Hi everyone,
I have always found the board to be one of the best places for advice on the business side of the practice. This topic came up today and started quite a stir.
We have always had good billers in our office, but it seems none were really concerned a lot about the 30, 60, 90, 120 days past due piece. So, since our newest biller is on top of this, we/I am faced with exactly what to do with them.
Some of the ideas have been:
Clearing the back balance (only for very small amounts, say under $50 to get them off the books.
Offering to allow them the option to pay 1/2 of the amount (especially large amounts like $600 and clearing the rest).
Setting up a payment plan.
Dismiss the patient from the practice.
Send to collections, then after one month; dismiss the patient from the practice
(What do youi do if they make two $40 payments for two months in good faith but then they stop paying again? Dismiss?)
Any of the options that lead to dismissal, always brings up the following issue. What if it is a patient that you would simply not want to lose. In fact, you just could not bring yourself to dismiss that patient. The patient with Dermatomyositis or Mitochondrial disease that you have followed for 14 years. Or just the family that you love. Sure, fair is fair, but it simply is going to come up. I suppose since, by definition, I am that close to them, I could call them.
What came up today which caused a huge stir, especially since my biller did not come to me with it first was what do you do with a patient who has been sent to collections and then wants an appointment? Do you turn them away by phone? Do you turn them away if they are in your office? Is it legal? What happens if they are self-pay, can't afford the ER or Walk-in Care and just happened to have meningococcemia? I should say that my biller thought it would be OK to see them if they paid on their bill. How much? 10%? 20%? My thought was if they are going to be dismissed after one month of collections any way, why not see them? At least you stay in some good stead.
Then, there are always issues which are just difficult to deal with. Say, somehow, a patient runs up a $800 bill. If you offer meeting them halfway, they are happy and pay the $400, you clear off the back balance, and you get the $400 you likely wouldn't have received. On the other hand, is that fair to the other self-pay patient who is paying his or her entire bill each time.
I think it is hard because from the moment one starts medical school, you start to develop this empathy that grows and grows until it is hard not to see everything from the patient's view, even when it means losing money or being taken advantage of. To use the now famous analogy, you couldn't buy a gallon of milk for half price. And, if you took your car to the mechanic, and somehow left with a $100 bill, you are not getting any more work done until you pay that off. Is it the intangible of health?
I would really appreciate any feedback on this subject. And, if anyone has form letters they use, if you wouldn't mind sharing them by sending to badams AT riverviewpediatrics.org_removespam. Thanks.
