Home Forums Discussions General Discussion Collections

Okay, I know this isn't about AC, but I'm sure it's an issue that each of his deals with our respective practices.

I find it really frustrating that patients who owe us money and are eventually set to collections, just up and move to another practice only to start doing this all over again. Most of these folks are those with Medicare or other insurances that require them to pay a deductible at the beginning of the year. Some of them are folks with Medicare, who don't have a supplement, and therefore are responsible for their 20%, or if they are folks who signed in ABN, and still don't want to pay the cost of service.

I'm sitting here this morning looking at a release of information on just one of these folks. She's now moving to another practice, after yelling at me last week that we should not have sent her account to collections. Mind you, she's had ample opportunity (all of 2007 thus far) to work out something with us, as well as with the collection agency. Her behavior is such that she does not call us back unless she needs medication refills.

Practice is difficult enough for all of us, but it seems unfair to the next practice to be unaware of this person's financial practices. Do you notify them? Do you make a notation in your charts that shows patients are set to collections? (Right now, we have that info in the yellow box on the demographics page.) Is that even our place to let them know that they are potentially taking on someone who will never pay their bill? Is this information you'd like to know about your new patients?

Well, this information may not stop me from accepting a patient, it certainly helped me formulate some of my financial policies. For example, one person did transfer to me, and even wrote on her reason for transfer that the previous office had sent collections. We agreed to work with her, with the understanding she would always have her co-pays up front. So far, so good.

So, what do you do?

(edit: spelling corrections - I had used DNS for this post)

Interstate 8?

I believe warning other clinics about their financial issues may lead to legal action (especially if this patient is unable to find care elsewhere). Certainly, I would document the patient's behavior and level of cooperation in my progress note. That is medically relavent to your success with the patient.

I think that the patient transferring out of your clinic is the best option. I have had those we send to collection and dismiss from the practice, yet, continue to claim that I am their one and only physician. I often get called into the ER to admit a previously discharged patient (and so I always check to see their status prior to accepting patients while on call). I encourage my on-call partner to call me as I do not want to be in a situation to repeat the whole dismissal procedure all over again (as I have reestablished care unwittingly via inaccurate information from the patient). Past behavior is an excellent indicator of future performance.

Thanks Roy...

Corrections made. That's why I use DNS less and less these days.

Hmm...legal action? I suppose I shouldn't be surprised. If one can sue for the coffee being hot, I suppose you can sue someone you owe money to for services performed.

I agree that you cannot notify another practice about someone's refusal to pay.

I, for one, though was all for the woman who sued McDonald's for hot coffee. It never ceases to amaze me how Dunkin' Donuts will give me coffee at a drive thru, mind you; where it is quite obvious I am planning to drive that is scalding hot with less than a millimeter of space at the top.

Since I'm a talk radio addict, I heard more info on the woman who sued McDonalds about the hot coffee. Turns out her lawyer found internal documents showing they knew their cups weren't up to that type of heat, but thought that if people sued, it would be cheaper to settle than distribute new cups. Now, this was from a "conservative" type station, so you know it must be right! Anyway, just another post to get my count up...

We're pretty aggressive about collections in our practice. We let people know that they don't get the NEXT visit if their account is past due for the LAST visit - unless they're bleeding or dying. Refusal to treat non-life-threatening stuff is NOT abandonment. Generally they pay up. The problem is if you let the balance get TOO BIG it becomes impossible for them to face, and you never get any of it. As soon as the EOB comes back saying it's part of the deductible, the bill goes out. Be gentle and firm WHILE THE BALANCE IS SMALL. Collect SOMETHING whenever they walk in the door - even if its only $20.

Roy, I keep a copy of our Amazing Charts database on my laptop, and can connect to the office server from home as well. If the ER calls at 2:00 AM and I flip on the computer and they're not my patient any more, I tell the ER doc that that patient isn't mine and ISN'T MY PROBLEM ANYMORE. I can tell them "Nope - we dismissed them in April of last year. Admit 'em to the hospitalists if they don't have a new doctor." Sorry - getting me out of bed at 2:00 AM to admit you is a privilage reserved for patients in good standing.. not deadbeats who have been dismissed, or people who have left because we expected them to pay their bills and now at 2:00AM want to come back because they made a mistake by leaving.

We actually had one tell the ER that we were their primary when they needed to be admitted in the middle of the night, who we had never heard of. When we had the ER doc ask them if they were SURE we're their doctor as we had no record of them, they said "Well, I've been MEANING to establish with them for MONTHS now!". They did not get admitted to my service.

Our policy - which is cast in stone - is that if you leave the practice either to dodge a bill or because the grass is greener at the clinic down the street - that you are placed on the "do not book" list.

It is AMAZING how well this works!

In mutual poverty,

V.

Speaking of collections, does anyone recommend any agencies? Or agencies to stay away from? I've been trying to get my doc to sign up with one but he keeps making excuses for the patients...

*sigh* Sometimes docs are too compassionate.

I like how Vinny does it. You're right scslmd. We are way too compassionate. If they are Medicaid, it's paid. If they have private insurance, almost all is paid unless deductible; and that was their choice (as hard as it is to purchase insurance these days). If they are self pay, well then they should pay. We give them 30% off anyway -- paid at time of service. I don't know why we should be the only business that allows customers to run up such huge bills. We should insist on payment and, if not, not see them.

Of course, the hardest part is we all have our patients we really like seeing; and if it's one for all and all for one, then we risk losing them.

Bert,

I used to be a puppy dog about collections because I felt so badly turning away patients I really liked....ones with whom I felt I had a great relationship. But then it dawned on me, after sending records on patients to other doctors that I have only a small handfull of patients who would be loyal to me at all costs, so why should I be loyal to those who do not respect me enough to pay for my services? Now, like Vinny, they have to have a really good excuse to be late or remiss with their payments.

Leslie

I like the way Vinny does it. GO VINNY! We just sent our first case to this collection agency so scslmd I'll let you know how they work out. This was a good one. Patient came in multiple times in a short amount of time. Had a deductible. So she then would ignore all phone calls and billing notices about her balance (about $400). Yeah, Vinny, I know, gotta catch 'em when the balance is small. But I've got one Im about to send to collections for $65. One visit, and this was the amount applied to her deductible. Wont return phone calls, cancelled visit when we asked about arranging for payment when she came in, etc.

I wasn't the one who was soft about using a collection agency...but my business partner was. I no longer have trouble talking directly with pts about their bills, and letting them know we will be sending them to collections. The ability for us to remain open is directly related to getting them/their insurance agency to pay their bills. Period.

No one is allowed in without a copay any longer (okay...true emergencies are the exception, but those usually go to ER not here). That alone took care of a huge problem.

Look at it this way. Do you call the plumber and expect them to fix your plumbing just because you need it...for nothing? I don't think so.

Looking forward to your experience with the collection agency.

Does anyone else have a collections agency that they use that they would recommend?

What is the typical "rate" that collection agencies take?