Lack of health insurance means more bad medical debt

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The medical billing field has been affected by the recession and higher unemployment, which means more people using emergency rooms are opting to self-pay — without insurance.

During 2009, the self-pay population increased from 25 percent to 30 percent at ATD Resources LLC in Lakewood, a medical billing company that specializes in billing for 60 physicians and mid-level providers working in level II trauma centers.

ATD Executive Director Bette Warn said that trauma centers have seen an increase in “indigent patients,” patients without insurance, unemployed patients, and that the Medicaid population is increasing. All of which contributes to a greater challenge in collecting medical debt.

Warn’s staff has a standard procedure for billing, and they look for ways to improve their collection abilities — the last resort is to send bills to a collection agency.

After patients receive treatment, they are billed immediately. And if they don’t have insurance, they are offered a discount if they pay within 30 days.

Then “pre-collectors” make calls within 30 days to confirm whether or not the patient has insurance.

Then, a series of statements are mailed, followed by numerous phone calls. And next, the billing center attempts to get patients set up on a budget payment plan.

If after 180 days, they are not on a budget plan or are missing payments, the bill is sent to an outside agency, Warn said.

About 1,000 statements mailed by the center each month are undeliverable because of erroneous addresses.

But recently, ATD hired an agency that verifies addresses of patients. Bills for patients who don’t have a viable address on file are sent to an outside collection agency immediately.

Warn’s office sends out an average of 12,448 statement per month, with an average total balance due per month of $6.7 million. About $ 1 million of this is sent each month to an outside collection agency — but only 5 percent is eventually collected.

During the last six months, the company has been able to improve internal collection by about 10 percent. Warn attributes this to the pre-collectors they’ve hired and to the use of an agency to screen addresses.

Business owners and billing companies should “use technology to the greatest extent possible. The volume of billing is increasing, and human resources are expensive and sometimes not as efficient for obtaining, verifying and posting information,” Warn said.

“Be alert for all the tools you can use.”

A whole lot of debt

During 2009, Commercial Collection Agency Association members received $17.7 billion in accounts placed for collection, an increase of 33.4 percent over 2008 and a record.

Account placement during 2008 held the previous record, at $13.3 billion.

The gain during the fourth quarter of 2009 was an increase of 48 percent, compared to the fourth quarter of 2008.

Source: Commercial Collection Agency Association of the Commercial Law League of America

When should business owners turn over an account to collection?

  • Generally, if an account is 120 days delinquent (ninety days after the invoice date), a creditor should initiate placement with their collection agency, particularly if no response has been received from the customer.
  • If there are two or more broken promises of payment. Payments were promised, but no checks have been received, and customer will not send immediate payment by overnight delivery.
  • If the customer’s telephone is disconnected. Double check with the information operator, and if no new listing can be obtained, place the account immediately
  • If the customer repeatedly requests documentation even though they have been supplied the documentation previously.
  • If the customer indicates that they do not adhere to your terms of sale. For example, they may indicate that they pay bills in sixty or ninety days and not according to the agreed upon terms of sale.
  • If the customer indicates an inability to pay and refuses to provide a specific date for payment or to initiate a realistic payment schedule.
  • If the customer states they will “take care of the account,” but refuses to make a realistic commitment for payment or to work out a payment schedule. This is another indication of a serious cash flow problem.

Source: Commercial Collection Agency Association