NHA Ch #2: Financial Procedures Related to the Organization's Cash Flow

Billing: Introduction
- Billing: securing, processing money owed by patients.
- Create, mail statements, bills.
- Complete billing, claim submission properly. Deliver care correctly, swiftly. No financial burden on patients. Providers promptly reimbursed. Health care facilities stay financially solvent.
- Follow your office's billing procedure.
Billling: Obligation
- Bills are a documentation of an obligation to pay.
- Submit bills to the person or organization responsible for paying for a service the provider delivered.
- Guarantor: person or organization responsible for paying the bill.
Billing: Included Information
- A bill must have: patient's and provider's identifying contact information, description of service provided, amount owed, signature, diagnosis/explanation of services.
- Bills are often itemized. Line-by-line list of services, supplies, medications.
Billing: No Insurance / Finance Plans
- Bills for copayments/no health insurance: patient pays at time of service; some offices establish other pay options.
- Financial plans. Payments agreement includes: patient, provider signatures; total amount due, payment due date, number of payments, amount of each payment, interest charged; penalties for late payments.
Billing: Credit
- Credit Check: give the patient a copy of the Truth in Lending form; have the patient sign the form.
- Truth in Lending Act: Specific regulation that governs credit, installments payments, physician services.
Billing: Fees
- Bills: fees for service
- Fees: amount of money the health care facility/professional charges for services it delivers. Reasonable, customary for the area.
- Health insurance companies determine most fees.
- Know workplace fees, be aware of what fees health insurance companies allow.
- Be capable of explaining changes in fees, financial policies, bills from a health insurance company.
Billing: Patient Inquires
- Patients may inquire about the costs of services they received, costs of the services they will receive.
- Reasonable explaination: Fee determined by: What is customary for that treatment in the area; What is reasonable given time provider expended, complexity of procedure.
Billing Explanations
- Explain fees to a patient privately.
- Know how to expain each part of the itemized bill.
- Have a copy of the patient's bill, physician's fee schedule with you. So the patient can see ther are no billing mistakes.
- Notify physician if patient is still unsatisfied.
- Physcians, other providers wil negotiate fees, but never mention the possiblity of fee negotiation.
Handling Overdue Bills: Cycle
- Cycle begins after you generate a bill, send out a copy electronically or mail a hard copy. Generate, send out bills as soon as possible after providers complete their services.
- Providers expect payment within 30 day s of receipt.
- Follow workplace procedure for collecting overdue bills.
Handling Overdue Bills: Introduction
- Review bill, confirm all information.
- Review account, determine how old it it.
- Follow workplace procedure: letter or phone call; use courtesy and tact.
Handling Overdue Bills: Phone Calls Part 1
- Review bill information.
- Double-check your office didn't receive payment.
- Make sure you sent a copy of the bill to the right person at the right address, confirm the right person received it.
- Phone calls: call at a reasonable time; identify yourself, confirm patient identity; state purpose of call, review bill details; ask the patients if she received the bill.
Handling Overdue Bills: Phone Calls Part 2
- Allow patient to explain his reason for not paying.
- Common reasons for non-payment: lack of funds; medical, family emergency; perceived unfairness of the bill; bill was not received.
- Do not negotiate.
- Document call.
- Be prompt.
Handling Overdue Bills: Letters
- Form letters: make sure you collect bills the same way each time; document when you mail the letter; send a copy of original bill with the letter.
- Follow workplace procedure: specifies how many letters to send; when to notify a collection agency.
Protecting Patient Privacy: Part 1
- HIPAA: Specifies how, by whom PHI can be used, and how those people can use it.
- PHI includes a patient's: Diagnoses, treatment, medications; Financial information.
- Patient must approve sharing.
Protecting Patients' Privacy: Part 2
- Restricted access to patient's PHI: only those who have legitimate interest, authority in patient's case/care can see it.
- Must identify recipient of PHI.
- Must store PHI safely, securely.
Protecting Patients' Privacy: Part 3
- You have access to financial information relating to medical care: you can also share, send, transmit.
- To protect PHI: protect computer passwords; don't leave hard copies of charts unattended; confirm receipt of information; make sure computer screen's not visible; store records in proper place.
- Procedure when faxing or sending PHI:
1. Identify the person who is asking for PHI. Ask for their name, and the name, phone number and address of their workplace.
2. Make sure they have a legitimate need for the PHI. If they do, ask for the fax number or email address you need to send the PHI. Confirm information by repeating back to them.
3. After you fax or email the PHI, always call the recipient to make sure if they received it.
Responsibilities Involving Cash Flow
- Post patient payments to the patients' accounts.
- Follow-up with claims.
- Determine status of unpaid/late payments from health insurance companies and patients.
- Office manager prepares all checks: post checks, payments to vendors', suppliers' accounts; record these properly.
Accounting and Bookkeeping
- Accounting system: records, classifies, summarizes financial transactions.
- Bookkeeping: keeps track of earnings, spending; maintains a record of what others owe, what your office has collected.
Bookkeeping Procedures
- Single-entry system: records income and expenses.
B. Double-entry system: records each transaction in 2 places assets and liabilities accounts; allows the production of a balance sheet at any time.
- To determine the financial status of the workplace.
Bookkeeping Process
8 Steps:
1. Review transactions for time period.
2. Enter transaction into appropriate place.
3. Post transactions to appropriate account.
4. Check trial balance.
5. Make adjustments if you find errors.
6. Enter adjustments into appropriate account.
7. Prepare income statement, balance sheet.
8. Consider cycle complete. Begin new cycle.