Chapter 4 Reality Check Billing and Reimbursement

Management of Accounts Receivable is a complex process which allows providers and their practices to get accurately, ethically, and legally reimbursed for services they provide to their patients. During the checkout process, all of the co-payments, coinsurance, and deductibles are collected from patients at that time. This is a major responsibility of the front desk office clerk to collect co-payments or make other appointments.

In Renal Practice Associates, one of the front desk clerks, Silvia, knows the patients very well. In fact, she knows when they are having difficulty paying co-payments and medical-related expenses. Some patients are in life-threatening End Stage III Renal Failure and on dialysis. Sylvia is aware the practice she works for is a big, successful one, and her rationale is no one will care about missing one or two payments from a patient, or stating on the patient account the bill is paid.

When patients with acute or chronic conditions check out at Silvia’s station, she will often tell them they owe no balance, and that she is happy to reschedule them for their next appointment.

After a few weeks of observing this behavior, Lily, her co-worker, is concerned. Lily has only been in her position for six months, while Sylvia has worked in the practice for ten years. Lily is not sure what to do or how to approach this problem. It’s obviously raising a red flag for her, but she can’t possibly lose her job. She’s not sure what to do, and feels these might be her options:

Not say anything and ignore this practice is going on.
Ask Sylvia if there is a special policy and procedure that she may not be aware of that allows some critically ill patients not to pay for their visit. If so, Lily should ask to see the policy and procedure herself so she is aware of it in writing.
Lily should go directly to the supervisor over Sylvia and share what she is witnessing.

Which of the above options is the best choice? Explain why. Does Lily have any other options?

Responce must be 2-3 paragraphs.