This blog post is a writing assignment for MAST 1110: Administrative Practice Management, part of the Health Care Management (HC23) Associate of Applied Science Degree program at Southern Crescent Technical College.

1. A new private pay patient, Anne Rule, calls for an appointment for Monday morning. It is your office policy to collect the physician’s fee at the time of the first visit. Convey this information during your conversation.
   • Since Ms. Rule is a new patient, I should make sure she knows the office payment policy and what to expect before arriving for her appointment. When she calls to make her appointment, I should say, “Payment for services is expected at the time of service. We accept cash, checks, debit, and credit cards for your convenience” (French, p. 420).
2. An established patient, Sylvia Cone, came in on Wednesday for a Level IV examination. She calls today and says she is not going to pay the bill because she is not satisfied with the treatment. She says, “Go ahead and send my account to a collection agency. I’ll call my attorney. I can make trouble for you and Dr. Practon.” Prepare your response.
   • I should remain calm, professional, and empathetic during the conversation in an attempt to de-escalate the situation. I should tell Ms. Cone that our goal is to provide excellent health care and that we want our patients to be happy and healthy. I should ask her why she did not tell the office staff, the manager, or her care providers at the time of service that she was not satisfied with the treatment rather than after receipt of the bill. I should ask her why she is not happy with the care she received and ask her to return to the doctor’s office so that we can meet her expectations, discuss the charges, and charge her negotiably (French, p. 439).
3. Mrs. Katrina Frenzel calls to ask you about the bill she just received for her son, Paul, who recently made his first visit to the office. She thinks the bill for $132.28 is “very high” and wonders if there is a mistake because the fee seems out of line. She says she has recently moved into this area. Prepare your response and state what action you would take.
   • I should remain calm, professional, and empathetic during the conversation. I should say that I understand her concern about the bill seeming higher than expected, especially since she moved from another area, as fees can vary by geographic location. I can also point out that charges can vary due to the complexity of the service. I can review the bill and tell her that the total amount of $132.28 accurately reflects the itemized charges for the specific services listed on the statement for Paul’s visit. I can review each item and its charges on the bill with her to verify their accuracy. If I do actually find any errors while reviewing the bill with her, I should apologize, correct them, and give her a revised bill. Then I should offer to answer any additional questions (French, p. 426).
4. Today you call Miss Wendy Snow about her account, which is overdue. You have sent her two statements, telephoned her, and finally sent a letter asking her to call the office about the $80 she owes. She has not responded. According to your records, she was seen on November 2, she lives at home with her parents, and she has health insurance but has not paid the deductible. Prepare questions you would ask her.
   • I should be professional and polite when I talk to Miss Snow. I should be empathetic and understanding because sometimes people cannot pay their bills for reasons they cannot control. I should work with her to find a solution. The following are questions I could ask her:
     • I noticed that you saw the doctor on November 2nd, and I see that you have insurance. Have you paid the insurance deductible?
     • When do you presume to be able to pay your balance?
     • Is there anything I can do to assist you in getting your bill paid?
5. Recently, Dr. Gerald Practon performed a two-hour operation and billed the patient his standard fee, which is what physicians generally charge in your region. However, the patient’s husband considers the fee exorbitant and has paid only part of it. What action would you take, and how would you collect the outstanding amount?
   • This patient indicates that he will likely not pay more toward his bill. However, since the surgery was recent, and he has paid part of the bill, I could continue to try to collect by sending monthly statements. If he continues not to pay the remainder of his balance, I should send a collection letter. If he still does not pay, the best option is a small-claims court instead of a collection agency.
6. Last week, Dr. Fran Practon made a lengthy long-distance telephone call to check on a postoperative patient who had a complicated major surgery. Should you bill the patient for the telephone charges? Explain your answer.
   • Like in this scenario, long-distance calls can technically be directly linked to a patient. Still, I believe that long-distance charges should be considered overhead for the normal cost of doing business and not be billed directly to patients. If long-distance calls are frequent, it would be a hassle to track which calls would be billable to a patient, the length of time of the calls, which doctor made the calls (if more than one doctor is in the practice), and to which patient the call was made. Doctors would be aggravated with tracking the calls. If the staff makes frequent long-distance calls, the doctor can most likely sign up for a long-distance plan with the phone provider for a reasonable monthly fee to make free long-distance calls eliminating the issue.
7. Recently, a patient whose account you have turned over to a collection agency saw you in the supermarket and mentioned that she would be telephoning for an appointment soon. Before making the appointment, you notify Dr. Practon of this circumstance. He insists she pay what she owes, and requires any future bills be paid in cash. Is this ethical? Explain your answer.
   • This is not ethical. Billing a patient after the account is sent to collections is illegal. It is recommended that the physician send a discharge letter to the patient rather than continuing to see the patient. I should remove the patient’s financial record from her regular file and mark it with the date and the name of the collection agency. It is recommended that I write off the balance of the patient’s account. I must notify the collection agency immediately if the patient pays the physician any amount instead of directly to the agency (French, p. 441).
8. You routinely bill Dr. Practon’s patients the amount that appears on the established fee schedule. In reviewing an account, Dr. Practon finds that a certain patient has been charged more than was intended. The patient makes no complaint and pays the bill in full. What action would you take?
   • I should notify the patient and issue a refund. This amount cannot be kept as a credit. If the insurance company also made any excess payments, I must report it and the reason for the excess payment to the insurance company and return the money (French, p. 658-60).
9. Sister Mary Benedict Ramer, a new patient, is seen in consultation. She gives you her insurance card and asks whether she will be given a discount because she is a member of the clergy. How would you respond?
   • Offering such discounts is unfair to other patients and could lead to insurance fraud charges if a discount is given and an insurance claim is filed. The office payment policy does not allow professional discounts but allows a discount for patients who pay the whole bill in cash at the time of service. I could tell Sister Mary Benedict Ramer, “I am sorry, but we do not offer professional discounts, but we do offer a 20% discount if you pay your entire bill in cash at the time of service.”
10. Dr. Practon’s fee for an appendectomy is $568.36 (CPT code 44950). Mr. Jefferson’s hospital stay for his appendectomy was unusually troublesome. His first symptoms appeared after midnight, and he was admitted to the hospital as an emergency patient. A decision to operate immediately was postponed by Dr. Practon when the patient began to improve; however, he had several abnormal laboratory results. During the following night, the patient’s condition worsened, and the appendectomy was performed, thereby interrupting Dr. Practon’s sleep for a second night. After the operation, the patient had a bad case of postanesthesia nausea and was quite demanding while in the hospital. Would Dr. Practon be justified in charging him extra because he was “a lot of trouble?” Explain.
    • Dr. Practon should not charge a fee or an additional amount simply for being more trouble than other patients. However, if any other services were provided (or additional codes apply) to his hospital stay, emergency admittance, or complications, Dr. Practon can also charge for those additional items.
11. You send a bill for $1500 to Mrs. Jamison for a major surgery. She tells you that the physician told her in a presurgery conversation that the charge would be “about $1300.” Dr. Practon says he does not remember quoting the figure to her. If the usual charge is $1500 for this procedure, what should you do about the bill? Explain.
    • Doctors do not like discussing the numbers. Since he typically is not the one doing this, he may not remember the numbers correctly to quote to the patient. Dr. Practon should have referred Mrs. Jamison to his other office staff, who could help her with financial questions instead of discussing numbers in the exam room. They could have provided her with a good-faith estimate for the most accurate estimation of costs and also could have explained that the estimate is not guaranteed. This estimate would have been more accurate and prevented any misunderstanding. I would maintain the charge of $1,500 and explain to her that it is our standard charge for the procedure and that we cannot guarantee unofficial and informal verbal estimates.
12. Mr. French calls in complaining about an overdue refund. He, as well as the insurance company, paid for a procedure, and he is owed a return of his payment. You have been swamped with billing and reply that the statements come first and when you can “get to it” you will mail the refund. What is the proper procedure in this instance? Describe.
    • This response is not adequate and will only make Mr. French angrier. Patients do not want to hear that you will help them when you can get around to it. It would have been good practice to educate Mr. French about how refunds are conducted when I notified him about the refund. Then he would have known what to expect in advance. In this scenario, he may just consider the refund overdue in his own mind because he does not realize how the office conducts the refunds and thinks it is taking longer than it should (French, p. 660).
13. Patient Joanie Franklin comes in to see Dr. Practon for an initial visit. When asked about insurance coverage, she states, “According to our divorce settlement, my husband’s insurance should be billed first.” How would you respond?
    • This scenario sounds like a dual insurance situation, but a divorce complicates it. I would first ask her if the divorce is finalized yet. If the divorce is finalized, she most likely cannot use her husband’s insurance at all unless laws allow a period of continued coverage after the divorce is finalized. In this case, I would tell her she could only use her insurance. If the divorce is not yet final, I would explain to her that her policy is her primary policy and would need to be billed first. Her husband’s policy would be the secondary policy until the divorce is final (Singh, 2023).
14. An established patient telephones and says, “The letter I received from the insurance company said you charged too much.” How would you respond?
    • This scenario sounds like the patient does not understand the statement. I should remain patient and professional during the conversation. I should find his statement, and then I can review each item and its charges on the bill with him (French, p. 426). I should explain that the billed amount is what they were charging the insurance company and him. I would explain that this amount was a set charge based on a fee schedule. Then I would explain that the allowed amount is the amount the insurance company agrees to pay based on its contract with the physician and that it does not mean the insurance company thinks the doctor charged too much. Then I would say that the write-off or adjustment is just the difference between the two amounts (French, p. 429).
15. New patient Bill Songer comes in to see Dr. Gerald Practon. He says, “My wife handles all the bills, so you will have to call her.” How would you reply?
    • Since he is the patient and is responsible for payment, I would have to explain our payment policy to him. If he is uninsured, I would explain that he is responsible for payment at the time of service. If he has insurance, I would tell him that he will need to pay the copay now but that he could wait to pay the coinsurance amount and share the statement for that portion with his wife when he receives it.
16. An established patient was seen by Dr. Fran Practon and returned the following week to have a treadmill test. His insurance was billed; however, the EOB was sent to the patient denying payment for the test. The patient came in and stated, “My insurance should have covered that service.” What questions would you ask and what action would you take?
    • I would ask if he has paid his deductible. Then I would ask him if he knows his insurance covers this particular test because he may just assume it does. I should review the statement and EOB for errors. I could check for errors because the insurance company will deny the claim if the incorrect code is used or because of a filing mistake. If I find an error, I can resubmit the claim.
17. You call patient Mary Edwards regarding an overdue account and reach an answering machine—the patient is not home. What will you do?
    • I can leave a message and ask her to call the office. I should then write a note about making the call, leaving a message, and that she did not answer. I should try to call again the next day and continue to call her once daily. I should make a note about each attempt. If I cannot reach her, I should send a collection letter. If she still does not respond, I should notify her that we will send her account to a collection agency if she does not pay within the specified number of days. I will send her account to the collection agency if she still does not pay after the specified number of days and flag her account as having been sent to collections (French, p. 442).
18. A patient who has not seen Dr. Practon in a long time comes in for an office visit. Upon leaving, the patient states, “My attorney told me not to pay the bill.” What would you say and what question(s) would you ask?
    • I would stay professional and calm. I would ask why he waited until he was leaving to say this and why his attorney told him that. He seems like he could be a deadbeat, trying anything to get out of paying. The fact that he has not been to see Dr. Practon in a long time could indicate that he is doctor-hopping, and he waited until he was leaving to say this information instead of upfront despite being told the payment policy upfront. I would check his registration forms for missing information and other red flags. If information is missing, I would ask for this missing information. I could ask for his lawyer’s name and contact information for verification. This would be another red flag if he does not want to provide the information. I can still legally bill him if his answers do not indicate bankruptcy, and he should still be able to pay unless he is in financial trouble. I remind him of our payment policy and ask if there is anything I can do to assist him in making a transaction. Does he need a payment plan (French, p. 420)?
19. A long-standing patient owes over $500, which is now past due. She calls stating, “I have just declared bankruptcy.” How would you respond?
    • I should remain professional and courteous and thank her for informing us. I should verify that the bankruptcy judgment has actually been made. I must stop sending statements every month or continuing to try to collect. If the account has been sent to collections, then collections can no longer try to collect either. The physician should file a proof-of-claim form with copies of the patient’s bill (French, p. 443-46).
20. You are calling Jana Lynn Rose about an overdue account. Her spouse answers the phone and states that the patient is deceased. How would you respond?
    • I should be empathetic to her spouse for his loss. After the phone call, I should contact the county recorder’s office or the superior court probate department to find the name of the estate administrator. Then I should mail him in duplicate an itemized statement to collect an account for a deceased patient by certified mail with return receipt requested (French, p. 443).

References

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

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

Singh, P. (2023, March 17). If both spouses have health insurance which is primary? Insure.com. https://www.insure.com/health-insurance-faq/cob.html.

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