copy
What are the importants of a Fee estimate slip?
– documents that a fee was quoted
– helps eliminate the possibility of misquoting the fee later
– simplifies collections by preventing misunderstanding and confusion over charges
Who is the person ultimately responsible for the entire bill??
Guarantor
Why is it ture the staff should be actively assistanting pts with their problems payment??
– First, the staff is almost always more knowledgable about the insurance business than the patient.
– Secondly, helping the patient secure payment means that the physician will be compensated for his or her services.
Always be sure to secure who in writing??
Guarantors
What are encouter forms??
The slips attached to charts while the patient is in the office
What is not recommened to charges??
Late, no show pts or telephone calls
Current charges and payments for the visit are added _______ the physician sees the pt??
After
Which colored copy of the encouter form should be kept in the pts records
White
Which colored copy of the encounter form should be giving to the pt
yellow and pink
Define transaction
is the occurrence of an event or of a condition that must be recorded.
What are the four stage process fo Accounting
Recording, classifying, summarizing, and interpreting financial statements
Bookkeeping is the recording stage of what?
Of accounting
A pt’s financial record is called what?/
an account
What three figures that are on the account ( or ledger)??
-Debit entering charges also called charge columm
– Credit which is sumtimes headed Paid or Payment and is used for entering payments received on an acct
– Balance column this column is used to record the difference btwn the debit and the credit column
An adjustment column is used for what??
to enter professional discounts, write-offs, disallowances by insurance companies, and any other adjustments.
Define posting
is the transfer of information from one record to another
Whats normally a debit balance, which means, that the charges exceed the payment on the acct??
The account balance
What is a Credit balance
exists when payments exceed charges ( when a pt pays in advance)
Defined receipts??
cash and checks taken in payment for professional services
Define Receivable?
are charges for which payment has not been received; that is, amounts that are owing.
Defined disbursements
are cash amounts paid out
Defined Payables
are amounts owed to others but not yet paid
What is computerized system??
reduces the time needed to balance the day sheet and the totals for monthly and YTD balance.
When checking out a pt using a pegboard system, what should the MA do??
insert the ledger card under the proper receipt and check the number precviously entered to make sure the correct card is being used
How can payments be recieved??
by mail or brought in by the pt
Special bookkeeping entries may be performed either with a pegboard or a computer accounting systems which includes??
– Adjustments
– Credit balances
– Refunds
– Insufficient funds checks
If a pt or guarantor files for bankruptcy what to do with the charges??
be adjusted off the books
When does a credit balance occurs??
when a pt has paid in advance or an overpayment or duplicate payment is made.
What is a credit balance??
money owed to the pt
What to do if a pt wants to have an overpayment refunded??
write a check for the amount due and enter the transaction on the day sheet.
If the pt send a check without having the sufficient funds to cover the cost what will happen??
the bank will return the check to the medical facility marked NSF
What are the two accounting functions must be performed when a NSF check sent back to the office??
– deduct the amount of the check from the practice’s checking account balance
– add that amount back into the pts account balance.
What does the accounts receivable controls??
a daily summary of what remains unpaid on the accounts
Payment for medical services is accomplished in the following four ways.
– Payment at the time of service
– Billing after making payment arrangements
– Insurance or other third- party billing
– Billing and collection assistance
When should pts without health insurance pay??
after the charges for the day have been totaled
What should the MA say to a pt who asks to be billed??
Our normal procedures is to pay at the time of service unless other arrangements are made in advance
The MA should believe that the physicians have the right to ____ for the services procided
Charge
When soes physicians prefer payments?
before or at the time of service
The truth in lending act states what??
If an agreement exists btwn physician and pt that provide a disclosure statement about finance charges.
What doesFair Debt Collection Practices Act do??
requires that debt collector act fairly in their collection efforts; it also restricts how and when a person can be contacted about an outstanding debt.
Billing can be accomplished using the following
-Computer-generated statements
– Encouter forms
– Photocopied or scanned statement
– Online billing statements
Why should the envelopes be imprinted Address Service Requested??
to maintain up-to-date mailing lists
A self-address return envelpe include with the statement is convenient for what??
the pt and encourage prompt payment
what are the advantages of cycle billing
it prevents once a month peak workloads and cash flow
What are sum factors tht prevent pt paying their medical bill??
-the pt may lost a job or insurance coverage
– An emergency could arise that depletes finances
What are some problems with collection procedures??
– MA fails to get the insuracne info
– Insurance forms are not completed correctly
– Minor errors such as failing to name the responsible party or omitting accurance numeric info
The offer of a discount should be made in writing, with insertion of the words??
without prejudice, and a definite time limit for making payment should be stated.
When a fee should never be reduced??
– on the basic of a poor result or
– as a means of obtaining payment to avoid the use of a collection agency
What does persuasive collections includes??
Telephone calls, colllection reminders and letters, and personal interviews
A bill less than 30 days old might need what??
a friendly call or reminder letter
A bill over 120 days may need what??
A final letter to encourage payment before the acct is turned over to a collection agency
Truth in lending Act is also know as what??
Regulation Z which is enforce by the federal trade commission and is part of the consumer credit protection act
What does the Consumer Credit Protection Act requires??
that individuals be given certain information when credit is extended, such as the annual percentage rate (APR), the terms of the loan, and the total costs to the borrower.
Credit information is what??
Confidential
When should you access a credit report of a pt??
if its necessary to process an application for credit privileges at the medical facility
Insurance billing in the medical office is a _____ to pt??
courtesy
Billing can be accomplished using the following??
– computer-generated statement
– encouter forms
– photocopied or scanned statement
– online billing statement
How often should statements be sent??
once each month
Once a month billing should reach the pt when during the months??
the last day of each month and preferably b4 the 25
What are the advantages of statement cycles??
– it prevents once a month peak workloads
– stabilize cash flow
Cycle billing allows the medical assisant to do what??
continue all routine duties each day, handling the statements on a day-to-day or weekly schedule rather than in one intentsive period at the end of the months
What is not determined how the physician chareges??
the pt ability to pay for the service
What are sum reasons why a pt could not pay the fee??
– lost a job or insurance coverage
– Emergency could arise that depletes finances
How can a collection problem arise??
if the medical assistant fails to get the necessary insurance information
What should the MA learn about to help indigent pt??
local organizations and agencies that aid pt in obtaining the necessary assistance.
What is the only deviation when keeping an record that will not be paid??
the financial record indicates no charge (n/c) in the debt column
Before adjusting or canceling a fee what should the MA do??
find out whether the pt is entitled to any funds for medical care or an insurance settlement of some kind
You should make the fee reduction the______?
exception rather than the norm
What should the student MA never expects??
to be treated while serving in an externship
When should a minor be responsible for a medical bill??
when emancipated
If the pt parents are separated or divorced who is responsible for the bill??
the parent who brings the child in for treatment
What is aging??
when some acct are grouped together according to the dates of the LAST PAYMENT activity
What are the DOs in general rules for telephone collections??
– call btwn 8am-9pm
– never repeat and repeat collection calls from a physician office
– Try to get a difinite commitment
What are the DON’Ts in general rules for telephone collections??
– do not call btwn 9pm and 8am
– do not make repeated telephone calls
How should a letter be presented to be effective in collection of a fee??
a friendly request for an explanation of why payment has not been made.
How can a MA sign a collection letter??
as Medical Assistant or Financial Secretary
What should the MA should not write under the pt name on a letter??
Collection
What helps the MA to come to an understanding of the problem more quickly, and an agreement about future payment plans can be reached??
Talking to a pt face to face
How can you consider a acct as a “skip”??
when a statement is returned marked “Moved– no forwarding address”
When should the MA responsed to a Skip statement??
Immediate
What is a vable tool in tracing skips??
The internet
What ae sum suggestions for tracing skips??
– Examine the pts original office registration card
– make a few discreet calls to the references listed
– check the internet to secure the names and telephone numbers of neighbors or the landlord
– checkt the debtor’s place of employment for information
– do not communicate with a third party more than ONCE
What is forbidden by law concerning tracking skips??
communicating with a third party more than ONCE
What can a courtesy dictates reguarding a bill owe by a deceased pt??
that a bill not be sent during the initial period of bereavement, but do not delay longer than 30 days.
What is a excutor??
the person responsible for settling the affairs of the estate.
When is a will generally filed?/
within 30 days of a death
Once a billed been sent out for a balance owe and theres no response is received in to 10 days what should the MA do next?
contact the executor or the county clerk where the estate is being settled and obtain forms for filing a claim against the estate.
What is a Chapter 7 bankruptcy??
usually is a “no asset” situation
What is a Chapter 13 bankruptcy??
the pt-debtor pays a fixed amount to a trustee that is agreed upon by the court
What is Chapter 13 also known as?
wage-earner bankruptcy
Reguarding the chapter 13 bankruptcy what should the MA field if a pt filed bankruptcy??
a credit claim with court or write
The MA using the outside collection services for what??
payment of medical services
The creditors can charge what percentage to collections?/
40% and 60%
When do the office makes no further collection attempts??
after an acct has been release to a collection agency
A acct must be what percentage of loss to the physician b4 legal proceedings are started??
100%
Remember never to threaten to ________ legal proceedings unless the physician is prepared to carry out the threat and has decided to pursue legal action
Instigate
Litigation to collect a bill generally is in order when the following are true.
– pt can afford to pay without hardship
– pts general condition after treatment is satisfactory
– defendant is legally liable for the services rendered to the pt
– the statute of limitationns has ruled out any possible malpractice action
Many medical practices find the small claims court how??
a satisfactory, inexpensive means of collecting delinquent accts
If the court awards a judgement for the amount owed, the plaintiff in a small claim court may also??
recover the costs of the suit

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