RevNet User Guide - Self-Pay Payers

How Do I.....Understand Statements and Collections for Self-Pay Payers?

     

A “Self-Pay” payer should be setup when an invoice needs to be sent to the patient or other responsible party. These invoices are sent to request payment for either an outstanding balance after payment by insurance or for the full amount because the patient does not have existing insurance.
   

This page includes the following information:
   

Self-Pay Payer Setup
   

Collection Agencies
   

Statement Information
   

Payment Plan
   

A/R Management
     

Self-Pay Payer Setup

Navigate to Setup -> RevNet -> Payer/Provider -> Payer
   

Setup this payer as any other payer. Items to take into special consideration for Self-Pay include Invoice Type, Statement Delivery Method and Statements
   

Billing Options -> Invoice Type
   

Select the Generic Invoice Type if an initial invoice should  be sent to the patient, regardless of when the patient last received a statement. Statements would follow this Generic invoice after the time frame from the last statement/generic invoice was sent.
   

   

Select the Statement Invoice Type if the patient should only receive statements. This would send one mailing to the patient in a 30 day period regardless of how many invoices were generated in that time frame. Statements would include all invoices with outstanding balances.
   

   

Billing Options -> Statement Delivery Method
   

Select Print to print the statements locally or Electronic to send the statements out for vendor printing and mailing.

   

   

Note: Contact PCDS Support for more information regarding the cost and setup for vendor printing and mailing.
   

Statements
   

Statements sent to the patient need to include Dunning Language regarding the request for payment. Dunning is the process of methodically communicating with the patient to ensure the collection of payments due and give warning of sending to collections if no payment is received.
   

This page includes the ability to customize the Dunning language that will appear on the statements sent to the patient. Options include No Payment Received, Payment Received and Insurance Paid Patient. There are separate language statements for each section to match the situation of the invoices.
   

Each state has their own laws regarding the number of statements a patient has to be sent before they can be sent to a collection agency. Traditionally, three (3) statements with the 3rd being the collections statement (Final Notice).
   

Enter the text in the Message Box and click Save Message. When entering the final notice statement, click Final Notice.
   

   

Setup Statements
   

Once the payer has been setup a ticket should be started with PCDS Support to add that payer to generate statements on an automatic cycle. This cycle is usually every 30 days, but is configurable by payer.
   

How statements are generated
   

There is an automated process that runs every evening to generate statements for patients (not invoices) that have not had a statement in the last 30 days, or whatever is setup for that payer.
   

 

Collection Agencies
   

Collection Agencies are contracted with providers to collect on past due bills for patients that have received the required number of communications and warnings, as setup on the Statements tab of the Payer.
   

Navigate to Setup -> RevNet -> Collection Agencies
   

Enter the Name of the Collection Agency.

   

   

Select the Organization from the drop down list. If the Organization does not exist, it will need to be added first.
   

Click

   

The Collection Agency is now available.
   

   

 
   

Statement Timing
   

If the payer is set for Generic Invoices, when the invoices are in Batch Processing, the invoices should be printed from the Action Item List (). Select Print Invoices.

   

   

Once the invoices are printed, they should be Marked as Billed.
   

If the payer is set for Statement type OR after the initial Generic Invoices is sent, patients will receive a statement every 30 days. If a patient receives a statement and the receives services again before it is paid in full, if that invoice is billed before the 30 days expires, the next statement will include that invoice as well. This happens regardless of when in that 30 days self-pay is billed.
   

Example: Patient John Doe is sent a statement on January 15th. On January 16th, he receives services again and that invoice is billed to the patient on February 1st. The patient will NOT appear in statements generated and appearing in Batch Processing on February 2nd, but will appear on February 14th.
   

The dunning language that was setup in payer info comes into play during this process. The language that is included on the statement is based on the OLDEST invoice and the number of times it has been sent.
   

Example: Patient John Doe is sent his first statement on January 15th. There is no insurance listed, so Self-Pay is the only payer. This statement will include the first message under Payer -> Statement -> No Payment Received.
   

If he does not make a payment or does not provide additional insurance information, on February 14th another statement will be sent and this will include the second statement.
   

If again he does not make a payment, on March 15th, he will be sent a statement and it includes the Final Notice that this will be sent to collections. This will also place the invoice in the Final Dunning Sent Bucket in A/R Management after 30 days (April 14th).
   

 
   

Payment Plans
   

Patient will make payments and not always pay the invoice in full. RevNet is working on an integrated Payment Plan feature, but it is not available yet. The following workaround should be used.
   

When the patient makes a payment that does not pay off the remaining balance on an invoice, there will be a prompt in the Cash Receipts page giving an option to reset the dunning language.
   

   

This will remove the statement history for this invoice and allow a new statement to be sent with the first dunning language. Because there is a payment, it will send the first dunning language setup under Payer -> Statements -> Payment Received.
   

The history of statements sent will still be available from Account Inquiry. Click View Statement History from the Action Item List ().
   

   

Removed indicates that the Dunning language was reset. OK indicates that one is sent.
   

 
   

A/R Management

Provider Info has the ability to customize the # of Days to Hide Invoices without Activity so agencies only see invoices that have aged. This is usually set to 30 in Setup -> RevNet -> Payer/Provider -> Provider.
   

   

If this option is set to 30, Self-Pay Invoices will not appear in A/R Management. This is because there is activity on these invoices every 30 days (based on the statement cycle setup previously). The exception will be when the Final Notice is sent. Once the Final Notice has been sent, the patient receives another 30 Days (the provider set # of Days to Hide Final Dunning) to make payment arrangements and/or send insurance information. Once this 30 days has expired, invoices will appear in the Final Dunning Sent Bucket on the A/R Management Summary page.
   

   

Collections
   

Invoices can be sent to collections. Select the Invoice(s) from the A/R Management Detail page.

   

   

Use the Action Item List () and select Send to Collections (Selected Invoices)
   

This will place the invoice(s) back on the A/R Management Summary page in the Send to Collections - To Batch bucket. Once a batch of invoices is ready, use the Action Item List () and click Create Batch.

   

 
   

This will place the invoice back on the A/R Management Summary page in the Send to Collections - To Send bucket. Once this batch is ready to send to the collection agency, use the Action Item List () and click Download Batch File to get an excel spreadsheet to send to the collection agency.

   

   

Once complete, use the Action Item List () and click Mark as Sent.
   

Sample File:
   

   

Invoices that have been sent to Collections appear in RED.
   

   

   

Write-Off Remainder
   

Based on the existing balance and per agency policy, invoices can be Written Off. Select the Invoice(s).
   

   

Use the Action Item List () and select Write Off Remainder (Selected Invoices).
   

   

This will create an adjustment and close out the invoice.