Best Practice Guidelines: Healthcare Practice Management & POPIA Compliance Framework

Best Practice Guidelines: Healthcare Practice Management

POPIA Compliance Framework




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15. Debt Management: Roles & Purpose

15.2. Debt Management Business Processes

The following steps need to be followed on a daily/weekly and monthly basis to ensure the most successful debt collecting process. 


Process Audit (Steps 1 - 4)

1. Billing 

Ensure that all transactions were billed to the patients account before claiming. Check that all patient billing is up to date and that no files are misplaced.

2. Claims 

All claims must be up to date. The debt management can not start if the claim administration chapter is not done. Ensure that all claims have been submitted. Reverse, Redo, Resend and Resolve where applicable.

3. ERA/RA/Patient Receipts

All ERA’s (Electronic Remittance Advice), RA’s (Remittance Advice), and Patient receipts must be up to date and posted to the accounts. This ensures the correct outstanding amount to reflect on the account. The correct dates must be used in order for the outstanding accounts to be under the correct age. Please follow the Receipting chapter for more detail. Confirm that the patient is aware of the outstanding amount that was not paid by their medical aid.

4. Unlinked Receipts

Draw the unlinked receipt report and confirm all receipts has been posted. This will ensure the correct age and that the correct invoices are followed up on. 


Account Clean Up (Step 5)

5. Journals & Journal Actions

Journal Actions are set up to only post as Credit or Debit amounts. The employee will not be able to manually use a plus or minus, the action will be set up to use the correct plus or minus according to the settings. Journal actions is linked to the correct Ledger account. The description is fixed. Management will decide on the Journal actions and the personnel will only choose the correct action to use.

The following journal actions can be pre-setup, and are used for the following:

  1. Small balance write off
  2. Settlement Discount
  3. Bad debt write off.

It is advisable that small balances and bad debt is regularly written off so the primary focus can be given to the collection of money that can be collected.


Collection process (Step 6 - 9)

The following steps can be part of the CCA function or part of the manual process in the practice.

6. Invoices Outstanding Report

  • Invoice outstanding report will indicate all the invoices that still has an outstanding amount on the Invoice. These are Invoices where a receipt was done but not for the full amount of the Invoice. Ensure the correct invoices are on the report and none of the invoices on the report are already paid in full.
  • The Invoice outstanding report can be grouped by days outstanding. Contact all patients with outstanding invoices that doesn't have an arrangement with the practice for paying the outstanding money.
  • Contact the Medical aids that are 30 days+ outstanding and follow up why the Invoices has not been processed for payment and the reasons for non payment.
  • Ensure all notes are done and up to date on all the outstanding invoices, and all the calls have been logged. 
  • Debtor Statuses can be linked to Debtors that have overdue accounts or have payment arrangements with the practice for paying off the outstanding amounts in installments.


7. Age Analysis Report

  • The Age Analysis report is used for showing all the outstanding accounts, Medical Aid and Patient outstanding accounts. 
  • The Age Analysis report will indicate all the accounts with an outstanding Amount/s. The report can be drawn in different ways to display the information, for example grouped by medical aid or grouped by service centre. Filters can be applied on amounts or the age the amounts are outstanding.
  • The age analysis must always be drawn not equal to zero to include the accounts that's in credit too. Accounts that's in credit must be followed up on to confirm if the amount must be refunded or kept for the next visit. 
  • The practice can send out SMS’s directly from the age analyses to the patients, with pre-setup SMS templates with the necessary information. 
  • Remember to save all notes and conversations that occurred between the practice and the patient.


8. Communication

Communication is the most important part in debt management. Without communication debt collection can not be done. Communication consists of sending SMS’s, Emails or making Phone calls. Statements can be added to the emails that are sent to the patients.

Statement runs can be used at a certain cycle to ensure the patient has the details of the outstanding account and practice banking details.

The Notebook is used internally to keep track of accounts and any communication between the practice and the patient. SMS and Emails that were sent from GoodX to debtors will automatically be logged in the Notebook. 

SMS / Email History

  • SMS - Short Messages Service.
  • EMAIL - Electronic Mail
  • SMS / Email History is a screen that shows all the SMS's / Emails that were sent to a cell number / email address. This is the Management screen of sms and emails to show which SMS and emails were sent.
  • The screen will also show all the SMS’s and Emails that failed to send or were cancelled. 

Telephonic Credit Control – Medical Aids

If a medical aid account has not been paid within 30 days after the electronic submission, the practice needs to follow up on a two-weekly basis. The practice needs to phone the medical aids to get confirmation of the following:

  • Did they receive the account electronically?
  • If yes – when can the practice expect a payment, what is the cause of the delay?
  • If no, resubmit via EDI again.
  • Always make notes on the system of all conversations with medical aids.

Use the same opportunity to do your queries on short payments and any other uncertainties. 

Notebook

  • The notebook will keep track of all SMS and Emails that were sent from the system. 
  • All communication between the patient or medical aid and the practice must be documented in the notebook. 
  • The notebook can be printed out and used in cases when the outstanding amounts must be handed over. 

Remember if there are no notes, the action did not happen.  

Debtor Statement Run

  • After all billing, receipts and corrections are done.
  • Debtor statement run can be used to create all the statements with outstanding patient accounts
  • The statements can be sent to all the patients that have email details captured in their demographic data. 

Check the error messages of the statements that we’re unable to send. 


9. Bad Debt Administration

Before an account can be handed over for legal action the following needs to be in place:

  • Notes on GoodX which serve as proof that all necessary credit control actions have been performed
  • Print the detailed account
  • Complete a Bad Debt Hand Over Form and ask the Practice Manager to sign it off
  • The Bad Debt Hand Over Form should contain the following information:
    • Name and Surname of the Guarantor.
    • ID Number
    • Patient account number
    • Amount to be handed over
    • The reason why the account is being handed over
  • The correct information the Debt collecting firm needs must be included. Each practice will need its own documentation for the handover process.