Reduce the Need to Turn Patients Over to a Collection Agency

By Aimee Wilcox, MA, CST, CCS-P

If you have worked in billing and reimbursement, you are aware that turning patients over to a collection agency to collect on a debt should always be a last resort. Are your office policies conducive to retaining happy, paying patients or harming the word-of-mouth advertizing so important to medical providers today?

Word-of-mouth advertizing is important to physicians in today's competitive market and miscommunication between patients over billing and payment issues can cause patients to feel that the physician is only interested in their money and not in their health and this can cause public-relations problems.

A well-managed billing and reimbursement department can reduce misunderstandings through establishing realistic and informative payment policies as well as one-on-one conversations that educate the patient on insurance benefits, coverage and billing processes.

Attaining and maintaining current and correct patient and insurance information is only the first step to reducing the number of patients sent to collections. The following is a list of several processes you can implement to ensure prompt and correct payment for services rendered.

Medical assistants and providers are not the best individuals to explain insurance benefits, coverage and policies to patients so billing and reimbursement personnel should be readily available to come and speak with patients before, during or after a provider visit to answer any questions or explain insurance coverage.

One of the more difficult situations to occur between patient, provider and insurance company is when the provider recommends a service or treatment that is not a covered benefit of the insurance plan and the patient incurs the expense.

Most private insurance payers will simply deny pre-authorization for a non-covered service or treatment, at which time the patient is informed of the cost and payment arrangements made for the cost of the service.

If the patient happens to be covered by Medicare an advanced beneficiary notification (ABN) form must be explained to and signed by the patient prior to the service being performed. If this is not done correctly, when Medicare denies payment for the service the cost of it cannot be billed to the patient and must be adjusted off.

Once the insurance company pays their portion and the balance remaining is the responsibility of the patient, there are some steps you can take to collect from the patient and avoid potential problems.

When it has been determined that the patient has no intention of paying their balance there are two steps you can take:

  1. Write off the balance as a bad debt. The patient must pay this bad debt balance off before being allowed to make any future appointments and then must pay any and all deductibles, co-payments and co-insurances at the time of the visit so as to avoid any more future issues with their account.
  2. Send the account balance to a collection agency. This removes the responsibility for the account balance from the provider and all communication with the patient regarding their balance must go through the collection agency. Once the balance has been paid through the collection agency, the provider may allow the patient to be seen again but with the understanding that all deductibles, co-payments and co-insurances must be paid, in full, at the time of the appointment.

Even if you have the best policies in your practice for patient education and collecting patient balances there will always be those few patients who simply are not concerned with paying for the care they receive. Some patients simply seek free services and shamelessly use every excuse in the book for not paying.

If you establish good policies, and train your staff properly, you will have a good chance of reducing negative situations that lead to unhappy patients and unpaid balances that end up going to collections.

Aimee Wilcox, MA, CST, CCS-P is a Certified Coding Guru (CCG) for Find-A-Code. For more information about ICD-10-CM, ICD-10-PCS, and medical coding and billing please visit where you will find the ICD-10 code sets and the current ICD-9-CM, CPT, and HCPCS code sets plus a wealth of additional information related to medical billing and coding.

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innoviHealth Systems, Inc.
62 East 300 North
Spanish Fork, UT 84660
Phone: 801-770-4203 (8-5 Mountain)

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