Health Care Finance 

Discussion Questions

1.)  

 a.) How often will a statement usually be sent out if there is a balance on the account?

 b.) In which part of the process is patient information verified?

 c.) What percentage comes from private pay insurance?

 d.) In which part of the process are no shows explained?

 e.) In which part of the process are fee schedules discussed?

2.) Tom Anderson is the controller for Morningside Medical Clinic. At the end of each month, the financial management system used by Morningside generates a series of standard financial reports. In his review of the current reports, Mr. Anderson notices that the accounts receivable aging report shows that patient accounts receivable over 60 days old has been steadily increasing over the past 6 months and is increasing at a rate faster than the growth of inpatient visits and scheduled fees for services. An accounts receivable aging report is a report available in computerized financial management systems that categorizes receivables based on the number of days elapsed since the date of service. Receivables are grouped as:

· Receivables less than 30 days old

· Receivables between 31 and 60 days old

· Receivables more than 60 days old

         This report serves as a measurement of the effectiveness of the medical facility’s billing and collection procedures.

         Morningside has detailed procedures in place to collect patient deductibles and copayments at time of service as well as procedures for billing account balances remaining after payments from insurance. Mr. Anderson calls a meeting with both employees responsible for receiving payments from customers at time of service and accounting personnel responsible for accounts receivable. The employees charged with the responsibility of receiving payments at time of service share an embarrassed look and admit that at times of high patient volume, they will sometimes tell patients that no payment is due simply to avoid delays at checkout. The accounts receivable clerks then share with Mr. Anderson how heavy their daily workload is and admit to neglecting to bill patients for balances due when other work needs to be completed. Mr. Anderson now understands the reasons behind the growth in accounts receivable balances. What steps would be appropriate to resolve the problem?

3.) Mrs. Johnson is an established patient of the medical practice. She comes into the office for her scheduled appointment and is seen by Dr. Smithers. At the checkout station, instead of paying her office visit copayment, she informs the cashier: “Dr. Smithers said that I did not have to pay today.” The cashier reports the incident to the practice manager. What steps should the practice manager take in a case like this?

4.) Ann Reynolds has recently been hired as practice manager for Dr. LaRue. In reviewing the financial records of the practice, she notices that a substantial amount of money is owed by patients with outstanding balances. Further review finds that the practice has no written financial policies outlining the responsibility of patients in paying for their costs of medical care. Outline a set of basic financial policies to address patient responsibility for payment of charges.

5.) Tom Gregory is the practice manager for a local urologist. The practice has a detailed set of financial policies dealing with required payments from patients, but the staff have not been enforcing the policies and patients are not familiar with the requirements or the reasoning behind these policies. 

 How does Mr. Gregory address this issue? 

6.) Granite State Medical is experiencing claims denials in a larger percentage than industry average. As the practice administrator, what steps would you take to bring down the percentage of denials? 

7.) As practice manager for a single-physician medical office, you notice that the physician is coding most patient contacts as simple office visits, and the practice is reimbursed by insurance at the lower reimbursement level. How do you ensure that the practice is paid for all appropriate costs of medical services provided?

8.) John Donald is an established patient of the medical practice with chronic health conditions. Mr. Donald also has a history of missing appointments without any prior notification to the practice. As the practice manager for the office, what steps would you take to convince Mr. Donald to stop missing appointments?

9.) Dr. Findley and Dr. Rocker are partners in a family medicine practice. The practice appears to be busy and well run, but always seems to be short on cash at the end of the month. Billing rates are appropriate, and staff member salaries and draws of the partners are in line with the area. You are the practice administrator, and the partners have asked that you review the problem and make recommendations. What areas will you look at to improve the revenues of the practice? 

 There's no word count requirement 

Chapter 11 

Course Materials- Cengage 2nd edition: Introduction to Health Care Finance and Accounting- Carlene Harrison and William P. Harrison