Patient Collections - Part 2

In my last post I discussed how often to run patient statements, how to mark the statements so the patient knows you are keeping track and what kind of letters to send before turning the account over to collections.  If you would like to refresh your memory or you haven't read Patient Collections - Part 1, you can find it here.

Once you have printed your statements and letters, stamped them and sent them your work is still not done!  Tracking what you have done and trying to contact the patient by phone are two very important ways to ensure that you are making every attempt to collect before having to resort to turning an account over to collections.

TRACKING
Something that I do in order to keep track of how many statements and letters I have sent to each patient is to print out a report of all the patients that owe money and how much they owe.  This is called a patient accounts receivable or patient aging report.  How you mark this report is up to you.  I am all about color coding, so when I am sending statements you will find my desk covered in papers and highlighters.  I highlight all the past due patient names purple, the first letter names green, the final letter names blue and the collections patients pink.  It doesn't matter what colors you choose as long as your color key is consistent each month.  Tracking on a report is important, but even more important is tracking on your computer system.  Each time you send the patient a past due statement or a letter you need to put a note in the patient's account.  I would also advise that you flag the account with a pop-up note indicating that the patient has a past due balance.  That way if the patient comes in for an appointment or calls to schedule one, the front desk will see your note and try to collect from the patient prior to the appointment.  At my office the pop-up notes alone weren't grabbing the front desk staff's attention, so I found a way to make the entire screen bright green when a patient has a past due balance.  Do whatever you need to do to make it noticeable.  Just don't forget to change it all back when the patient finally pays their bill.

PHONE CALLS
Last but not least I want to give you some advice about phone calls.  I would recommend that you make at least one attempt to call the patient before turning their account over to collections.  On the off chance they aren't getting their mail or they simply need a verbal reminder, a phone call might just do what three or four months worth of statements could not.  When you call a patient with a past due balance it is important not to speak to them in an accusatory tone.  Be friendly but firm.  For example, you can say, "Hello Mr. Johnson, my name is ____ and I'm calling from __ _.  How are you doing today?  Good, glad to hear it!  The reason for my call is that you have a past due balance of $150 and we have sent several statements and a letter.  I want to make sure you have been receiving our correspondence."  This will make the patient think you are just checking in to make sure they received their bill, which is not accusing them of not paying the bill and therefore will usually prevent the conversation from going south.  As long as you keep it going in this tone, you should be able to resolve the matter by the end of the conversation.  Usually the patient will tell you they've been meaning to pay the bill but just haven't gotten around to it, in which case you can offer to take their credit card number over the phone.  Or they might tell you they didn't receive any of your statements.  If so, confirm their address and offer to fax or email the bill to them.  If they tell you they did receive the bill but can't or don't want to pay it for whatever reason, this would be the time to mention that their account is scheduled to go to collections soon and you would rather resolve this with them before it comes to that.  Offer them a payment plan if necessary or tell them you can give them a discount if they pay today.
If the patient doesn't answer the phone when you call and you need to leave a voicemail message, it's extremely important that you do not leave a detailed message unless the patient has previously indicated that it's okay.  In the interest of not saying something that could be considered a HIPAA violation, it would be best if you leave a vague message that sounds like this.  "Hello, this message is for Mrs. Brown.  My name is             and I'm calling from                   to discuss a personal business matter.  If you could please return my call as soon as possible, I would appreciate it.  My number is                  .  Thank you and have a nice day!"

The last thing I would like to mention is this.  If after all your efforts you still need to turn accounts over to the collection agency because the patient never paid their bill, don't feel bad.  Some patients are just plain irresponsible and or indifferent.  The important thing is to have a policy in place for collections patients who try to return to the office.  Will your office let them continue to be seen at the risk of having to go through this process with them all over again?  I certainly hope not.  I would advise that you either tell them they can no longer be seen at your office or tell them they have to pay up front as a cash patient from now on.  One way or another, make sure you have a policy in place and that you communicate this policy to the patient preferably before sending them to collections.  Because...

 

Patient Collections - Part 1

Patient collections is a very important part of the medical billing process.  It doesn't always end when a claim gets processed by insurance.  If the patient also owes a balance, it's important to collect it as soon as possible, especially early in the year when most claims don't get paid but instead applied to the patient's deductible.  Sometimes it's easy to lose sight of patient collections when insurance collections are usually the main focus.  As long as you have a good system in place, patient collections should not take too much of your time.  Today I will go over printing statements, marking statements and sending letters.

PRINTING STATEMENTS
The frequency with which you should print and send your statements depends entirely on your schedule, your preference or how big your office is.  Right now I work for a small office and run a different letter range every week.  For example on the first week of the month I run all statements for patients whose last name starts with letters A through F.  The second week of the month I run all statements for G through L and so on.  This format could work for big or small offices.  I like it because it keeps the work consistent week to week.  But if you work in a small enough office and you would rather send them all out at once you could print out all your statements once a month. 
Some small offices will also print out a statement as soon as the patient has a balance.  For example if you were posting an explanation of benefits and after the payment and adjustment the patient still owed a balance, you could immediately print a statement and send it out to that patient.  Some billers prefer to do this with the hope that the sooner the patient gets the statement the sooner they will pay the bill.  I don't use this method, but I will say that if it is a large balance and the patient is not due to receive a statement for another few weeks, then I could see it being beneficial.

MARKING STATEMENTS
It is likely that large practices with multiple locations do not have the time or manpower to look at each individual statement and mark or stamp it if the balance is overdue.  If you do not work for a large practice however, I would highly recommend that you do.  By stamping a statement or marking it in some way you are reminding the patient that this is their second or third time receiving this statement and showing them that your office is keeping track.  If they got the same bill month after month without anything that said second or third notice, they might think they can get away with not paying the bill for a few more months.  But by getting those notices stamped on the bill, they might start worrying about their account being turned over to a collection agency and they will pay the bill sooner. 
When it comes to marking statements there are a couple of options.  If you are sending a statement to a patient for the second time you could use a 2nd notice stamp and then a 3rd notice stamp when you send it the third time.  Or if you don't want to have to worry about keeping track of how many times you send each statement you could wait until the balance is more than 60 days old and then simply use a Past Due stamp.  Whatever method you choose, make sure you stay consistent. That way they'll know you mean business!

LETTERS
It is important that you communicate with your patients through letters when their balance is past due.  A letter is more noticeable than a bill and, if you keep a copy, it is proof that you exhausted all efforts before turning the account over to collections.  I used to work at a place that would send the first 3 statements and by the 4th we would send the statement with a letter signed by the doctor notifying the patient that if the bill was not paid in 10 days the account would be turned over to collections and they would not be able to come back to the office moving forward unless it was an emergency.
The place where I work now isn't quite as drastic.  We send a letter with the 3rd statement letting them know that their balance is past due and prompt payment will avoid the account being sent to collections.  By the 4th statement we send a final letter telling them they have 10 days to pay the bill before we turn the account over to collections.  We do not however tell them that they can no longer be seen in our office. 
How strict you want to make these letters and policies moving forward is up to you and/or the doctors you work for.  The important thing is to communicate with the patients in writing before sending the account to a collection agency because this will affect their credit and you need to have proof that you did inform them beforehand.

The three topics discussed above are the foundation of patient collections.  In my next post I will cover some other tricks of the trade that will make patient collections easier to track and will tell you how to successfully make a collections phone call.