10/9/2014. Loews Philadelphia October 14, :00 PM

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Donna Greene
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1 Loews Philadelphia October 14, :00 PM 1

LEGAL FINE PRINT The Physicians Playbook for Collections is presented for educational purposes only.

appropriate licensed attorney in your jurisdiction.

Health Care Compliance Association (HCCA).

2 LEGAL FINE PRINT The Physicians Playbook for Collections is presented for educational purposes only. The information contained in or discussed at this seminar is not intended to be legal advice and should not be used as a substitute for personalized legal advice from an appropriate licensed attorney in your jurisdiction. The presentation of legal news and information does not, and is not intended to, form any type of attorney client relationship with Emilie Rayman, Dix and Associates, or the Health Care Compliance Association (HCCA). Therefore, attending this seminar and using the information obtained herein does not and shall not be construed as establishing any type of attorney client relationship. Collections laws apply to Creditors collecting their own debts TCPA, FCRA, FDCPA, Data Breach [Encryption] [OIG, HHS, CFPB, FTC] Issues facing Collection agencies are similar to those issues facing medical providers By doing more up front you can improve front end collections and collections on accounts assigned to a collection agency 2

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Described Below (The Terms Of Service ) Covered Entity May Use/Disclose

5 You Can Do Whatever You Want! Biggest Lie: I Have Read, Understand, And Accept The Terms And Conditions Described Below (The Terms Of Service ) Covered Entity May Use/Disclose Phi To Carry Out Essential Health Care Functions: Treatment Payment Healthcare Operations 45 CFR (a),

FIRST YOU NEED A BOOK Every Regulator Is Going To Demand To See It First They Are Fishing Make Sure That The Book Is Followed FIRST YOU NEED A BOOK Book is admissible if: a) Made at or near the time

6 FIRST YOU NEED A BOOK Every Regulator Is Going To Demand To See It First They Are Fishing Make Sure That The Book Is Followed FIRST YOU NEED A BOOK Book is admissible if: a) Made at or near the time of the occurrence b) By employees who are under a business duty to make the record c) Kept in the ordinary course of business d) Kept in orderly fashion (files, or computer records) Absence of Business Record Can Prove that Event Never Occurred 6

7 CELL PHONES TEXT 7

8 IMUM ESSARY 8

9 WHAT IF I WANT TO SELL MY PLAYBOOK? You can sell Medical accounts Common Concerns/Contract Terms: Provider buy-back rights Prohibition of secondary market sales (no resale of accounts) Individual stop work protocols Recording of all inbound and outbound calls 9

10 REPORT: ONE IN FOUR AMERICANS HAS MORE MEDICAL DEBT THAN EMERGENCY SAVINGS PEOPLE FROM LOWER-INCOME HOUSEHOLDS ARE MORE CONCERNED ABOUT THEIR MEDICAL EXPENSES. TWENTY-FIVE PERCENT OF AMERICANS SAY THEY CURRENTLY HAVE MORE MEDICAL DEBT THAN EMERGENCY SAVINGS, ACCORDING TO THE MONTHLY HEALTH INSURANCE PULSE REPORT FROM BANKRATE.COM. THIS NUMBER NEARLY DOUBLES (TO 44 PERCENT) AMONG THOSE EARNING LESS THAN $30,000 PER YEAR. 10

11 MEDICARE BAD DEBT PAYMENTS Reasonable Collection Efforts: To be considered a reasonable collection effort, the PRM 15 1 at 310 requires that a provider's effort to collect Medicare deductible and coinsurance amounts be similar to the effort the provider puts forth to collect comparable amounts from non Medicare patients. Specifically, the collection effort must involve the issuance of a bill on or shortly after discharge or death of the beneficiary to the party responsible for the patient's personal financial obligations. Delays in sending a timely first bill could result in the disallowance of the bad debt claim. Additionally, the PRM indicates that the collection effort should include other actions such as subsequent billings, collection letters and telephone calls or personal contacts with this party which constitute a genuine, rather than a token, collection effort. The provider's collection effort may include using or threatening to use court action to obtain payment. MEDICARE BAD DEBT PAYMENTS Can you Collect Interest?: CFR (b)(2)(ii) provides in pertinent part as follows: "To collect only the difference between the Medicare approved amount and the Medicare Part B payment (for example, the amount of any reduction in incurred expenses under Sec (c), any applicable deductible amount, and any applicable coinsurance amount) for services for which Medicare pays less than 100 percent of the approved amount. MEDICARE BAD DEBT PAYMENTS Use of Collection Agencies: Section 310(A) of PRM 15 1 permits the provider's collection effort to include the use of a collection agency in addition to or in lieu of subsequent billings, follow up letters, telephone and personal contacts. Where a collection agency is used, Medicare expects the provider to refer all uncollected patient charges of like amount to the agency without regard to class of patient. The "like amount" requirement may include uncollected charges above a specified minimum amount. Therefore, if a provider refers to a collection agency its uncollected non Medicare patient charges which in amount are comparable to the individual Medicare deductible and coinsurance amounts due the provider from its Medicare patient, Medicare requires the provider to also refer its uncollected Medicare deductible and coinsurance amounts to the collection agency. Where a collection agency is used, the agency's practices may include using or threatening to use court action to obtain payment. 11

12 MEDICARE BAD DEBT PAYMENTS Use of Collection Agencies (cont.): According to PRM (B), when a collection agency obtains payment of an account receivable, the full amount collected must be credited to the patient's account and the collection fee charged to administrative costs. For example, where an agency collects $40 from the beneficiary, and its fee is 50 percent, the agency keeps $20 as its fee for the collection services and remits $20 (the balance) to the provider. The provider records the full amount collected from the patient by the agency ($40) in the patient's account receivable and records the collection fee ($20) in administrative costs. The fee charged by the collection agency is merely a charge for providing the collection service, and, therefore, is not treated as a bad debt. Presenters LLOYD DIX Dix & Associates Mulholland Hwy. PMB 414 Calabasas, CA O: (818) F: (818) Lloyd@dixandassociates.com EMILIE RAYMAN Community Memorial Health System O: (805) F: (805) M: (310) erayman@cmhshealth.org 12

CMS Reasonable Collection Requirement Probate and Bankruptcy

CMS Reasonable Collection Requirement Probate and Bankruptcy Introduction Angela Horn Contributor to national publications Longterm Living, Healthcare Finance News, HFM Magazine, Credit and Collections