Patient Money Collection System Proposal

  1. The Problem
  2. Patient Money is uncollected.
  3. The true scope of the problem is unknown. Could be several thousand to several hundred thousand dollars in lost AR.
  4. Medicare, PPO patients with a percentage of financial responsibility, HMO/PPO with copay.
  5. Medicare with secondary and Worker’s Compensation are not part of the problem.
  6. By the time EOB’s are processed, returned to us, patients are invoiced, and follow up occurs, it could be 60, 90, 120 days during which we have not received the patient’s fees.
  7. Treatment is devalued when a patient has recovered yet still has not paid their bill.
  8. Too much work for CMM to follow up on. Simply too many accounts to handle.
  9. CMM could be spending this time following up on insurance payments.
  10. Receipts are lost or never posted.
  11. There is several thousand dollars available in uncollected patient AR.
  12. We need a solution to collect this patient money.
  13. There is no reason why we should have to wait 2-4 months for patient money. That is money that is already owed to us and remains in the hands of the patients. This is money that we should possibly be collecting interest on.
  14. Solution
  15. Collect patient money at the time of service
  16. Brings about new problems
  17. Who collects the money? – Front office staff? More burden on already overworked personnel?
  18. How do they collect it? We have CC, Check, and Cash payment systems. All of these payment systems are currently in place.
  19. What amount to they collect? Insurance companies reimburse at different rates. We need a fee estimator - tables and formulas for rapid charge calculations.
  20. What about cascading? Need tables/formulas for rapid calculation. One option may be to avoid cascading by not allowing for physical therapists to cascade charges.
  21. Could potentially decrease our business. Patients will be seen for fewer visits because they will realize the “real cost of physical therapy” when they are forced to pay it at the time of service.
  22. Need to properly track who has paid what.
  23. Need to communicate this payment information to the billing office so they can post payments to each patient ledger.
  24. Need accountability. Staff needs to be responsible for collecting patient payments and recording the information.
  25. All payments must be accounted for.
  26. Complex process that needs to be efficient, measurable, scaleable, with audit trails, and reviewed on a periodic basis in order to make changes and improvements.
  1. Proposal
  2. David Straight will create and administer over the process.
  3. There will be a percentage compensation for his efforts (to be determined).
  4. Front office staff will be under the management of David Straight and report to him on a weekly basis.
  5. To motivate the front office staff to collect the money, it is proposed that they receive a small stipend for their efforts.
  6. Workflow
  7. Complete consistency is required at all offices.
  8. Proposed Workflow
  9. Patient super bills are created and placed in each chart.
  10. Super bills are color-coded and CPT code choices are specific to the insurance provider to avoid cascading.
  11. The appropriate reimbursement for each code is located on a table, the super bill or computer spreadsheet and used for calculations of patient AR at the time of service.
  12. Patient arrives
  13. Patient signs in
  14. Patient is checked in at the computer.
  15. Patient is treated
  16. Physical therapist completes a “super bill” at the end of treatment and gives it to the patient.
  17. Patient checks out at the end of the treatment and hands front office staff the super bill.
  18. Front office staff makes calculation of percentage.
  19. Front office staff collects percentage in the form of cash, check, or charge.
  20. Front office staff writes the amount collected on the super bill.
  21. Front office staff writes the amount on a spreadsheet.
  22. Note is made in chart if patient does not make their payment.
  23. Auditing of process
  24. On a biweekly basis (Tue, Thurs) spreadsheets are collected.
  25. Spreadsheets are cross referenced with the schedule to insure that payments are being made and not being missed.
  26. Money – checks, cash, and CC payments are verified.
  27. Money is delivered to Kristin Gaspar for deposit each Monday AM.
  28. Kristin would have all of the audit records for further verification.
  29. The physical therapy staff must be made aware of the process to insure that it runs smoothly.
  30. Super bills can be created to avoid cascading
  31. Question: is it illegal to perform a procedure and not charge for it?
  32. If not, super bills should be created to avoid the opportunity to allow a physical therapist to bill charges that will cascade.
  33. Policy can be created that will state that we do not bill for treatment if it will result in a “charge cascade”.
  34. Thoughts
  35. Because this will create an extra workload on the front desk, we need to be prepared to shift some of the work from the front office staff.
  36. We could create a gate keeper: centralized answering/scheduling system for initial evaluations.
  37. Calls could be routed to the appropriate office, messages taken and communicated to the respective therapists, aides, and staff.
  38. This would free up the front office staff to do other jobs such as collecting money.
  39. All insurance verification could go through this person. They would be solely responsible for communicating the information to the billing office.
  40. A computer system tied into the billing office could be used to record the payment. Auditing of records could occur from this scheduling system as well.
  41. This is the most logical piece of the Patient AR Auditing Process.
  42. Thorough planning and communication must occur to transition from the Therassist system to the Breckel Research System if Gaspar PT is to share a scheduling system with CMM.
  43. Since CMM will be relieved of the burden of collecting patient money, there reimbursement for services rendered should be reexamined.
  44. We could pay them a lower percentage.
  45. We could pay them for the remaining monies collected; therefore, since they will be primarily insurance money, there compensation will be based on a lower AR.
  46. They will still have to post the Patient AR but this work will be more than offset by time recovered when they no longer have to follow up on Patient AR.
  47. There will be additional refunds that will have to be made for overpayment of patient money. This effort should be negligible since we already make patient refunds.
  48. Potential problems is the is not done correctly
  49. We will further alienate CMM with a poor P&P
  50. Poor customer service
  51. Poor motivation on administrative end
  52. Loss of AR

In conclusion, it is obvious that we need to improve our collections which will make the business more solvent, allow for appropriate and hopefully additional profit sharing, and relieve the burden from the upper management’s shoulders to “produce” for the good of the business. This process should also decrease the workload on CMM thereby allowing them to spend more time auditing other accounts (e.g. Medicare) to insure timely reimbursement by the insurance companies and to avoid financial pitfalls such as those experienced in 2004 with the Medicare and Blue Shield issues.