Automated Medical Office Chapter 6 Posting The Payment

Front 1

Accrual Basis Accounting

Back 1

*is income is considered when services is performed even though no payments are being made

*expenses are recognized when inquired enev though not paid

Front 2

Cash Basis Accounting

Back 2

*is for charges for services that has been entered income which payments are received

*expenses are recorded as they are paid for

Front 3

Understanding the Formula

Back 3

Assets=Liabilities+Proprietorship(Capital)

*Assets-property owned by business(bank accounts, buildings, equipment, furniture, etc)

*Rights to these assets are called equities

*Proprietorship(capital)-equity of the owner

*Liabilities-creditors to whom money is owed (debt)

*Equipment purchase of $1500 Asset

*Down payment $250 Capital(equity)

*Debt owed $1250 Liability

Front 4

Defining Terms

Back 4

*EOB(Explanation of Benefits)-document that defines what was paid

*Billing Number-an internal number identifying a claim

*Pt. Financial Record-transactions associated with the patient

*Batch Payment-lump sum payment for multiple patients

*Posting-an entry of figures into an accounting system

*Auto Post-instructions given to a software program to automatically post multiple payments

*Statement-document stating what is owed

*Billing Cycle-system used to send statements periodically

Front 5

Internal Billing

Back 5

*Duties performed within the office of the provider:
-Collection of monies
-Mailing statements
-Billing to third parties
-Posting monies
-Follow up of accounts
-Patient's bill inquiry calls

Front 6

Responsibility of the Bill

Back 6

*is the patient of the guaranter

Front 7

Payment at Time of Service

Back 7

*Time of service(TOS) payment should always be encouraged

*Discount may apply for no insurance patients

*When this practice is followed:
-Patients get into the habit of paying
-Increases cahs flow of the office
-Decreases follow up of funds


"Payment is expected at the time services are rendered unless other financial arragements have been made"

Front 8

Other Paying Sources

Back 8

*will be that of the insurance company

*they come in from the thrid party carrier

*they will be under a fee scheduled allowance

*you will not get the full dollar amount(a good bulk of the finances will come from)

*guaranater who is ultimately responsible for the bill and possibly and employer which is cover under a workers comp or self insured for the company

Front 9

Patient Payments

Back 9

*can be made at the time of service, by mailing payment with the statement, or calling on the phone, or may be able to pay on the internet(depending on how the office is)

*patients are able to pay by cash, credit card, check(if the office accepts personal checks), or debt card

Front 10

Patient Cost Responsibility

Back 10

*Premiums-the cost for coverage
-may be paid monthly, quarterly or annually

*Copays-a flat rate paid for a providers E/M visit
-may depend in price between PCP and Specialist

*Deductibles-a speciificed amount of money that must be paid out of pocket of the insured individual
-Individual and family
-Yearly or per incident

*Coinsurances-a percentage set by plan that insured is responsible for payment(90/10, 80/20, etc)

Front 11

Insurance Payments

Back 11

*primarily pay by check(its a good tracking mechanism)

*payments can be transferred through electronic funds into the physicians account

*when checks come they are usually accompanied by an EOB(gives the break down of how the money is to be applied)

*could have a single patient or multiple patient(just know how to distribute the money into the persons account)

Front 12

Insurance Fee Schedule

Back 12

*is how insurance companies pay for the services

*this is a listing of accepted charges or established allowances for medical services and is referred to as an allowable amount

*allowable amount is the full amount to be reimbursed by the insurance company

*each insurance company will have their own fee schedule and u may be using multiple fee schedules in the office

*the allowable amount and the dollar fee schedule is gonna be different

*if the doctor participates the amount will need to be written off

Front 13

Insurance Allowances

Back 13

Participating Physicians
*The insurance pays the allowable amount of the negotiated charge
*The provider accepts this as paid in full and adjusts the difference off of the patients account, with exception to patients obligations under the contract(i.e. copay, deductible)
*The difference cannot be billed to the patient for covered services
*Non-covered services or ineligible benefits can be billed to the patient

Non-Participating Physicians
*Payment may be sent to provider or to patient
*The provider may obtain payment in full from patient at the time of service
*The difference between the charges and payment are billed to the patient

Front 14

Fee for Service

Back 14

*patient or third party reimburses the provider for each professional service that has been performed

*Standard Form of Insurance

Front 15

Capitated Payment

Back 15

*Capitation is a system where providers are paid by a fixed, per capita amount for each member enrolled in the plan

*The payment is for a specific period of time(monthly, quarterly, annually)

*The amount paid doesn't change regardless of the services the patient receives

*Providers will be paid even if the member has not received services

Front 16

Adjustments

Back 16

*Common adjustments:
-Insurance write off
-Professional discount
-Payments
-Bankruptcy

*Some adjustments are automatic when insurance payments are applied

*All adjustments should be made prior to bill being sent to patient to avoid refunds

Front 17

Refunds

Back 17

*verify who should actually be getting the refund

*make sure to verify and investigate the account to find out who properly owns the refund balance

*have a policy set in place in the office

*who is the person who processes the refund

*make sure that there is one person in charge of the refunds

*find out what days the checks are actually processed

*should be at least 1 time a month(maybe every week)

*if refund has to go out every week find out what the billing structure is

*know how soon the refunds will be sent out

Front 18

Collection Strategies

Back 18

*Collection Letters
-Collection letter starts as a friendly reminder
-Composition of a series of letters that will increase in intensity for demand of payment

*Telephone Collection
-Direct contact is more personable than letter
-Have better knowledge of patients circumstances

*Face to Face Collection
-Personal contact with patient can often be more effective than any letter or phone call
-Could be more information is wanted or a misunderstanding of their responsibility on the bill