PIEDMONT ACCESS TO HEALTH SERVICES, INC.
Policy Number: 02-03-007
SUBJECT: Patient Account Collection
EFFECTIVE DATE: 03/16/2011
Revised: 08/15/2012, 08/27/2013, 11/24/2014, 03/26/2015, 03/09/2016
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POLICY: Patient Account Balances will be billed and addressed according to the following:
1. All patient account balances $4.99 or less will be adjusted to “Small Balance Write-Off.”
2. All patient account balances between $5 and $29.99 for medical, dental, and behavioral health services that have not been paid within 120 days, or for which there is no active payment plan in place, will be adjusted to “Bad Debt.” The patient owing the debt will be required to either pay the Bad Debt balance in full, or to set up a payment plan prior to being allowed to make another appointment.
3. Patient account balances of $30.00 or more, over 120 days old and in which the patient has demonstrated “refusal to pay” by not making payments and/or payment plan has been established, will be flagged as “Transworld.” These accounts will be forwarded to Transworld Systems for processing under their Profit Recovery phase.
As of 03/26/2015, this policy consolidates and replaces the following policies:
· 02-03-007: “Patient Account Collection”
· 02-03-017: “Delinquent Patient Account Balances $5.00 - $29.00”
PROCEDURE:
Once per month, PATHS’ Billing Department will review all outstanding patient accounts.
1. Patient Account Balances $4.99 or less: Any self-pay balance found to be $4.99 or less will be adjusted to “Small Balance Write-Off.”
2. Patient Account Balances between $5.00 and $29.99: Any self-pay balance found to be $5.00 or more, up to $29.99, will be evaluated to determine the date of last payment.
A. If the account has a payment of any kind applied within the last 120-days, or if there is an active payment plan in place, the account will be left as is and reviewed again during the next month’s review process.
B. If an account does not have a payment of any kind applied within the last 120-days and there is no payment plan in place, the account balance will be adjusted off using the “Bad Debt” adjustment code and a billing alert will be applied to indicate the amount of the Bad Debt adjustment.
C. Should a patient marked with a “Bad Debt” billing alert contact any PATHS’ site for an appointment, of any kind, PATHS’ staff will instruct the patient to either pay the balance in full or to enter into a payment plan (See Section “4. Payment Plans” below).
D. The “Bad Debt” alert will remain on the patient account until the account has been paid in full. Front Desk staff will review the account of each patient having this alert before any appointments are given to ensure that there has been a payment on the account within the last 120-days.
E. In the event that an account does not receive any kind of payment for a period of 240-days (six months), the patient will be formally discharged from care according to PATHS’ policy number 02-02-005.
3. Patient Account Balances $30.00 or more: Any self-pay balance found to be $30.00, or more, will be evaluated to determine the date of the last payment.
A. If the account has a payment of any kind applied within the last 120-days, the account will be left as is, and reviewed again during the next month’s review process.
B. If an account does not have a payment of any kind applied within the last 120-days and there is no payment plan in place, the account balance will be transferred to Transworld Systems for ‘profit recovery’ and flagged with a “Transworld” global alert. Transworld will contact the patient through letters instructing the patient to contact PATHS to pay or set up payment arrangements to resolve the account.
C. At the end of the profit recovery phase, if there has been no resolution to the account, the patient will be sent a letter notifying them they have 30 days to resolve the debt or they will be discharged from the practice. If the account results in no resolution/discharge, the account will then be moved to Transworld’s ‘collection phase’, and the patient account will be flagged with a “Greenflag” global alert.
D. When accounts reach the point of being assigned to the Greenflag collection phase, payments should be made directly to Transworld, unless other arrangements have been made with PATHS billing department.
E. Patients who complete the profit recovery phase and who fail to resolve their account:
i. Will be discharged from all PATHS services, according to policy 02-02-005: “Ending the Patient-Provider Relationship.”
ii. The patient account in both eCW and Dentrix will be moved to inactive status. They will not be able to make another appointment, receive refills, referrals, etc. (except as permitted according to policy 02-02-005) until the delinquent balance is resolved in full.
4. Payment Plans: PATHS will make every effort to enter into a payment plan with any patient having a balance owed for medical, dental, or behavioral health services rendered. Payment plans will be administered as follows:
A. The patient will be given an opportunity to identify an amount that they can afford to pay monthly that will be applied to their balance. Staff has the authority to accept as little as $1.00 per month.
B. Once an amount is established, the patient will need to make at least one payment prior to being given an appointment. Payment can be made either in person, by mail, or by any other mechanism by which PATHS routinely accepts patient payments.
SIGNATURES:
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Chief Executive Officer Date
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Chief Operating Officer Date
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Chief Financial Officer Date
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Board Chair Date
02-03-007 Patient Account Collection
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