User Guide — Managing Collections

 

Step 1: Make sure that you have an active contract in place with the collection agency

 

Step 2: Set up the custom transaction code for the collection agency

 

For each collection agency that you use, you must create a unique agency-specific transaction code. All collection adjustments and recoveries are tagged with the custom transaction code for the agency that you use. The custom transaction code identifies the collection agency in the Activity Wizard report and the Collections AR Report.

1. Display the Custom Transaction Codes page: On the Main Menu, click Settings > Practice Manager. In the left menu, under Practice Links — Miscellaneous, click Custom Transaction Codes.
2. Code — Enter a unique code to be used for collections, such as AGENCY1COLLECTIONS.
   Note: For reporting purposes, each custom transaction code used for collections should correspond to a single agency.
3. Name — Enter the name of the collection agency.
4. Text on Patient Statement — You can enter text in this field that will be printed on patient statements when this transaction code is applied to a patient balance.
5. Note — Enter any internal notes about this transaction code. We strongly recommend including the name of the person who created this custom transaction code, the date added, and any details about the collection agency that others may need to know.
6. Click Save.
   The custom transaction code appears in the list below.

Step 3: Set up the collection agency

 

athenahealth maintains electronic connections with established agencies. Collection files created by the practice will be submitted electronically by athenahealth on behalf of the practice. To view a list of Marketplace partner and established agencies, see the list of established collection agencies.

 

Important: If your practice would like to use Transworld Systems (TSI) as your collection agency, please contact TSI to set up an account. The TSI service representative will walk you through the athenaOne setup steps when you establish your TSI account.

1. Display the Collection Agencies page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Collections, click Collection Agencies.
2. Click Add new. Additional fields appear.
3. Name — Select the name of the collection agency. This menu contains the list of Marketplace partner and established agencies.
   Note: If you choose to use a non-established agency, select the Other (Non-established agency) option from the menu. For more information, see "To set up a non-established collection agency" on the Collection Agencies page.
4. Custom transaction code — Select the custom transaction code that you created for this agency.
   Note: You create and administer custom transaction codes on the Custom Transaction Codes page.
5. Who submits batches for this collection agency? — When this field is set to athena, all collection files will be delivered to the agency through our secure electronic connection.
6. Status — Select Active to indicate that the practice has an active contract in place with the collection agency.
7. Customer ID — Enter your agency-provided customer ID, if required by the agency.
8. Display Order — Enter a digit to specify the order of this collection agency in the list of agencies. Agencies with lower order numbers appear nearer the top of the list.
9. Notes — Enter any notes about this agency. We strongly recommend including the name of the person who created this collection agency, the date added, and any details about this agency that others may need to know.
10. I agree — Select this option to confirm that your practice is already contracted with the collection agency.
11. Click Save, or click Save and Add Another to add another collection agency.

 

Charges can become eligible for collections outside the normal statement cycle when you change the status of a claim to COLLECT. You can enter COLLECT as a kick reason from the Claim Action page.

1. Make sure that the patient has an outstanding patient balance (only patient balances can go to collections, not insurance balances).
2. Display the View Claim History page: On the Patient Actions Bar, click Billing, and then click View Claim History.
3. Locate the claim that contains the charge, then click the Claim Action page link below the claim number.
   The Claim Action page appears.
4. Actions — Select Add Kick Reason from the menu.
   The Add Kick Reason view appears.
5. Applies to — Select Patient.
6. Charges — If you are adding a kick reason that affects the balance, select the relevant charges.
7. Kick reason — Enter the word COLLECT in the field.
8. Click Submit.
   The patient claim is now eligible for collections.
   

To send the patient balance to collections and adjust the balance off the claim

9. Display the Collections Worklist page: On the Main Menu, click Claims. Under SELF-PAY AND COLLECTIONS, click Collections Worklist.
10. Provider group — (Appears if your practice uses provider groups) Select a provider group and click Continue.
    The filter fields appear.
11. Collection policy — Select Sent to COLLECT (manually).
12. Use the filter fields to create the collections worklist.
13. Click Filter. The list of eligible patient accounts appears.
14. Select all charges that you want to send to collections. You can click the checkbox at the top left of the list to select or deselect all charges.
15. Send to collections — Select this option (if it is not already selected) and select the collection agency from the menu.
16. Click the Send to Collections button.
    A confirmation message appears.
17. Click OK to batch the selected patient claims into a collection file.
    The View/Edit Billing Batch page appears for the collection batch file that you just created.

When a balance is sent to collections:

• The charges are adjusted off for reason COLLECT and the claims are closed.
• All selected charges on the Collections Worklist page are put into a collections batch, which includes the essential information about the charges needed by a collection agency to process them. You can view the collections batch (file) using the View/Edit Billing Batch page.
• If you have a contract with an established vendor (see Established Collection Agencies on the Success Community), athenahealth submits the collections batch file to the collection agency selected by your practice.

 

If your practice does not yet have a collection agency, athenahealth recommends that you refer to our list of established collection agency vendors on the Success Community.

 

To set up a new collections vendor for your practice, follow the instructions below, or contact the CSC by selecting Support > Create Case or Call in the Main Menu.

 

Managing collections with athenaOne requires a variety of tasks using several athenaOne pages.

• athenahealth can set up one or more collection agencies used by your practice on the Collection Agencies page, assigning each collection agency a unique custom transaction code. If your practice does not yet have a collection agency, see the athenahealth list of established collection agency vendors on the Success Community.
• You can set a claim to COLLECT status using the Claim Action page.
• You can send patient charges to a collection agency and adjust off the charge using the Collections Worklist page.
• You can retrieve collection files in athenaOne using the View/Edit Billing Batch page.
• You can post recovered payments at the time of service using the Collect Payment or Check-in page, or you can post these payments at the time of payment posting through athenaOne or through the athenahealth automated posting application.
• You can report on activity and A/R in collections using the advanced view of the Activity Report Wizard and the Collections AR Report page.

 

A patient can incur a balance when an amount is transferred from the insurance company to the patient, or when the patient is registered as "Self-pay" and receives service. These self-pay charges and insurance company transfers are called "patient charges." The Patient Outstanding amount (displayed on the patient Quickview) is the total of all outstanding patient charges, both current and delinquent. If a patient charge is not paid, it goes through the dunning cycle and may become eligible for collections.

 

Patient charges appear on the collections list in one of three ways:

• Charges can go through the normal statement cycle, become overdue, and be set to COLLECT status.
• Charges can be set to COLLECT status if they are covered by a payment plan and payments have been missed.
• Charges can be set to COLLECT status manually.

If a claim contains charges eligible for collections, athenaOne sets the claim status to COLLECT, and any charge items associated with the claim are listed on the Collections Worklist page. After the charge is listed as eligible for collections, you can use the Collections Worklist page to select it and send it to collections.

 

Note for Transworld collections: When a patient is in Phase 1 collections with Transworld, athenaOne generates a daily report for all transactions (payments or changes) posted on patient accounts. After a patient is in Phase 2 or CMS0, any payment or change made to the patient's outstanding amount that is not initiated by TSI must be reported by your practice because athenaOne does not send this type of information automatically.

 

 

athenahealth sends invoices, or statements, to your patients when they have open balances due to you. We generate and mail statements every day of the week. Each patient is put on a 35-day statement cycle (so that in any given week, approximately one quarter of all patients who are responsible for charges receive a statement). A patient does not receive more than one statement every 35 calendar days. Your practice's phone number is on the statement, and you are responsible for handling patient inquiries.

 

athenaOne generates and sends patient statements only for outstanding balances that exceed $9.99. athenaOne sends a maximum of three statements per charge. The statement minimum balance and the maximum of three statements per charge also apply to online statements.

 

If charges on a statement go unpaid, progressively severe dunning messages appear on each subsequent statement. You can edit the default dunning messages using the Dunning Messages page.

Note: The simplified patient statements used with the Online Statement-based Experience (formerly QuickPay Portal) display the default dunning messages instead of any custom messages you create on the Dunning Messages page. For information about simplified and standard patient statements, see Patient Statement Samples.

 

• CSV2 Output
• Patient ID
• Patient Name
• Patient DOB
• Address 1
• Address2
• City
• State
• ZIP
• Country
• SSN
• Home Phone
• Work Phone
• RP Name (Guarantor)
• RP Address
• RP City
• RP State
• RP ZIP
• RP SSN
• RP Phone
• RP Employer Name
• RP Country
• Employer Name
• From Date (DOS)
• Procedure Code
• Procedure Code Name
• Amount Outstanding
• Claim ID
• First Billed Date
• Number of Statements Sent
• Service Department Billing Name
• Supervising Provider Billed Name
• Primary Insurance Package Name
• Primary Insurance Package Address
• Primary Insurance Package Address2
• Primary Insurance Package City
• Primary Insurance Package State
• Primary Insurance Package ZIP
• Primary ID Number
• Primary Policy Number/Group Number
• Primary Payments + Adjustments
• Secondary Insurance Package Name
• Secondary Insurance Package Address
• Secondary Insurance Package Address2
• Secondary Insurance Package City
• Secondary Insurance Package State
• Secondary Insurance Package ZIP
• Secondary ID Number
• Secondary Policy Number/Group Number
• Secondary Payments + Adjustments

 

The collection recovery workflow enables posting of collection recoveries at the time of service through the Collect Payment or Check-in page, or at the time of payment posting through athenaOne or the athenahealth automated posting application.

 

After a patient charge is adjusted off to collections, the outstanding collection amount appears in red on the patient Quickview page. This amount equals the total collection adjustments plus recoveries posted.

 

The Billing Summary page displays (in red) the collections pending amount for each claim that has a collection adjustment, with the total collections outstanding at the bottom of the page.

 

Outstanding collection amounts appear on the Collect Payment page, the Check-in page, and the Checkout page, so you can collect a patient payment at the time of service and post it directly to the collection adjustment. Any payments made are posted as a recovery adjustment and decrement the patient's collections outstanding amount.

 

Collections can also be recovered and posted via the payment posting workflow (either automatically or manually through the Post Payment page). Any patient payment that is submitted as a remittance through your lockbox is posted to the collection adjustment.

 

We support the ability to post the following transactions in the context of collection activity:

• Recovery payment — The amount collected from the patient that is retained by the practice.
• Fee adjustment — The amount collected from the patient that is retained by the agency as commission.
• Recovery adjustment — The recovery adjustment is posted to reverse the collection adjustment. This positive adjustment provides the patient with a positive account balance. The rest of the transactions then work down this balance. The amount of the recovery adjustment is the sum of any recovery payments and fee adjustments. This adjustment typically represents the total amount paid by the patient.
• Bad debt adjustment — When a collection amount is deemed unrecoverable, it can be adjusted to bad debt in part or in full.
• Takeback — A takeback is posted when an agency indicates that a commission was due to them on a payment recovered from the patient. The takeback is posted as a positive payment to balance the fee adjustment.

If a collections adjustment is only partially recovered, any remainder will remain as a collections adjustment until it is either recovered or written off to bad debt. This outstanding amount appears on the patient Quickview, Billing Summary page, and Collections AR Report (see "Reporting on collections").

 

If your practice uses the athenaMailbox service and you receive a collection invoice and check directly from a collection agency, we recommend that you send the check and remittance to your athenahealth P.O. box for processing.

 

If your practice uses an alternate lockbox service, we recommend that you forward a copy of the deposited check along with the collections invoice to athenahealth using the Lockbox BYOLB Remittance Template so that athenahealth can create appropriate batches and post them for you.

 

For information about Collection Recovery Posting, see Post Payment.

 

 

athenaOne provides reporting on collections activity and outstanding collections A/R. For example, you can use the advanced view of the Activity Report Wizard to run a report using the following criteria:

• Start date/End date — Select Month-to-Date.
• Show patient name, ID and DOB — Select this option to display this information.
• Custom transaction code — Select the custom transaction codes that are used with your collection agency.

This report shows any collection activity, by patient, for that time frame, including collections adjustments, payments, fees, recoveries, and bad debt adjustments. If there is collections activity on an account, the custom transaction code identifies the agency to which the activity is attributed. The Activity Wizard results columns are:

• payment — Recovery payment. The amount collected from the patient that is retained by the practice. This amount is balanced to the payment batch.
• collect — Amount adjusted to collections.
• recovery — Recovery adjustment. The recovery adjustment is posted to reverse the collection adjustment. This positive adjustment provides the patient with a positive account balance. The rest of the transactions then work down this balance. The amount of the recovery adjustment is the sum of any recovery payments and fee adjustments. This adjustment typically represents the total amount paid by the patient.
• fee — Fee adjustment. The amount collected from the patient that is retained by the agency as commission.
• baddebt — Debt adjustment. When a collections amount is deemed unrecoverable, it can be adjusted to bad debt in part or in full.

Note: You can sort this report dynamically by clicking the column headers.

 

To run a report on outstanding collections adjustments (unrecovered adjustments), display the Collections AR Report, then select filter criteria, including:

• Collection Agency — The agency assigned to this item.
• Primary Department — The patient's primary department as registered on the patient Quickview page.
  Note: If the primary department is blank on the patient Quickview page, this filter will not function.
• Usual Provider — The patient's usual provider as registered on the patient Quickview page.
  Note: If the usual provider is blank on the patient Quickview page, this filter will not function.
• Patient's Last Name Starts With — Lets you filter the list by last name.
• Date of Collection Adjustment — Date on which the user posted the collections adjustment. This information is posted when you click Send to Collections on the Collections Worklist page.

The Collections AR Report includes an Outstanding column that shows any collections adjustment less any recovery adjustments. Recovery adjustments include recovery payments, fee adjustments, and bad debt adjustments on a charge sent to collections.

 

 

athenahealth recommends the following actions and processes with respect to collections:

• Establish a collection vendor relationship. If your practice does not currently use a collection agency, contact the athenahealth CSC by selecting Support > Create Case or Call in the Main Menu. We will help you choose from a list of athenahealth established collection vendors.
• Implement a process to review accounts eligible for collections and send appropriate accounts to collections before the end of every month.
• For every patient charge in COLLECT status (eligible for collections) you should, within 15 to 30 days, either send the charge to collections, adjust off the charge for reason "bad debt," or put the patient on a payment plan.
• Reconcile legacy collection recoveries. To do this, access the Report Library and run the Collections Recovery Report. This report will indicate patient accounts that have unapplied payments and a collections adjustment.
• Post unapplied payments against the outstanding collection adjustments to maintain accurate Collections AR report results. To do this, display the Post Payment page for the patient, select "Unapplied Credit" from the Payment menu, and enter the amount of the payment that you are posting to the collections charge. This process will help reduce the amount in your unapplied total and will help reconcile legacy collection recoveries, giving you cleaner activity reports.