This blog post is a writing assignment for MAST 1060: Medical Office Procedures, part of the Health Care Management (HC23) Associate of Applied Science Degree program at Southern Crescent Technical College.

“Scenario: You are an administrative medical assistant and the office manager has asked you to speak to Mrs. Madelyn Wilson when she comes in today about charges that were denied by Medicare. She just moved into the area in March 2016 and had a 24-hour Holter monitor put on in your office on April 2, 2016. The results were positive, showing that the patient goes in and out of a bigeminal rhythm. However, she had this same service done in January 2016 by a physician where she used to live; the results were negative. Medicare pays for one Holter monitor every 6 months. When she received these services you had her sign an Advance Beneficiary Notice (ABN) and advised her that Medicare might not pay for the services. You can legally bill her and expect to receive payment; however, you have done so and she has not paid. It is June 10, 2016” (French, 2019, Job Skill 4-12).

This scenario requires two people: Mrs. Wilson, a patient, and Amy, a medical assistant. Amy replaces a few loose strands of her hair and adjusts her uniform while she waits for Mrs. Wilson to arrive. Mrs. Wilson arrives, and Amy greets her warmly with a smile. Amy leads her to a separate office where they can talk privately. Amy introduces herself, telling her she is a medical assistant helping Dr. Williams and that she needs to discuss her account with her today. Amy sits at the desk and allows Mrs. Williams to sit down and get comfortable in the chair facing her opposite the desk.

Amy looks directly at Mrs. Wilson and reviews her financial statement activity. Amy tells her that she received a Holter monitor in April and reminded her that they gave her notice that Medicare might not pay. Amy informed her that Medicare did not pay and that she should have received a bill from the doctor’s office. She asks, “Did you receive this bill?” Mrs. Wilson appears a little nervous and nods her head yes.

Amy politely asks Mrs. Wilson if she can pay the bill while she is in the office today. Mrs. Wilson pauses and nervously says, “No, I can’t pay it now. It’s too expensive right now without help from Medicare. Are you going to turn me in to collections?” Amy attentively listens to Mrs. Wilson’s dilemma. Amy says, “I understand that sometimes paying without help from Medicare or insurance is difficult. I can go over payment plan options with you to get you on a payment schedule, so that does not happen.” Mrs. Wilson appears to show signs of relief, and she says, “That sounds good.”

Amy explains two possible payment options. Mrs. Wilson can make a monthly payment toward her balance or pay any initial amount she can afford today, paying the remainder monthly. Amy suggests she make her first payment today, paying as much as she can afford at this time. Mrs. Wilson agrees this is the best option and now pays the first $150 of her balance. Amy says, “Thank you, Mrs. Wilson. This payment is a big initial step toward paying the entire amount, and your remaining payments will be lower and more affordable because of it.” Mrs. Wilson leaves, and Amy smiles and says, “I hope you have a great afternoon” (French, 2019, 4-4a, Procedure 4-10, Job Skill 4-12).

References

French, L. L. (2018). Administrative Medical Assisting. (8th ed.). Boston, MA: Cengage Learning.

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