Analyzing the Billing and Collection System

February 28, 2005

PATIENT SCHEDULING

What are patients instructed when they call into the office for an appointment?

What is the office visit payment policy?

When is the patient’s insurance information first obtained?

When is insurance verified?

PATIENT CHECK IN

Are patients required to sign in?

__yes  __no;

If yes, is the sign in sheet maintained as a permanent office record?

__yes  __no


How does the office find out if a patient’s insurance coverage has changed since the last visit?

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Does the office make a copy of the patient’s insurance card?

__yes  __no

Does the office make a copy of the patient’s driver’s license?

__yes  __no

Does the office document and track where new patients come from?

__yes  __no

If yes, how: 

Is new patient demographic information inputted into the computer before a patient is escorted to the exam room?

__yes  __no

If no, please explain:

_________________________________________

_________________________________________


PATIENT CHECK OUT

Does the doctor complete all information on the charge ticket?

__yes  __no

If the patient is on a managed care plan, how does the front desk know how much to collect as a copayment from each patient?

When the patient checks out, is all the charge and payment information entered into the computer before the patient leaves the office?

__yes  __no

If no, explain why not:

_________________________________________

_________________________________________

If the patient has an overdue balance, is there an attempt to collect this amount from the patient while the patient is in the office?

__yes  __no

If no, explain why not:

_________________________________________

_________________________________________

If the patient is scheduled for surgery, does the office attempt to collect a surgical deposit?

__yes  __no

Do patients receive any type of financial counseling before the procedure is performed? __yes  __no

When a patient checks out after the office visit is complete, does the front desk (or check out desk) attempt to collect full payment, deductibles, and/or copayments?

__yes  __no

BILLING

Explain how the office communicates inpatient (generally hospital) charges to the office so that the office can bill these services to the patient’s insurance carrier.

_________________________________________

_________________________________________

How are surgical or procedural charges captured so they may be billed properly and timely?

_________________________________________

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How often are insurance claim forms filed each week?

_________________________________________

_________________________________________

Are operative notes attached to claim forms when they are filed with an insurance company?

__yes  __no

If yes, detail situations when operative notes are attached:

_________________________________________

_________________________________________


Does the doctor dictate notes on a timely basis?

__yes  __no

If no, how long does it take and explain why.

_________________________________________

_________________________________________


Does the practice utilize electronic billing?

__yes  __no

If no, explain why.

_________________________________________

_________________________________________

Are insurance claim forms held for any reason?

__yes  __no

If yes, explain situations when this occurs.

_________________________________________

_________________________________________

How accurate is the front desk or other personnel in obtaining the patient’s insurance information?

_________________________________________

_________________________________________

How are charge denials handled in the office?

_________________________________________

_________________________________________

COLLECTIONS

When does the practice begin following up on unpaid insurance claim forms?

_________________________________________

_________________________________________

What is the practice’s follow up procedure for unpaid insurance accounts?

_________________________________________

_________________________________________

How does the office follow up on unpaid patient receivables and how often?

_________________________________________

_________________________________________

When are patient account statements mailed out?

_________________________________________

_________________________________________

Are collection letters used by the practice?

__yes  __no

If yes, how often are they sent out and what types of collection letters are sent.

_________________________________________

_________________________________________

Does the practice use a collection agency?

__yes  __no

If yes, how often are accounts sent to the collection agency?

_________________________________________

_________________________________________


Does the practice routinely review a detailed aging of the accounts receivable?

__yes  __no

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