Final Project Design a Financial Policy
Carrie George
HCR/230
October 23, 2012
Janet Bargar

Part A
WEST ADVANTAGE PEDIATRICS OFFICE FINANCIAL STATEMENT
The preceding is aimed to notify you of our practice, administrative center practices, and our benefits. We urge our patients to be completely advised as possible, so do not think twice to come to staff members with inquiries concerning care, treatments, coverage, or costs for service. Our employees will be eager to help you. Letting you know a head of time of our administrative center guidelines permits for an effective movement of interaction and assists us to accomplish our ambition. Please look through this thoroughly and if you come up with any questions, please do not be reluctant to question an associate of our team (Annis, November 2005). 1. On entrance, please sign in at the main reception desk and show your up-to-date insurance card at each appointment. You will be expected to sign your name and date so we can file a photocopy of your insurance card. This is your confirmation of the accurate insurance and agreement to send the bill to them on your child’s behalf. If the insurance company that you specify is false, you will be liable for the cost of the appointment up until you present the adjustments to the right plan, which will at that time be charged for the office visit and be compensated. 2. If we remain your primary care doctor, make certain our office name or telephone number shows on your card. If your insurance establishment has not been notified that we are your main care general practitioner as of this day and time, you possibly will be financially accountable for the appointment. 3. According to your coverage plan, you are accountable for any co-payments, deductibles, and co-insurances. Co-Payments and deductibles are owed at the time services are arranged despite who come with the child to the prior arrangement of their appointment. (Annis, November 2005). If we do not have an agreement with your insurance company payment is due in full and is mandatory at the time services are arranged for. There will be an extra $10.00 expense for any Co-Payment and/or deductible that is requested to be payable to the guarantor on the account. If you have not met your deductible, we will collect 50 percent of the administrative center visit expenses at checkout. If your account balances matures 90 days past the scheduled date and is not on a signed payment agreement, you may possibly also be terminated from this medical clinic. 4. It is your obligation as a parent to the minor child to be familiar with your benefit plan. Please be knowledgeable that handful if not all of the services, you accept may be non-covered or not take into account satisfactory or essential by Medicare or additional insurers. If you and your provider come to an agreement non-covered services are considered necessary to care for you with the maximum level of care, expense in full for the services is required at the time of the appointment. Please keep in mind that for the reason that the widespread selection of medical insurance policies and possibilities accessible these days, it is difficult for us to be aware of if you are covered for all your appointments to your physician. Please get in touch your insurance company immediately, before your appointment, to confirm coverage particularly for once a year physical examinations. 5. If our medical doctors do not take part in your insurance plan, payments in full are required from you at the time of your office visit. For scheduled times, previous balances have to be paid before your appointment. 6. If you do not have any insurance, payment for a clinic visit needs to be paid at the time of the scheduled visit. 7. If you are not insured and have a fixed low income, you may perhaps meet the requirements for a sliding fee for your medicinal services. If your family’s household earnings are less then the federal poverty level you possibly will meet the requirements for a reduction from our original amounts. Income represents your take-home pay before deductions, retirement pension, or social security income, cash child support, spousal support, workers compensation disbursements from entirely all sources in the family (Annis, November 2005). All visits to our office are qualified for a sliding fee. If you have no insurance or no capability to pay, help by means of a state organization or plan may be presented. Our organization can offer information. 8. We suggest advance payment, which you might want to complete by filling out the appointment request, history, and permission forms, and then fax, mail or deliver them to the office filled out and signed. For scheduled appointments, 100 percent down payment is needed up front. You can specify a means on the appointment application document. If you neglect to show up to your scheduled appointment lacking a previous cancellation, then you will have to be charged $50.00 for that missed appointment. If documents are not finished before your scheduled appointment then altogether services completed are the financial responsibilities of the patient or liable party, which payments are required at the time services are performed. 9. Patient balances are to be paid instantly on acknowledgement of your insurance plan’s clarification of benefits. Your payment is due within 14 business days of receipt of your billing statement. 10. If prior agreements have not been discussed or completed with our finance office, any account balance owed over 90 days will be passed on to a collection bureau and possibly will also be dismissed from this practice. 11. If you take part with a high-deductible health plan, we insist on a photocopy of the health funds account debit/credit card or private credit card remains on file. There are additions to this financial contract, which are endorsed individually (American Academy of Family Physicians, 2012). 12. We insist on 24-hour notification for withdrawing any appointments. There is a $50 fee for appointments if they remain not canceled or if 24-hour notification was not provided. 13. We accept cash, personal checks, money orders and personal credit or debit cards. A $25 fee is charged for any checks sent back because of not enough funds, plus any and all bank fees sustained. 14. Beforehand find time for a yearly physical appointment making sure to certify with your insurance company whether the visit will be included as a healthy appointment. Not all plans include yearly healthy physicals or hearing and vision examinations. It is your accountability to be on familiar terms with your insurance plan profits. If it is not included, you will be accountable for the payment at the time of any visit (Valerius, Bayes, & Seggern, 2008). 15. Not all essential services presented by our office are included by each plan. Any service verified to not be included by your plan will be your accountability. 16. Our patient billing division is here to assist you in setting up payment agreements if necessary. We will stretch out payment agreements that will let you to pay your balance in full over a limit of 90 days. Payment agreements will be sent to you in the mail with the details that were discussed and agreed on. Please put your signature on the paperwork and return the payment agreement with your first payment. We will hold on to debit or credit card information on file to auto debit the amount you are contracted on the 5th of each month. Payment schedules will sustain finance fees of 5.99% APR. Please speak to our patient account department at 612-759-2032. Should you require extra time to take care of your amount owed, we have reached agreements with Northern Financial Credit Facilities to supervise all payment plans expanding past 90 days. A $15.00 handling fee will be charged by West Advantage Pediatrics to send your balance to the credit bureau. NFCS will add an extra 15% of the balance as a fee to supervise the plan. Failure to make appropriate payments to NFCS will be caused by the account being switched to a collection account and release of the patient from the practice (AAP, 2011). At the point in time of your appointment; you will be offered a breakdown of your expenses and payments. You want to hold on to this document as a documentation of your visit. A once-a-month report of your bill will be mailed to you for any not paid remainder following your insurance company issuing their Clarification of Benefits for your visit (MEDPROS of America, Inc., n.d.).I have read and understand this office financial contract and come to an understanding to fulfill and agree the accountability for any payment that would be due as summarized before.
When signing any paperwork for West Advantage Pediatrics Office you need to make sure that you include the signature of patient, or responsible party, along with the date of service.

Part B
The foundation of a sturdy medicinal office financial policy is an agreement between the medicinal office, the insurance company, and the patient. The medicinal office is liable for confirming the patient’s treatment, authenticating if a detailed service is included, and confirm the co-pay total so it can be gathered at the moment of the visit or service. The insurance company’s accountability differs on whether the physician is hired with them or not. The insurance company is accountable for the appropriate managing of medical claims. The patient is liable for paying their co pay at the time of the visit and repaying any extra balances inside a sensible time as soon as being billed. The medicinal office wants to guarantee that every patient is knowledgeable of their billing guidelines and in what way they influence each patient. A patient should realize that the medical office will process a request with the insurance company as a courtesy but it is initially the accountability of the patient to make sure their insurance company manages and pays the claim. A patient correspondingly needs to be knowledgeable that their co-pay is required at the moment of the visit, any deductible or coinsurance is required when charged, and that if their statement stays unpaid the medical office can decide to no longer service them (Valerius, Bayes, & Seggern, , 2008). The main accomplishment for most health care facilities does rest on the strength of the medical office's financial policy. It is the accountability of the business office branch or patient financial services crew to confirm appropriate company procedures are respected. Forming a financial course of action assures the capability of the association to carry on to deliver exceptional health care to their patients. The medical office teams have to be presented with the financial policy in the course of orientation and once-a-month educational seminars to keep them up-to-date (American Medical Association, AMA, 2005). The significance of charge capture has to be communicated to all sectors. The medical staff must be informed of their responsibility to accounts receivable by detailed documents and charge capture. A payment course of action lets the patients know what you as a clinic anticipate of them and also what they can anticipate of you. A well-crafted policy will put a stop to patients from being taken by surprise regarding their financial responsibility when they accept your services. It also gives your clinic some lawful security should a patient neglect to repay what you are permitted to collect (American Academy of Family Physicians, 2012). Furthermore, the suitable networking of medical codes to services and practices submitted during the patient visit. Each medical area portrays a significant role in the suitability of coding and the accurateness of billing. Be familiar with the diverse procedures of payment is vital for the financial managing of the medical office. Financial managing consists of all elements of the profits cycle as well as accounts receivable. Accounts receivables, also identified as patient accounts, relate to incomes generated but not yet collected. To ensure cash flow is satisfactory for successful management, the medical company has the obligation to make the most of its proceeds capability (American Academy of Family Physicians, 2012). In any medical office there are components that can prompt the achievement of the institute. The key is recognizing and acquiring a plan that will show the way to the success of the organizations yet to come goals. This procedure of distinguishing the medical office objectives, and acquiring the plans to accomplish those objectives, is mentioned to as tactical preparation. Medical practices have financial procedures to standardize the billing of patients and the methods exhausted to collect money they are to be paid (AMA, 2005). Each administrative personnel member donates to successful patient collections and therefore to the financial feasibility of the practice. All the money billed, however, cannot constantly be collected. Some patients do not repay their bills, and specific situations cause a practice to write off the financial records of others. Then again, in each of cases, the practice must meet the terms with state and federal laws all through collection actions and by preserving patient records and material. Successful patient billing starts with comprehensive financial guidelines and procedures that distinctly justify patients’ liabilities for payment. These actions set the platform for the billing and repayment steps that follow, mailing patient accounts and pursuing up on patient payments (Valerius, Bayes, & Seggern, 2008). Furthermore, the subject that has continuously been of the greatest worry is fraud and misuse particularly with concern to Medicare, Medicaid, and other government supported programs. Fraud commonly refers to intentionally and knowingly billing medical claims in an effort to cheat any federally supported program for money. The most familiar types of fraud and misuse involve billing for equipment by no means supplied, billing for services by no means completed, up coding expenses to obtain a higher refund percentage, and unbundling expenses. Accomplishing the profits phase effectively is no easy job and involves your continuous concentration. Each stage of the Expenses Cycle from the instant a patient is scheduled for an appointment up until the time payment is acknowledged from the insurance company is just as critical to make the most of insurance refunds. It is imperative for the financial constancy of the hospital or general practitioner office to make sure a technique is in place for every stage of the proceeds cycle (American Academy of Family Physicians, 2012). Not only will the patient arrive at making payments in a sensible behavior but will also decrease the weight on the billing staff, keeping low administrative expenses, and for the most part uphold an encouraging relationship with the patients.

Reference:

1. Annis, J. P. (November 2005). REPORTS OF COUNCIL ON MEDICAL SERVICE. Retrieved from http://www.ama-assn.org/resources/doc/hod/i05cmspdf.pdf

2. American Academy of Family Physicians. (2012). Choosing and Using a Locum Tenens. Retrieved from http://www.aafp.org/online/en/home/practicemgt/mgmt/locumtenens/choosinglocumtenens.html

3. Valerius, J., Bayes, N. L., & Seggern, J. I. B. (2008). Medical Insurance An Integrated Claims Process Approach (3rd Ed.). Retrieved from The University of Phoenix eBook Collection database.