Best Practice Guidelines: Healthcare Practice Management

4. Debtors & Patients

Responsible Roles

Ensure that all information is checked by Reception. Double check that all patients have electronic files. Ensure there are knowledgeable personnel available at reception to open files on a daily basis.

Open electronic files of Debtors and Patients, upload all required documents and ensure the correct demographic details of debtors and patients. Do validations and benefit checks prior to the consultation. Double check the demographic information. When dependants pass away or get their own medical aid, they must be marked inactive and moved to their own electronic file.

Purpose of Debtors & Patients

It is essential that the correct information for medical debtors (the person responsible for the medical account, eg main members of medical aids or guardians of minors) and their dependants are captured so that claim processing and follow up will be successful. A patient's clinical information should also be saved to provide a useful medical history of the patient.

Critical Steps for Debtors and Patients

Create new debtor

A Medical Debtor is the person who is responsible for the account, eg

  • The main member of the medical aid and who signs an agreement accepting responsibility for the medical account of his or her dependants;
  • Any major private patient;
  • The guardian(s) of any minor patient;
  • Any person signing an agreement who accepts responsibility for the medical account on behalf of a patient (guarantor).

Make sure the following demographic information is correct and captured on the system:

  • Debtor and patient full names and surname
  • ID Numbers of both
  • Medical aid and plan, medical aid number and dependant number
  • Contact information of debtor and patient

At the opening of a patient electronic file, the patient validation and benefit check can be done to see if the patient is active on the medical aid. Some demographic information can be imported from medical aids, depending on the information different medical aids make available for import.

Add dependants

Dependants are the persons for whom the medical debtor is responsible. The main member will be responsible for all the invoices for dependants posted on his or her file.

Make sure that the dependant codes correlate to the dependant codes listed on the medical aid card to ensure successful claim processing. 

Dependants can be the children, spouses, step children or even grandparents.

Patient validations and benefit checks

Validate all medical aid patient files before the patients consult with the practitioner to ensure that demographic information is up to date. Update any incorrect or outdated information.

Use the benefit check to ensure that there are funds available on the medical savings account. Only three benefit checks are available on each patient file per day. The practice will request the medical aid if a certain amount is available and the system will reply with the availability. The system does not show the amount that is available in the patient’s savings account. Only the amount that the user has typed into the benefit checker will be checked.

Debtor and Patient Documents

  • There are different types of documents that can be scanned and uploaded into the software and linked to the electronic file of the patient.
  • Debtor document types: Financial, Personal or Practice documents.
  • Patient document types: Medical, Financial, Personal, Practice, Portrait or Correspondence documents.
  • Compulsory documents can be marked as required in the Web App. The document icon will show red until all necessary documents have been uploaded.
  • The debtor and patient IDs and medical aid documents can be scanned and stored in the debtor’s file.
  • This will eliminate the cost of printing and filling space and it will always be available in electronic format.

Make a patient inactive

If dependants get their own medical aids or pass away, they can be marked as inactive on the system. This will ensure that no further correspondence will be sent to those patients. All new notes and/or correspondence will be done on the new patient accounts or electronic files.

Some clinical notes can be copied from the old electronic files to the new electronic files.

Web App: Worklists for bureaux

Medical bureaux can use the stack view of the Web App diary as a worklist to help them manage all instructions they receive from clients. Opening of Debtors is the starting point of the workflow process as indicated on the above Medical Debtors Management diagram.

The diary statuses can be customised to assist bureaux to follow the progress on claims, eg

  • Invoiced - yellow
  • Submitted - purple
  • Receipted - green
  • Done - blue

Every day's instructions can be viewed as a batch and the progress will immediately be visible so that outstanding work and follow up work can be completed.

The booking types can also be used for information purposes, eg

  • Medical Aid claims
  • Private patient invoices
  • IOD claims

The following reports will assist bureaux to follow up on outstanding work and give quick progress reports to their clients:

  • Booking status report - provides information on outstanding work to be done depending on the status that was configured.
  • Turnover report - provides turnover per billing code (the practitioners can see which procedures are more viable for their business).
  • Doctor overview - provides turnover, journals, medical aid outstanding and patient outstanding totals.

Bureaux will be in a position to get a full overview of all instructions so that no claims will lapse due to human error.