# small monthly payments from patients



## lisaevans (Apr 5, 2013)

Hi All!  I work the patient ticklers (among many other things) in our practice's billing office and I'm having an issue with patients with very high balances $700+ who are making very small monthly payments of $5 - $10.  The payments are consistent, but the AR for 120+ days is higher than it should be and that is obviously the reason why.  The Billing Manager expects me to call these patients and tell them that our office cannot accept such small monthly payments on such a high balance.  Every patient I call gives me a reason as to why they can't pay more:  "I'm on a fixed income, it's all I can afford", "I'm out of work", etc.  Never once has a phone call successfully raised that patient's monthly payment and I feel like I'm wasting my time, plus it's mentally and emotionally draining to spend 20 minutes on the phone with each patient listening to all of their woes.  Does anyone perhaps have any suggestions and/or perhaps a  template letter to the patient that they use which explains this that they would be willing to share?  (These are patients that the physician has seen on rounds at the hospital - we have no way of collecting money up front to avoid this issue and most are self-pay, as well.)

Also, patients get very upset when they're making monthly payments and still get turned over to collections because the payments are too small.  They assume that because they make consistent monthly payments we cannot turn them over.  Does anyone know of a federal or state (Georgia) statute that I can refer to which states that we reserve the right to turn balances over that aren't paid promptly?

All advice and suggestions are welcome and much appreciated.  Thanks!


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## jennburgel (Apr 14, 2013)

*small payments on large balances*

Does your practice have a policy in place for payment plans, we have our pts sign out plan which makes it legal and binding.  They must pay 1/2 now and we break the rest into 3 monthly payments.  We get them to sign this up front and if they miss a payment for three consequetive months they will be placed in collections.  We get it on they way in so we don't have to get it in the back end so much. Hope this helps.


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## mitchellde (Apr 14, 2013)

lisaevans said:


> Hi All!  I work the patient ticklers (among many other things) in our practice's billing office and I'm having an issue with patients with very high balances $700+ who are making very small monthly payments of $5 - $10.  The payments are consistent, but the AR for 120+ days is higher than it should be and that is obviously the reason why.  The Billing Manager expects me to call these patients and tell them that our office cannot accept such small monthly payments on such a high balance.  Every patient I call gives me a reason as to why they can't pay more:  "I'm on a fixed income, it's all I can afford", "I'm out of work", etc.  Never once has a phone call successfully raised that patient's monthly payment and I feel like I'm wasting my time, plus it's mentally and emotionally draining to spend 20 minutes on the phone with each patient listening to all of their woes.  Does anyone perhaps have any suggestions and/or perhaps a  template letter to the patient that they use which explains this that they would be willing to share?  (These are patients that the physician has seen on rounds at the hospital - we have no way of collecting money up front to avoid this issue and most are self-pay, as well.)
> 
> Also, patients get very upset when they're making monthly payments and still get turned over to collections because the payments are too small.  They assume that because they make consistent monthly payments we cannot turn them over.  Does anyone know of a federal or state (Georgia) statute that I can refer to which states that we reserve the right to turn balances over that aren't paid promptly?
> 
> All advice and suggestions are welcome and much appreciated.  Thanks!



If a patient is making regular monthly payments and you have never refused them, I do not beleive you can then turn them to collections just because you feel it is too small of an amount.  If a patient cannot pay then it is up to you to help them come to terms in a contract they and you can accept.


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## seanny (Apr 16, 2013)

I am dealing with the same thing.  If a patient is making any payment regularly, I don't believe you can turn the account over to collections.

I live by the mantra: "We are not a finance company."  We have employed a partnership with carecredit, so that the patient may pay us in total and finance it through a third party at little or no interest.  This has helped quite a bit.

We offer everyone this option first, so that we are not expected to wait years to get the balance paid.  It certainly is a challenge!!


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## airart (Apr 16, 2013)

*Debt Collections and Collection Agencies*

Actually, even if the patient is making some sort of payment towards their balance, but its not what was agreed upon, in writing by the physician practice originally then the practice may use internal collectors or sell the patients debt to a collection agency.  This would benefit the provider by getting off old debt and getting some kind of payment now versus from a patient that is slow or no to pay.  

This is why every provider needs to make clear what the provider's payment policies are from day one of seeing the patient.  For your scenario of receiving info on patients from the back end, contacting them as soon as possible and letting them know what the provider's payment policies are is key.  Set up an agreement then or mail an agreement to them of their choices, if none are agreed upon by the patient and followed by the patient thereafter agreement then you can sell the debt to a collection agency.  

HIPAA agrees that debt collectors are a part of the process of payement, but there are restrictions that a provider must follow in regards to the privacy rule before selling the debt which are listed below:

Does the HIPAA Privacy Rule prevent health plans and providers from using debt collection agencies? Does the Privacy Rule conflict with the Fair Debt Collection Practices Act?

Answer:

The Privacy Rule permits covered entities to continue to use the services of debt collection agencies. Debt collection is recognized as a payment activity within the “payment” definition. See the definition of “payment” at 45 CFR 164.501. Through a business associate arrangement, the covered entity may engage a debt collection agency to perform this function on its behalf. Disclosures to collection agencies are governed by other provisions of the Privacy Rule, such as the business associate and minimum necessary requirements.

(Link: http://www.hhs.gov/ocr/privacy/hipaa/faq/disclosures/268.html)

Title 45 - Public Welfare
Volume: 1Date: 2002-10-01Original Date: 2002-10-01Title: Section 164.501 - Definitions.Context: Title 45 - Public Welfare. SUBCHAPTER C - ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS. PART 164 - SECURITY AND PRIVACY.

Subpart E - Privacy of Individually Identifiable Health Information. 
§ 164.501Definitions.

Link to an amendment published at 67 FR 53266, Aug. 14, 2002.As used in this subpart, the following terms have the following meanings:
Payment means:

(1) The activities undertaken by:

(i) A health plan to obtain premiums or to determine or fulfill its responsibility for coverage and provision of benefits under the health plan; or

(ii) A covered health care provider or health plan to obtain or provide reimbursement for the provision of health care; and

(2) The activities in paragraph of this definition relate to the individual to whom health care is provided and include, but are not limited to: 

(i) Determinations of eligibility or coverage (including coordination of benefits or the determination of cost sharing amounts), and adjudication or subrogation of health benefit claims;

(ii) Risk adjusting amounts due based on enrollee health status and demographic characteristics;

(iii) Billing, claims management, collection activities, obtaining payment under a contract for reinsurance (including stop-loss insurance and excess of loss insurance), and related health care data processing;

(iv) Review of health care services with respect to medical necessity, coverage under a health plan, appropriateness of care, or justification of charges;

(v) Utilization review activities, including precertification and preauthorization of services, concurrent and retrospective review of services; and

(vi)Disclosure to consumer reporting agencies of any of the following protected health information relating to collection of premiums or reimbursement:
(A) Name and address;
(B) Date of birth;
(C) Social security number;	
(D) Payment history;
(E) Account number; and	
(F) Name and address of the health care provider and/or health plan.

(LINK: http://www.gpo.gov/fdsys/pkg/CFR-2002-title45-vol1/xml/CFR-2002-title45-vol1-sec164-501.xml)


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## lisaevans (Apr 18, 2013)

Thanks everyone - I'm bringing this to the next staff meeting!


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## ajb1986 (Apr 19, 2013)

Yeah you cannot send them to collections if they are making monthly payments just because the payments are too low. If they are not paying at all you can but there is a time limit, and you have to warn them with collection letters. I believe if they havent responded to bills or letters after 120 days you can turn them over. If they make a payment then start skipping out the process starts all over again.

Best option is to just take what their getting but establish a new protocol with anyone who goes on a payment plan from here forward.


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