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INSUR {CBCS-CPC}
Patient Billing and Collections
| Term | Definition |
|---|---|
| bad debt | An account deemed uncollectible. |
| bankruptcy | Legal declaration that a person is unable to pay his or her debts. |
| collection agency | Outside firm hired by a practice or facility to collect overdue accounts from patients. |
| collection ratio | The average number of days it takes a practice to convert its accounts receivable into cash. |
| collections | The process of following up on overdue accounts. |
| collections specialist | Administrative staff member with training in proper collections techniques. |
| credit bureau | Organizations that supply information about consumers’ credit history and relative standing. |
| credit reporting | Analyzing a person’s credit standing during the collections process. |
| cycle billing | Type of billing in which patients with current balances are divided into groups to equalize statement printing and mailing throughout a month, rather than mailing all statements once a month. |
| day sheet | In a medical office, a report that summarizes the business day’s charges and payments, drawn from all the patient ledgers for the day. |
| embezzlement | Theft of funds by an employee or contractor. |
| Equal Credit Opportunity Act (ECOA) | Law that prohibits credit discrimination on the basis of race, color, religion, national origin, sex, marital status, age, or because a person receives public assistance. |
| Fair and Accurate Credit Transaction Act (FACTA) of 2003 | Law designed to modify the Fair Credit Reporting Act to protect the accuracy and privacy of credit reports. |
| Fair Credit Reporting Act (FCRA) | Law requiring consumer reporting agencies to have reasonable and fair procedures to protect both consumers and business users of the reports. |
| Fair Debt Collection Practices Act (FDCPA) of 1977 | Laws regulating collection practices. |
| guarantor billing | Billing system that groups patient bills under the insurance policyholder; the guarantor receives statements for all patients covered under the policy. |
| means test | Process of fairly determining a patient’s ability to pay. |
| nonsufficient funds (NSF) check | A check that is not honored by the bank because the account lacks funds to cover it; also called a “bounced,” “returned,” or “bad” check. |
| patient aging report | A report grouping unpaid patients’ bills by the length of time that they remain due, such as 30, 60, 90, or 120 days. |
| patient refund | Monies that are owed to patients. |
| patient statement | A report that shows the services provided to a patient, total payments made, total charges, adjustments, and balance due. |
| payment plan | Patient’s agreement to pay medical bills over time according to an established schedule. |
| prepayment plan | Payment arrangement made before medical services are provided. |
| Regulation F | A rule that clarifies debt collection practices created by the FDCPA. |
| retention schedule | A practice policy that governs which information from patients’ medical records is to be stored, for how long it is to be retained, and the storage medium to be used. |
| skip trace | The process of locating a patient who has not paid on an outstanding balance. |
| Telephone Consumer Protection Act of 1991 | Federal law that regulates consumer collections to ensure fair and ethical treatment of debtors; governs calling hours and methods. |
| Truth In Lending Act | Federal law requiring disclosure of finance charges and late fees for payment plans. |
| uncollectible account | Monies that cannot be collected from the practice’s payers or patients and must be written off. |
| ECOA | equal credit opportunity |
| FACTA of 2003 | fair and accurate credit transaction act of 2003 |
| FCRA | fair credit reporting act |
| FDCPA of 1977 | fair debt collection practices act of 1977 |
| effective patient billing | sound financial policies and procedures that clearly explain patients' responsibilities for payment |
| effective patient billing | includes educating patients from the start of the billing and reimbursement process |
| good financial policy | address all possible scenarios: financial arrangements & payment plans, payments not covered by insurance, & various circumstances. |
| good financial policy | a policy that both staff members and patients can follow |
| good financial policy | are supported by clear office procedures that can be consistently applied by both professional and administrative staff |
| effective patient billing | educating patients from the start of the billing and reimbursement process |
| patient ledger | the record of a patient's financial transactions; also called the "patient account record" |
| day sheet | summary of financial transactions that occur each day |
| aging | begins on the date of the bill |
| patient aging report information | patient's name, most recent payment, and remaining balance |
| Category 1) Current or up-to-date: | Thirty days |
| Category 2) Past due: | Thirty-one to sixty days |
| Category 3) Past due: | Sixty-one to ninety days |
| Category 4) Past due: | More than ninety days |
| TB | Telephoned business |
| TR | Telephoned residence |
| TT | Talked to |
| NA | No answer |
| HU | Hung up |
| PTP | Promise to pay |
| RP | Refused payment |
| LM | Left message |
| SD | Said |
| PD | Phone disconnected |
| LB | Line busy |
| PT | Patient |
| UE | Unemployed |
| DNK | Did not know |
| EOM | End of month |
| EOW | End of week |
| NLE | No longer employed |
| EDU | Educated |
| payment plan calculation | Principal (the charge) x Rate (the interest rate) x Time (fraction of a year) |
| Types of Collection Agencies | local, regional, or national scale |
| NPP | Notice of Privacy Practices |
| Notice of Privacy Practices (NPP) | explains the practice's policy on when accounts are sent to an outside collector. |
| Notice of Privacy Practices (NPP) | patients' acknowledgement of this document protects the practice from liability under HIPAA law |
| uncollectible account | also known as a write-off account |
| Six Years | covered entities must keep records of HIPAA compliance for: |
| FDCPA | collection calls are regulated by these FEDERAL guidelines |
| patient aging report | this report is used to collect overdue accounts from patients |
| Patient Ledger Cards | also called: patient statements |
| PMP | Practice Management Program |
Created by:
VA_MedCod3r