The Collection Process in Medical Billing

Francie Walters

Jennifer Randall

Alternate Title

How to get the Most out of your Receivables!

What we will Cover

• Establishing a collection program at your lab• The collection module in MB and how it works• The aging reports in MB • What the collection process looks like at

Northeast Dermatopathology• General Discussion about what works in your lab

Establish a Collection Plan

• Before you can begin the collection process in MB you should first determine your specific companies collection plan both for patient account balances and for insurance account balances.

Questions to answer in developing your patient collection process.

• How much time will you give a patient to pay their bill before it enters the collection process?

• How many statements should a patient receive before entering the collection process?

• Will you allow the patient to make payments?• Will you make any internal collection attempts, ie

phone calls before you begin the MB collection process?

• What is the minimum balance you will attempt to collect?

What we do at NDI

• We allow 75 days from the date the patient received the first bill to pay the balance.

• We want the patient to receive a minimum of 2 statements.

• The patient will not enter the collection process if they have made a payment in the last 30 days.

• We make no additional attempts to collect prior to the patient entering the collection process.

The Collection and Aging Module

Prepare the Aging Table

NOTE: AGING YOUR RECEIVABLES HAS NO EFFECT ON THE MEDICAL BILLING COLLECTION PROCESS!!!!

Aging based on Print Date vs Date of Service

• Aging based on Print Date will age your receivables based on the FIRST patient statement or the LAST claim generated

• Aging based on Service Date will age your receivables based solely on the number of days since the date of service

The 5 step collection process in Medical Billing

• The collection process in MB should be run monthly.

• Phase One or steps 1 and 2 are done at the start of the process

• Phase Two or steps 3 thru 5 are done approximately 15 to 20 days after Phase one.

A Possible Time Line

• June 1, 2014– Age the receivable based on the Print Date– Run the first two steps in the collection

process, Generate the Pre-Collection Records and Print the Pre-Collection Letters

• June 20, 2014– Run Steps 3 thru 5, Generate Collection

Records, Send Accounts to Collection, Write off Overdue Accounts

Step 1Generate Pre-Collection Records

Sets Credit Status to 2 on the Patient Demographics screen

The Credit Status Code

• The credit status field is updated as the account moves through the collection process. This field is stored in the patient demographics tab.

Pre-Collection Report• Review For

Medicare Patients

• Review for Full Balances

You can cease the collection process by changing

the credit status to none.

Generate the Pre-Collection Letters

Tip: We print the pre-collection letters on bright gold paper Credit Status Field advances to 3

Phase One is Complete

Generate Collection Records

Credit Status Code Advances to 5

Send Accounts to Collections

Credit Status Code Advances to 6

Write off Overdue Accounts

Posts the Adjustment to the Service and Sets Service to a 40Changes the Credit Status Code from 6 to 7 to none

What we do at NDI after the account is written off

NDI Timeline for September Collections

• Sept 2, 2014 – we run the pre-collection program and send the precollection letters

• Sept 16, 2014 – we run phase 2 of the collection process

• Oct 1, 2014 – We make calls to all delinquent accounts where no payment has been made

• Oct 10, 2014 – We send personalized letters to collection accounts.

• Oct 20, 2014, We send final collection letter (same letter to all accounts)

• Oct 31, 2014 we send any outstanding collection accounts to an outside agency.

Payer Aging Detail Report

Why is the claim still Open?

There are only three reasons an insurance

claim should be over 90 days old:

• There was no response from the insurance company (happens a lot on secondary claims or paper claims)

• The claim was denied and never addressed

• There was a posting error on the account

“Tools” That assist in working our Aging Reports

• Scanning our Request Slips

Tools” That assist in working our Aging Reports

• Websites we use daily:

• Zirmed

• Promise (PA Medical Assistance Site)

• Navinet

“Tools” That assist in working our Aging Reports

• Zirmed • Electronic Claims• Credit Card Processing• Electronic Payments• Eligibility• Medicare• Blue Shield (Other than the local

Blue Shield)• Humana• Miscellaneous Insurance

“Tools” That assist in working our Aging Reports

• Navinet

• Claims Status and Eligibility

• Local Blue Shield Plans

• Geisinger

• Aetna

• United Health Care

• Cigna

“Tools” That assist in working our Aging Reports

• PROMISE

• Pennsylvania Medical Assistance

• Claim Entry, Eligibility

In ClosingWhat I learned!!!!

• Aging has no bearing on the MB collection Process.

• 75 days is too long before they enter the collection process

• Our write off process is valuable and worth the time and effort

• The importance of alternating the aging of your receivables

QUESTIONS?