MED105 JOB SKILL 13-4
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Midlands Technical College *
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Course
105
Subject
Medicine
Date
Dec 6, 2023
Type
docx
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4
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1. A new private pay patient, Anne Rule, calls for an appointment for Monday morning. It is your office policy to collect the physician’s fee at the time of the first visit. Convey this information during your conversation.
“Yes Mrs. Rule We can fit you in on Monday at 2:30 to see Dr. Smith. You will need to bring your
insurance card and valid state ID or drivers license. In our practice it is policy that we collect the
physicians fee during your first visit please be prepared to make a payment.”
2. An established patient, Sylvia Cone, came in on Wednesday for a Level IV examination. She calls today and says she is not going to pay the bill because she is not satisfied with the treatment. She says, “Go ahead and send my account to a collection agency. I’ll call my attorney. I can make trouble for you and Dr. Practon.” Prepare your response.
“Mrs. cone I apologize that you are not satisfied with your service but by accepting treatment you must pay the balance for what was provided. I'll send this over to collections and you can work it out from there. Please let me know If and how I can further assist you.”
3. Mrs. Katrina Frenzel calls to ask you about the bill she just received for her son, Paul, who recently made his first visit to the office. She thinks the bill for $132.28 is “very high” and wonders if there is a mistake because the fee seems out of line. She says she has recently moved into this area. Prepare your response and state what action you would take.
“I would go over the bill with her and break down the cost for everything charged and answer any
other questions she may have and also inform her on programs that may be able to help her cover
some of the cost if she happens to qualify”
4. Today you call Miss Wendy Snow about her account, which is overdue. You have sent her two statements, telephoned her, and finally sent a letter ask-ing her to call the office about the $80 she owes.
She has not responded. According to your records, she was seen on November 2, she lives at home with her parents, and she has health insurance but has not paid the deductible. Prepare questions you would ask her.
I would call her and inform her that her insurance is no longer active because she hasn't paid her deductible. I would also inform her of her overdue $80 balance at the doctor's office. After calling and informing her of the overdue balance I would then issue a reminder letter in the mail with a deadline of 30 days. If the deadline is not met, then I have no choice but to send it over to collections
5. Recently, Dr. Gerald Practon performed a two-hour operation and billed the patient his standard fee, which is what physicians generally charge in your region. However, the patient’s husband considers the fee exorbitant and has paid only part of it. What action would you take, and how would you collect the outstanding amount? I would first mail out a letter letting her know that she has an outstanding balance and if she doesn't reach out to the office within 30 days I would escalate the case to collections
6. Last week, Dr. Fran Practon made a lengthy long-distance telephone call to check on a postoperative patient who had a complicated major surgery. Should you bill the patient for the telephone charges? Explain your answer.
No, this call should already be included in the bill for the procedure
7. Recently, a patient whose account you have turned over to a collection agency saw you in the supermarket and mentioned that she would be tele-phoning for an appointment soon. Before making the appointment, you notify Dr. Practon of this circumstance. He insists she pay what she owes, and requires any future bills be paid in cash. Is this ethical? Explain your answer.
No. it is unethical to refuse services to patients who have an outstanding balance and it is also unethical to force them to pay in cash
8. You routinely bill Dr. Practon’s patients the amount that appears on the established fee schedule. In reviewing an account, Dr. Practon finds that a certain patient has been charged more than was intended. The patient makes no complaint and pays the bill in full. What action would you take? I would notify the patient, make the changes in the computer and allow the payment to be reversed
But only paying what is owed.
9. Sister Mary Benedict Ramer, a new patient, is seen in consultation. She gives you her insurance card and asks whether she will be given a dis-count because she is a member of the clergy. How would you respond?
No. We do not provide discounts based on religious preference
10. Dr. Practon’s fee for an appendectomy is $568.36 (CPT code 44950). Mr. Jefferson’s hospital stay for his appendectomy was unusually troublesome. His first symptoms appeared after midnight, and he was admitted to the hospital as an emergency patient. The decision to operate immediately was postponed by Dr. Practon when the patient began to improve; however, he had several abnormal laboratory results. During the following night, the patient’s condition worsened, and the appendectomy was performed, thereby interrupting Dr. Practon’s sleep for a second night. After the operation, the patient had a bad case of post anesthesia nausea and was quite demanding while in the hospital. Would Dr. Practon be justified in charging him extra because he was “a lot of trouble”? Explain. No because doctors cannot charge you extra based off behavioral issues
11. You send a bill for $1500 to Mrs. Jamison for a major surgery. She tells you that the physician told her in a presurgery conversation that the charge would be “about $1300.” Dr. Practon says he does not remember quot-ing the figure to her. If the usual charge is $1500 for this procedure, what should you do about the bill? Explain. I would Refer her to her our billing department so that she can double check and make sure that she was charged correctly
12. Mr. French calls in complaining about an overdue refund. He, as well as the insurance company, paid
for a procedure, and he is owed a return of his payment. You have been swamped with billing and reply that the state-ments come first and when you can “get to it” you will mail the refund. What is the proper
procedure in this instance? Describe.
I Reassure the patient that his refund will be dispersed at the earliest date possible and provide him with documentation letting him know how much money he will get back.
13. Patient Joanie Franklin comes in to see Dr. Practon for an initial visit. When asked about insurance coverage, she states, “According to our divorce settlement, my husband’s insurance should be billed first.” How would you respond? I would make sure to see and verify her insurance card and go over the terms of her policy before making any changes
14. An established patient telephones and says, “The letter I received from the insurance company said you charged too much.” How would you respond?
I would immediately go back in the computer and see what the charges were made and match them up to what was being charged and dispute with the insurance company if something isn't right. I could also call the insurance company to verify certain information before disputing it just in case my office did make a mistake. 15. New patient Bill Songer comes in to see Dr. Gerald Practon. He says, “My wife handles all the bills, so you will have to call her.” How would you reply? “If that's what you prefer I'm gonna need you to sign these forms saying that we can contact your
wife and discuss your medical information. We need your authorization before moving forward.
“
16. An established patient was seen by Dr. Fran Practon and returned the following week to have a treadmill test. His insurance was billed; however, the EOB was sent to the patient denying payment for the test. The patient came in and stated, “My insurance should have covered that service.” What questions would you ask and what action would you take? I would break down why the insurance company might have not covered his/her treatment and tell her that she is more than welcome to dispute anything if she feels her insurance should have covered it. 17. You call patient Mary Edwards regarding an overdue account and reach an answering machine—the patient is not home. What will you do? Leave a message with all the contact information to call the office back and get the matter resolved
18. A patient who has not seen Dr. Practon in a long time comes in for an office visit. Upon leaving, the patient states, “My attorney told me not to pay the bill.” What would you say and what question(s) would you ask? I would ask them why they don't feel the need to pay and let them know that it's very important that
they pay the amount owed on their bill however they have all right to consult their attorney and can
feel free to reach out with any questions
19. A long-standing patient owes over $500, which is now past due. She calls stating, “I have just declared bankruptcy.” How would you respond?
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I would have no coice but to escalate the case to collections, make the changes in the computer and send the necessary paperwork that is needed
20. You are calling Jana Lynn Rose about an overdue account. Her spouse answers the phone and states that the patient is deceased. How would you respond?
I would express my condolences and let them know that most of the time debuts are able to be cleared with a valid death certificate from the patient