Patient Billing

Learn about:

• How to work with the tabs
• Features found on every tab
  • Filtering
  • Sorting
• Reviewing the patient account
• Changing your statement schedule
• Patient Responsibility tab
• Action buttons
• Some suggestions

How to work with the tabs

To get to the Patient Billing page, hover over Claims on the navigation bar and click Patient Billing. The Patient Billing page has the following tabs:

• Active

• Final statement pending

• Final statement sent

• Collections letter sent

• Other suspensions

• Estates

• Payment plans

Active

The "Active" tab shows all accounts that have at least one claim in the account where the patient is the current payer.  On this tab you can find the patient name, account number, the date the last statement was sent, amount paid by the patient, and outstanding patient responsibility.

Final statement pending

The "Final statement pending" tab shows a list of patients who are down to the wire – they only have one more scheduled invoice. You may want to use this list to send final notices, call the patient to ask for a payment or to inquire if they received retroactive Medicaid.

Final statement sent

The "Final statement sent" tab shows accounts that the system automatically suspended because the patient has received the maximum number of statements, and the number of statements set on the statement interval has passed. The system is no longer sending patient statements to these patients and all associated claims for which the payer is the patient have been suspended. It is time to make the determination of what to do next – send another patient statement, move this account to collection agency/state debt collections, or write off the amount as bad debt. You will want this tab to be empty so work these case daily.

Collections letter sent

This "Collections letter sent" tab shows the account, number of claims, last statement date, the day you sent the collection letter, and account balance.

Other suspensions

The "Other suspensions" tab shows accounts that a user manually suspended. A user can manually suspend an account by clicking the "Review" icon and then the "Suspend patient billing" button. The reason for the suspension displays under the "Suspension reason" column. Accounts under this tab need to be worked daily. If a new claim opens for this account, the claim will be sent to the patient’s insurance but if the patient becomes the payer, the system suspends the claim and automatically lists it under the "Final statement sent" tab.

Estates

User accounts can be suspended with one of two estate reasons:

• Clam against estate filed

• Claim against estate needed

This suspension is applied to all claims that are currently in patient billing and future claims for this patient. If the account is suspended with one of these estate reasons, invoices will not be generated for this patient.

Estate suspended accounts can be managed on the Patient Billing page under the "Estates" tab.

There is more helpful information in this Estates in Probate video.

Payment plans

The "Payment plans" tab shows a list of patients that have a negotiated payment. Click the icon under the "Review" column to remove the patient from the plan, determine future steps, and view open claims and patient statements. For more information, see Patient payment plans.

Features found on every tab

Filtering

Use the boxes under the column headings to enter a letter or number. The screen will filter to show data with that name or number.

Sorting

Click the heading name to sort rows by ascending or descending order.

Reviewing the patient account

Click the review icon to view the patient's account. This page will help you to determine the best way to deal with the account. It shows the patient’s propensity-to-pay, current patient responsibility, running balance, and statement details.

With the exception of the "Final statement sent" and "Other suspensions" tabs, the Review window displays the same information regardless of which tab you are on. You can suspend the account, edit the reason for the suspension, remove the suspension, and send another statement.

Patient Responsibility tab

This tab displays when you review an account on the Patient Billing page and on the Account page. It contains:

• The patient’s propensity-to-pay information: Propensity-to-Pay runs automatically when the patient is new, when the claim moves to Patient Billing, and when a user accesses the Patient Billing page. The results of the propensity-to-pay query is divided in four categories, credit score, available credit, income compared to federal poverty level, and likelihood to pay.
• Income compared to FPL: The Federal Poverty Level (FPL) is used to measure a household's poverty status. This level can help determine if the individual can qualify for Medicaid.
• The likelihood to pay value is derived from the credit score:
  • Low: Credit score 0 – 500
  • Medium: Credit score 500 – 600
  • High: Credit score over 600
• A list of claims with charges and payment information displays under "Current patient responsibility." Use this tab to see if the patient has made any payments. If they have, you may want to send another statement.
• At the bottom of the page, under "Patient statements", a list of sent statements along with the date of the next scheduled statement displays.

Action buttons

The following action buttons display on the "Patient responsibility" tab.

Move to Collections Agency

Use this action button to move the account to a collection agency. The first time you click this button, you will need to enter the collection agency information.

Once entered, you will have the option to select that collection agency or create a new one.

When you send the account to a collection agency, the status of all the claims in patient billing for that account changes to "Closed - In collections." The write off amount displays on the "Move to collection agency" window. In addition, we add the collections agency as the final payer on the claim level COB. This allows you to post payments from the collections agency when they collect money.

Use this action button to move the account to state debt collections. Start by selecting the state from the drop-down list and clicking Confirm.

After you click Confirm, the status for all claims in the account with the patient as the current payer changes to "Suspended – In state debt collections." The status is suspended (not closed) which means you don’t have to write anything off your books after performing this action. If the state collects from the patient, you can post the payment because the state is added as the final payer on the claim level COB.

Use the "Suspend patient billing" button to manually suspend an account.

There are two ways an account can be suspended:

• Automatically - Exceeds the number of sent invoices: The system suspends the account if the number of sent invoices is equal to or exceeds the value set in the statement schedule. When this is the case, the account displays under the "Final statement sent" tab on the Patient Billing page. To remove the suspension, click "Send another statement." This action removes the account from the list on the "Final statement sent" tab and changes the status on the claims associated with the account to "Queued for submission – Patient statement."
• Manually – Biller suspended: A biller can manually suspend the account because of an account review, when a patient address is needed, or when a patient is homeless, bankrupt, or sent a grievance.

When an account is manually suspended, the following things happen:

• ZOLL Billing will no longer generate patient invoices on existing claims associated with this account. This is true even if the number of patient invoices has not exceeded the statement schedule.
• ZOLL Billing will not generate patient invoices on future claims associated with this account. However, if the patient has insurance, the claim will still be sent to the insurance provider.
• You can continue to post to this account.

In cases where collection is not worth the effort or impossible to obtain, use the "Write off as bad debt" option. After you click Confirm, the status for all the claims associated with the account changes to "Closed – Balance resolved." The system shows the write off amount.

Running account balance

This tab shows the running balance of all the claims associated with the account. This list is dynamic, as claims are added or payments are made, the running balance changes. There is an option to print the running balance.

Note: You can add a company logo at the top of reports that you print (see Add a Company Logo to Invoices).

Claims in collections

This tab shows a list of claim numbers associated with this account that have been sent to collections or state debt. Click the claim number to view the claim details.

Some suggestions

If the account is not in collections, you can use a combination of the information from the "Patient responsibility" and "Running account balance" tabs to help make a determination on your next steps. Here are some examples:

• If the credit score is over 600 (high) with a high likelihood to pay, you may want to send another statement.
• If you are in the "Final statement sent" or "Other suspensions" tab and the number of sent statements exceeds the maximum number configured in the statement schedule, you can generate an additional statement by clicking the "Send another statement" button.
• If the income compared to FPL is low, you may want to contact the patient and see if enrollment in Medicaid is an option.
• If the credit score and likelihood to pay are low, and the patient has never made a payment, you may want to either move the account to collections or write off the balance as bad debt.