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Collecting Medical Accounts Receivable

Doctors are Not Bankers

By Dr. David Edward Marcinko; MBA, CMP™

By Hope Rachel Hetico; RN, MHA, CMP™

Collecting accounts receivable (ARs) is one of the most important elements in maintaining the financial health of any medical practice. Your practice is not a bank and an effective billing system should be complemented by an efficient collection system. Accordingly, we often address this issue with our clients, as follows. 

Setting your AR Policy 

An AR collections policy that is too conservative may results in poor collection rates while an aggressive policy may be counterproductive and increase liability. Have collectors call early and often. Waiting encourages patients to pay late. Use the 80/20 rule and concentrate on your biggest accounts first. Get non-performing receivables off the books. Accounts over about 120 day should be turned over to third party agents. Out-sourcing to collection agencies however, varies significantly in terms of quality and results.  Most charge from 20 to 50% of what they collect.

Using Proper Protocol

According to human resources managerial expert, Rachel Pentin-Maki; RN, MHA of our firm www.MedicalBusinessAdvisors.com and John Broderick, an executive staffing consultant from New York, the following protocol should be considered when selecting a collection agency or using in-house personnel:

  • Assertiveness and Analytical Skills: Collectors should be able to break a billing problem into component parts and aggressively pursue each part without being unduly tactless. 
  • Creativeness and Curiosity: Collectors should keep abreast of new computer and software technology and pursue innovative philosophies related to the billing process.
  • Empathy and Communicativeness: Collectors should be able to communicate with both patients and doctors, yet still be able to put themselves in others’ shoes to view problems from each perspective. 
  • Perspective and Stability:  Collectors should be able to see the patients entire economic picture and maintain an emotionally objective and neutral attitude toward the collection process.
  • Integrity and Tenacity: Collectors should have steadfast attitude and still earn the trust of clients, relative and the doctor employer. Collections should be in immediately since waiting. 
  • Salary: An entry level full time office billing collector should be familiar with most States laws regarding the collection process and be paid in the low 30s per annum.  If not, after some time he or she may take their experience and training to another office for considerably more compensation.

About Going to Court

Remember, small claims court is the last avenue for payment. Often a decision has to be made whether to forgive or “write off” a patient’s balance if indemnity insurance coverage is maintained and this decision is best made on an individual basis. Unfortunately, malpractice claims have resulted by pursing past due accounts too aggressively. This is especially true with surgical patients and it is best to pursue payment diplomatically, gently and often forgivingly. Also, think about potentially adverse community public relations.


You could be losing money if your medical practice is still using a traditional checking account for its daily cash activities. One-way to make your cash work more effectively is to open a cash management account with a brokerage firm. This will ensure that your practice’s money is earning a much higher rate of interest; even in today’s low interest rate environment.

More info: www.HealthcareFinancials.com


Let us know what’s on your mind with a post, opinion or comment on this topic. How do you address the medical AR problem?

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One Response

  1. More on ARs,

    To enhance the collection of accounts receivable, physicians should consider increasing the number of accounts that their staff can handle. The following suggestions will help increase the number of accounts, per staff member, and increase the possibility of collecting prior to referring the account to an outside collection agency.

    Standardize your collection policies and procedures and allow the staff and management to offer the same terms to the patients. Be willing to accept the same terms that a collection agency would accept on your behalf. This will reduce the number of patients contacted by your staff.

    Use your technology effectively. Standardize your letters sent to your patients. Include in your letter not only the balance due, and net payable amount, but options to pay over longer periods. Offer solutions for payments, not just demand of payments.

    Establish routine orders to review the accounts, not just those over 120 days old. In addition to separating accounts by size, you should separate accounts by possibility of collecting or the possibility of not collecting.

    For example, accounts that have moved out of the geographic area will be more difficult to collect since it is unlikely that the patient will use your services again. Also, if the client has minimum assets or the assets are protected, like a homestead property in Florida, heavy collection or judgments will be ineffective. This will help you establish a policy for charging off accounts or referring the account out to a third party earlier and reduce staff time in working accounts that are uncollectible.

    Establish an efficient system for collecting small balances by automating your collection letters for those small balances to reduce labor cost and to increase staff effectiveness.

    Since collections can become very time consuming, and expensive using an outside agency for those improbable accounts, one should be considered immediately. However, choosing an
    out-side collection agency requires some due diligence.

    Consider using an agency that is local in the area. Check with your State to see if there are excess complaints against the collection agency. Review the payment structure they offer to the collectors and the monitoring system they use. What policy do they set for charges?

    The above will assist you in increasing the number of accounts your staff can handle which should increase your collection attempt on your accounts receivable.

    -Amaury S. CiFuentes; CFP


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