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MOM Ch 13

Side A

OBRA (Omnibus Budget Reconciliation Act) legislation passed by ongress in 1993 to calculate healthcare service fees by formula
fee schedule list of services and their fees
national standard point of reference for developing charges for healthcare services used throughout the United States
GPCI (Geographical Practice Cost Index) Medicare system of adjusting fees based on the county in which the healthcare provider practices
RVU (Relative Value Unit) numeric value assigned by Medicare to formulate fee schedules for healthcare providers
national conversion factor number released by Medicare each year that determines fee schedules for all healthcare services
TN – 6 years; VA – 5 years Statutes of limitations for collecting a healthcare debt
red flag rule when offices doesn't collect co-pays; legislation to reduce fraud and identity theft; applies to any business or entity that extends credit; requires the medical office to have a written program in place to verify patient identity, before extending credit
accounts receivable (AR) money owed the medical practice
aging report documentation of the money owed the medical office and how long accounts have been outstanding; OUTSTANDING ACCOUNTS; CHECK WEEKLY
verify the patient's identity, tell the patient the reason for the call, document any promises the patient makes, call the Patient between 8am and 9 pm Dos for collection telephone calls
call the patient if the patient asks not to be called, become angry if the emotion arises, make promises that cannot be kept, neglect to document all parts of the conversation with the patient Don'ts for collection telephone calls
Insurance fraud illegal act by a healthcare provider involving an insurance company
hardship agreement agreement a patient signs to indicate an inability to pay full healthcare costs due to financial hardship
professional courtesy a discount offered to friends, colleagues, and family members of the physician
patient billing statement monthly statement sent to patients who have outstanding balances; COPY CHECKS OF PAYMENTS & SEND IT TO PATIENT; PUT A COPY IN PATIENT FILE
security envelope in order to be HIPAA compliant, patient billing statements must be sent in a
certified letter postal service letter that the recipient must sign for
tickler file tool for tracking future events, such as patient appointments
collection agencies company that pursues overdue accounts for a fee
Fair Debt Collection Practices Act law that dictates how debts may be collected
write off to remove a balance from a patient account
uncollectible account account that will likely never be paid
Chapter 7 all nonexempt patient assets are sold and the proceeds distributed to creditors
Chapter 9 used for town reorganizations; does not apply to medical bills
Chapter 11 used for business reorganizations; does not apply to medical bills
Chapter 12 used by farmers who cannot meet their financial obligations; does not apply to medical bills
Chapter 13 protects debtors from creditors while the debtors arrange to repay all or some of their debts over 3- to 5-year periods
community property laws legislation that deems one spouse financially responsible for the other spouse's debts
face to face best way to collect
ID verifying patient's
send a letter forgiveness
cash, check, debit card, credit card types of payments
explanation of benefits EOB
Created by: Stacey_Gantt5