User Guide — Self-Pay AR Management

 

Dunning levels are used to evaluate the delinquency of a patient account. Dunning levels are important in the setup of the Self-Pay feature because this architecture is used as the basis for patient account alarms and patient account alarm types. Your practice can define the dunning messages that are printed on patient statements 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.

 

Patients progress through dunning levels if they have a patient charge or payment plan charge that is not closed (neither paid nor adjusted). athenaOne provides two dunning level tracks: one for standard charges, and one for payment plan charges. Dunning levels are as follows:

• 0 indicates a patient in good standing with no active alarm
• 1-4 are used for standard patient charges
• 5-8 are used for payment plan charges

If a patient has a standard charge that is unpaid by the next statement cycle, that patient advances a level. If a patient has a payment plan charge, that patient advances a level only if he misses a scheduled minimum payment.

 

Patients who receive E-statements

If a patient has not paid his bill in full after receiving several E-statements, athenahealth sends both a paper statement and a final electronic statement. The paper statement is sent for the final non-payment plan statement (dunning level 3) or the final payment plan statement (dunning level 7). Patients continue to receive email notifications about new e-statements.

 

You can see which statements were sent electronically and on paper on the patient's Quickview: Under the Outstanding Balances heading, click Show patient statements. In the Method column, E-statement and Paper both appear, indicating that athenahealth sent both types of statements.

 

Number of statements sent before charges are sent to Collections

Your practice can specify how many statements must be sent to a patient before delinquent patient charges are sent to collections. The dunning level printed on a statement is the dunning level of the oldest charge as measured by the date of first billing. To change the default setting, contact the CSC by selecting Support > Create Case or Call in the Main Menu.

 

Patients with Family statements

A patient and family may have both standard and payment plan charges that are billed on the same statement at the same time. Because a patient and family can have only one dunning level (and one patient account alarm), a hierarchy is used to evaluate dunning levels on individual charges. The account dunning level is always based on the most delinquent charge on the account. A missed payment plan is considered to be more delinquent than a missed standard payment. The hierarchy is as follows, beginning with "in good standing" to most severe: 0,1,5,2,6,3,7,4,8

 

Because only one account alarm is set, a patient or family appears only once on one worklist. The user following up on that account can access information about all delinquent charges from the Patient Account View page. For example, if a patient has standard charges in dunning level 2 and payment plan charges in dunning level 6, the account appears only in the worklist that is sorting for dunning level 6 because that level is more severe.

 

 

A patient account alarm is an automated trigger that fires based on the patient dunning level. This structure is similar to claim alarms, except that the alarm is at the account level instead of the claim level. Account alarms correspond to dunning message levels and fire after a specified number of days have passed since the patient reached a given dunning level.

 

Patient account alarm types are used for self-pay account management. If you use the self-pay account management functionality in your practice, an alarm is set up for every dunning level. Based on the patient account alarms configured on the Patient Account Alarm Type page, you can create customized worklists to divide and assign self-pay accounts for follow-up using the Self-Pay Account Worklist page. When a patient's self-pay account appears on a worklist, your staff can then take appropriate action on the account using the Patient Account View page.

 

Note: Because alarms can be cleared manually (on the Patient Account Alarm Type page) and automatically (via payment or adjustment), the self-pay worklists are always a current reflection of outstanding work.

 

 

Worklists are created to identify patient accounts that have certain active alarms. The only function of the alarm is to route the patient to the appropriate worklist. Therefore, you should set up an alarm for every dunning level, regardless of whether you create a worklist for that level. When a patient's self-pay account appears on a worklist, your staff can take appropriate action on the account using the Patient Account View page.

 

After you create the patient account alarms, you can use the Self-Pay Account Management Worklists page to create customized worklists to divide and assign self-pay accounts for follow-up.

 

Note: Self-pay worklist alarms are cleared when the patient balance is paid in full, unless the patient is using a payment plan. If the patient has a payment plan, the patient must pay the full balance due for their monthly payment to clear the worklist alarm.

 

For example, to assign follow-up work to self-pay account reps, your practice could define worklists called

• Follow-Up Call #1: Guarantor Last Names A-L
• Follow-Up Call #1: Guarantor Last Names M-Z etc.

Worklists can be created based on a number of different parameters. The only requirement is the worklist name and dunning level. The structure of the worklists should correspond to the process your practice uses for self-pay follow-up (that is, whether you divide work by location, provider, patient, etc.).

 

You should ensure that collectively, the worklists you create include the entire body of patient accounts.

 

You can use the worklist to click each individual patient name to access the Patient Account View page for that patient, and you can generate letters for multiple patients from the worklist itself.

 

 

The Patient Account View page displays the demographic information, account summary, and account notes for a particular patient. From this page you can review the entire account, use the demographic information to make phone calls or address letters, and record your actions (for example, "made a phone call") using the fields at the bottom of the page. You can reset the next statement date if necessary, and the statement will be generated on the first statement run after the "next statement date." If modified, the patient's statement cycle is reset to 35 days after the last statement generated.

 

You can clear an alarm on this page to remove the patient from the worklist.

 

Each outstanding patient charge is listed on the page, with a total amount outstanding and indication of any payment plan amount due. At the bottom of the list you'll see the dates when statements were sent out, and a link to "show patient statement as it would be printed today." Account Note information for any action taken on the account is also available at the bottom of this page, similar to the audit history on the Claim Edit page.

 

The Patient Notes field at the top of the page displays the same information as the Patient notes field located at the top of the patient Quickview. Also, the Statement note field on the Patient Registration page allows for a 75-character, patient-specific message. Text entered in the Statement note field is printed on all subsequent statements for that particular patient (until the text is cleared), in addition to the standard dunning message printed on the statement.

Note: The simplified patient statements used with the Online Statement-based Experience (formerly QuickPay Portal) do not display custom statement notes. For information about simplified and standard patient statements, see Patient Statement Samples.

 

The Collect Outstanding amount is displayed on this page. This information makes it easy for users to remind a patient of debt owed to a collection agency, when making a phone call concerning an account balance.

 

This page also displays the payment plan overdue amount for the patient or family. When you follow up with the patient, you can see how much of their total outstanding is actually due (or overdue) according to their payment plans.

 

 

For patients with Family Billing, the worklist results are grouped by family, where all family members are listed under the head of the family. Because only one account alarm is active for any family, all family members appear in the worklist whether or not they have an outstanding balance. You need to review all family members and follow up on the family account as a whole. You can access the Patient Account View page for any individual family member; notes saved on the Patient Account View page for one family member appear on the Patient Account View for all other members of the family.

 

Because a family receives one consolidated family statement, the dunning message on that statement is based on the most severe charge across all family members. At the same time, each member of the family has a specific dunning level. This separate dunning level is important because membership in a family can fluctuate. To set the patient account alarm, we look at the most delinquent charge of any current family member at the time of statement generation to ensure that the family appears on only one worklist and that one user pursues the outstanding amount from the entire family.

 

 

You can select multiple patients in the worklist and then add a note about all the selected patients or create a letter for all the selected patients via mail merge (this option generates a standard CSV file for use in a mail-merge).

 

Note: A separate entry is generated for each patient, even if some patients are part of the same family. athenahealth suggests that when using family billing, the practice sort letters and mail separate family letters together in the same envelope.

 

 

In accordance with HIPAA's Privacy Rule 45 CFR 164.522(a)(1)(vi), patients can request that fully self-paid services not be disclosed to their health plan (payer). You can enable this non-disclosure for a patient on the Privacy Information page. When you select the Patient Requested Health Plan Restriction for Self-Pay Services option:

• athenaOne does not run eligibility checks (including coverage scan eligibility checks) on self-pay claims for this patient.
• The patient is excluded from Pay for Performance programs.
  Note: To ensure that self-pay services are exempt from periodic reporting (monthly, quarterly, yearly, etc.) related to quality programs, athenahealth recommends that this option remain selected for an extended period.

Note: You can report on self-pay patients excluded from pay for performance programs using the Report Builder. Select the "Patient Self-Pay Restricted Yes/No" column in a Patient Demographics report.

1. Display the Privacy Information page: On the Quickview, click Manage Privacy (under the Privacy heading).
2. Scroll down to the HIPAA Self-Pay Restrictions heading.
3. Patient Requested Health Plan Restriction for Self-Pay Services — Select this option if a patient requests that fully self-pay services not be disclosed to the patient's health plan (payer).
   Note: This option applies to all self-pay services until it is deselected.
4. Click Save.

1. Display the Self-Pay Account Management Worklists page: On the Main Menu, click Claims. Under SELF-PAY AND COLLECTIONS, click Self-Pay Account Worklists.
2. Name — Enter a descriptive name for the worklist, for example, include the staff member name, letters of the alphabet, etc.
3. First letter of guarantor's last name — Select one or more letters to include last names that begin with those letters, or leave this field blank to include all patients in the worklist.
4. Patient's current department — Select one or more departments, or leave this field blank to include patients from all departments in the worklist. Because the worklists evaluate the patient account in its entirety, the current department is based on the primary department set on the patient's full registration page. The worklist does not split patient accounts by the location of service.
5. Patient's primary provider — Select one or more providers, or leave this field blank to include all providers in the worklist. Because the worklist evaluates the patient account in its entirety, the primary provider is based on the usual provider set on the patient's full registration page. The worklist does not split patient accounts by the rendering provider.
6. Patient's insurance — Select Self Pay is Primary or Other is Primary, or leave this field blank to include all patients. All patients fall into one of these categories, and no patient is included in both categories.
• A patient whose primary insurance is registered as "Self Pay" appears in the "Self Pay is Primary" list.
• A patient whose primary insurance is not "Self Pay" but who has had transfers for deductibles, copayments, and so forth, appears in the "Other is Primary" list.
7. Amount outstanding — Enter a dollar range to include only patients that owe amounts within this range, or leave this field blank to include all amounts in the worklist.
8. Patient account alarm type — Select the alarm type from the menu (see Patient Account Alarm Types).
9. Exclude patients with upcoming appointments within __ days — To exclude patients who have upcoming appointments from the worklist, enter a number in this field. For example, if you enter 21 in this field, patients who have appointments within the next three weeks are not included on the self-pay worklist.
10. Sort by — Select Lastname or Outstanding Amount to order the worklist by patient last name or by the outstanding amount.
11. Click Save to create the worklist.
    The new worklist appears in the list at the bottom of the page.

After a worklist is created, you can run the worklist, and you can edit or delete it (if you have the appropriate user permissions).

 

 

You can report on payment plan revenue using the advanced views of the A/R Aging Report Wizard and the Activity Wizard: check the Show Payment Plans checkbox.

 

You can also report on bad debt adjustments using the Activity Wizard, or you can create a report in Report Builder to show only bad debt adjustments.