# Presentation: 781966

## Managing Debt Collection & Advanced Debt Collection Procedures

- Ms. Sharon Sorrell, BOM
- Mr. Bernie Yazzie, BOC
- April 16, 2003
- “Partners for Compliance”

## Re-Engineering

- Business Office Standards of Operational Procedures (BOSOP)
- Process and operational changes to the traditional IHS Business Office structure
- Revised PDs – Billing Technicians and Accounting Technicians
- New PDs – Voucher Examiner (Collections – focus on follow-up)
- New Section – File Clerk (Maintains financial files)

## Collections – Voucher Examiner

- Understanding timely filing limits
- Work assignments by payer
- “Working the telephone”
- Changing payer behavior
- Appealing denials
- Understanding billing functions (CPT, ICD-9, HCPCS & E/M coding)
- Tracking and Monitoring denials
- Communication back to billing section

## 3-StepApproach to Third Party Debt

**3-Step****Approach to Third Party Debt**

**Phase I: ****Intense, **
**Condensed Internal **
**Follow -Up Procedures**

**Phase II: Transworld **
**Insurance Resolution System:  Early In-House use of a Licensed Third-Party Collection Agency**
**Driving Dollars recovered, Valid Denials, and Correspondence back to Medical Center**

**Day 131 – Federal Debt Management / ****Treasury Offset Program / Dept of Justice **

**Phase III:  DEBT Management Program**

**29-30% Contingency Fee**

## Medical Center Benefits

- Collection Agency Impact
- 65% Recovery and Resolution of Aged Bills
- Reimbursement for a fixed fee, no percentages regardless of size of bill
- Lower Cost to Resolve Bills
- Corresponding State Reimbursement Law Listed on Transworld Collection demand
- Ensures ALL Bills are Systematically Worked
- Process Improvement - Productive use of internal A/R follow up efforts

## Existing Partners

- Redlake, MN
- Tahlequah, OK
- Santa Fe, NM
- Winslow, AZ
- Shiprock, NM
- Gallup, NM
- Sharon Sorrell feels the Customer Service she receives from Transworld is second to none.  Whenever Gallup has a technical situation, Transworld is right on top of it with their MIS staff.  Also, the software interface makes the contract easy to use.

- WW Hastings
- 	Total Collected as of Oct 1st $246,457
- 	4827 Bills Transmitted
- 	Cost $22,928 or 9.3%
- 	Return per Bill Transmitted $51
- 	ROI 10.75 to 1
- 	March ’03 collected $36,236
- Gallup IMC
- 	FY 03 Collected $22,168
- 	$314,856 Total Resolution
- 	864 Bills Transmitted
- 	Cost $4104 or 18%
- 	Return per Bill Transmitted $25.65
- 	ROI 5.4 to 1

- For more info: Mike Buske (281) 480-1977 ext #4 michaelb@gotsi.com

## Advanced Debt Collection

- Utilizing “Bill of Collections” through FMS
- Navajo Area Approach
- First, the Business Office must certify that their debts are valid and due process has been completed.  "Due process" basically means that you had submitted claim(s) to the payer/patient over a period of time and the debt has not been resolved.
- Business Offices should establish a financial file for each Non-Ben account.  The financial file should contain a copy of the claim, and all documents related to your attempts to collect the outstanding debt (E.g. RPMS A/R Message, telephone discussions, promissory notes/payment agreements, etc.)

## The purpose of the financial file is to provide a proof of "due process."

Service Unit-Business Offices should create an adjustment category in RPMS-Accounts Receivable Module, called "Debt Management".

Service Unit-Business Offices should establish a timeline of claim processing, submission, and follow-up.  Please use the following as an example:

			a)  Biller approves itemized claim (within 72 hours of             		visit)
			b)  Certified mail (claim) is sent to patient
			c)  Thirty (30) days after claim generated, send a 		"Notice to Collect" letter to patient.

- Service Unit-Business Offices should create an adjustment category in RPMS-Accounts Receivable Module, called "Debt Management".
- Service Unit-Business Offices should establish a timeline of claim processing, submission, and follow-up.  Please use the following as an example:
- 			a)  Biller approves itemized claim (within 72 hours of             		visit)
- 			b)  Certified mail (claim) is sent to patient
- 			c)  Thirty (30) days after claim generated, send a 		"Notice to Collect" letter to patient.

- Advanced Debt Collection (cont.)

## 			d)  Fifteen (15) days after "Notice to 				Collect" letter was sent, send a "Final Notice to 		Collect" letter to patient.
			e)  Fifteen (15) days after Final Notice letter was 		sent, create Bill of Collections document, 			forward to Area-Finance Office				f)  Close-out claims in RPMS-A/R using 			adjustment category - Debt Management.

    *Please note that the age of the debt is a significant factor in collecting outstanding debt.  Please use "Debt Management" adjustment category.  Reports can be generated in RPMS to identify total dollars amounts written-off for debt management. 

- 			e)  Fifteen (15) days after Final Notice letter was 		sent, create Bill of Collections document, 			forward to Area-Finance Office				f)  Close-out claims in RPMS-A/R using 			adjustment category - Debt Management.
-     *Please note that the age of the debt is a significant factor in collecting outstanding debt.  Please use "Debt Management" adjustment category.  Reports can be generated in RPMS to identify total dollars amounts written-off for debt management.

- Advanced Debt Collection (cont.)

## Other factors to consider before beginning BOCs:
Create a dollar threshold for Bill of Collections.  It's strongly recommended that Service Units set the limit at $50.00 (fifty dollars.)
Create another adjustment category called, "Bad Debt FY2002."  You should create several categories representing each fiscal year.
A/R reports would reflect totals for write-off.

- Create a dollar threshold for Bill of Collections.  It's strongly recommended that Service Units set the limit at $50.00 (fifty dollars.)
- Create another adjustment category called, "Bad Debt FY2002."  You should create several categories representing each fiscal year.
- A/R reports would reflect totals for write-off.

- Advanced Debt Collection (cont.)