Home Forums Discussions Amazing Charts Practice Management Delinquent Accounts and Blocking Appointments

I'm sure others have had this problem, so I'm throwing this out for some ideas/feedback.

We've had some issues with patient's walking away from bills and have had to send some of the naughty ones to collections - after 3-5 months of statements and weekly telephone calls for up to a month with no response. Once it's forced to go to collections, it's pretty clear the patients have no intention of paying us directly. Then, we don't hear anything from the patient for several months, sometimes up to a year - until...shock! They need something.

A week or two ago, I left early on a Friday. The doctor was here and got a call from the patients PCP that the patient had stopped taking his medication (on his own) about 5 months ago and had an event in the last 2 days. The doctor didn't think twice, looked up the patients phone number in AC and called him and gave him medical advice and an appointment the following Monday afternoon.
Then he looked in ACPM after he hung up and saw that the patient's account had gone to collections back in October 2017 and had still not been paid. He called me at home and told me what happened; I then had to come in Monday morning and call the patient and tell him he couldn't be seen and why. I'm sure you can imagine how that call went. I got multiple calls that day from both the patient and his mother (he's not a minor, BTW) grilling me about what my problem was? (Right, MY problem) I then had to explain, "well, if you'd paid your bills this wouldn't have been an issue. You never returned my calls or responded to our billing statements," *insert cricket sounds*.

We've had this situation and similar ones to it 5 times in the last 4 months.

That's the context. Here's the suggestion/recommendation that I've sent to the Development Team (without acknowledgement):

Add a box, simply titled: Block Scheduling or Scheduling Prohibited, etc. that when checked, creates a Hard Stop and prevents a patient from being scheduled. It then forces the user to look more closely at the account. It can later be unchecked by the Physician (username and password necessary, just like deleting an imported item), once the account is made current if he so chooses. This would prevent patient's from worming out of bills and still getting appointments and stealing the doctors time.

I understand that patient's need care, but I have to protect the office as well. As a small practice, we can't afford to have patients abuse us. Does any one else think this could be a useful feature? I've now sent the recommendation/request to the DT three times, but unless others are facing the same issue, I doubt they'd do anything with it.

Trista, I love that idea. It would be so helpful. Not everyone looks at the "pop up note" on the front screen. Even if it is in RED.

Thank you for suggesting that idea. Our office would use it!!

Alley

Don't have a in AC do this answer however if your doc gave advice and an appointment think med/legal you may be on the hook to provide appropriate care

Trista, ACPM actually has this feature already but it isn't tied to their accounts. It is instead tied to their patient expiration date (on their demographics). If you try to book an appointment, the system checks their effective dates and compares it against the appointment date. If they aren't effective then an alert is displayed:



I like the idea of locking things down from an accounting standpoint (as opposed to doing it from the demographics) but specifying an account isn't required on appointments so I'll work on this concept a bit and send it along to the ACPM team for you.

As for regular AC users, I'll also send this along to that team as well

~Andrew

Trista: This is a very bad situation, but I do not think a "block scheduling" box would help. It's the process at your office that is wrong, not the chart. Here's why. (I'm not a lawyer, but I have a good one. The following advise should only be taken after running it by your counselor, but this is why I do for entertainment purposes only.)

If the physician has an ongoing relationship with a patient, he or she cannot just decide to not schedule over a bill. It is that provider's legal responsibility to continue to care for the patient until they are properly discharged. In your situation, the patient was not properly taken care of when going to collections, and that is the root of the problem.

1. The patient who is delinquent should get a series of letters after the 3rd statement asking for payment and explaining the account will go to collections if they do not pay, set up a payment plan, or make a partial payment by a certain date. Also explain that when patients have no intention of paying a bill the practice will discharge them and they will need to find another doctor. "We'd hate to lose you, so please call us today!"

2. Send them a discharge letter (certified) and tell them the account is now going to collections. They have 30 days to get any refills, but in no circumstance will care be provided by the office after that date. Tell them they had 3 statements, 2 letters, a phone call, etc, and they still haven't paid.

3. After PROPER discharge (consult your malpractice insurance attorney, they are glad to help!) DEACTIVATE the patient in AC EMR. (I only look at ACTIVE patients in my patient list.) Then the physician will not be accidentally scheduling them or giving advice. My understanding legally is once they give advice again on the phone, they have to start another 15-30 days as they are re-establishing a relationship.

I hope this helps. Having a "do not schedule" box would get doctors into trouble for abandonment.

I appreciate your detailed response and all the points you mentioned. Here's my rebuttal

We actually have a pretty strict policy regarding collections. They get multiple statements, a minimum of 3 typically, which ACPM generates and logs each month, we call the patient's weekly to follow up on delinquent accounts, which we also document in ACPM, and before the statement is sent to collections, they get a call and written notice that their account is going to be sent.
We also send them a generic letter indicating that we've been unsuccessful reaching them and want to know if they're OK. If any of this mail is returned by the post office as a bad address, we contact the PCP to see if they've been in touch with the patient and that we can't reach them.

Once it goes to Collections, we give the attorney a copy of the record of contact attempts and statements that were sent and we stop trying to reach the patient. The collections attorney sends them several letters before requesting funds from us to file suit. Most people go find a new doctor on their own if we had to send them to collections to get paid.

The problem is that if a patient won't return a phone call to address an issue - financial or otherwise - they've already broken the relationship - but you can be sure they'll call and give you an ear full when they want something.

When we discharge a patient, we do send a certified letter letting them know that as of a certain date, we will be available to them for 30 days for appointments and/or refills, but in no event longer than 45 days past the specified date and that we will send their records to a physician of their choice.

What happens if your receptionist of 5 years, the front office collective memory, leaves and you hire a new person?
The problem with just deactivating a patient, IMO, is that, when you go to search them and they don't show up in the system, someone is more likely to just start a new account for them. If your front office staff, or whoever is making new patient charts, doesn't know to search ALL instead of ACTIVE, you have the potential for the same issue down the road.

At least by creating a Hard Stop, which can be overridden by a Practice Manager or the physician, you can keep the chart available and easy to find and the appropriate decision maker can make the call as to whether or not the patient will be allowed back into the practice - it prevents receptionists from booking people that have been dismissed.

I hate that this is even an issue that needs discussion. I don't like paying for healthcare when I have insurance either, but that's my problem, not my doctors - that's what credit cards are for (but I digress).

It's a very simple thing to teach a receptionist to check if someone has been in before and is inactive - by clicking all. We do this all the time, and is a minor task in her wide spectrum of competency. No one here just starts a new chart without looking to see if the patient was in sometime past. Being inactivated IS a hard stop.

BTW, is your attorney looking for more clients? There are a few I would like to pursue with an attorney instead of just an agency.

I collect all funds due at the time of service, before the patient is seen. I don't have in office labs or imaging, which makes that easier (no charges added during visit). I would set up at payment plan if needed, but have never had to before. I also like that the patient knows fully what we are charging before they are responsible for the bill. I never have to send to collections. Do any of you folks collect at time of service like I do? And if you don't, why not?

As far as I know, he is only licensed in RI and MA. But I'm sure you could find a local attorney who would be able to give you some direction.

If you create a new patient chart with the same name and DOB as an existing chart, AC will show a prompt saying are you sure you want to create a duplicate chart? But I hear you, we still have duplicates if the spelling of the name is off by 1 letter. That's why I have only 2 staff members who are supposed to create new patient appointments. Other receptionists/MAs can only book established pt appointments.

Did anyone come up with an answer for how to stop a discharged patient from calling a down the road and making an appointment?

Nope; at least not from AC. And it's been a topic of discussion in our office of late. I'm not sure there ever will be an effective answer; at least not with the method we've asked AC/ACPM for. We just recently got a phone call from a patient who we properly discharged in writing, certified mail with return receipt requested, which they signed and returned, asking for an appointment...mind boggling.

Trista,

This is one of those things where one can make a request to AC and see if they bite... if they do not, then it is up to us to come up with the best possible work around.
To some extent, what works will be dependent on your scheduler's workflow. As noted above, you want your schedulers to work fast, but trying to enter a patient as "new" when they are coming up as a duplicate (and therefore were likely previously inactivated) should be a signal to stop and take a look before giving them an appointment. Maybe not the "hard stop" that you are asking for ... but a signal to slow down and figure out what is up.

When we discharge a patient we create a "high alert" which shows up on the main screen, which of course is where scheduling is done.
Unfortunately I cannot seem to get the image to upload here, but please look at this post, scroll to the second image, and see what a "red alert" looks like. It does catch your eye: