Cambridge Medical & Rehabilitation Center

Credit & Collection Policy Code: CMRC - ---- - ------

Credit & Collection Policy

2016

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 Cambridge Medical & Rehabilitation Center

Credit & Collection Policy Code: CMRC - ---- - ------

Index

S.N Policy Page

1.0 Policy 3
2.0 Purpose 3
3.0 Scope 3
4.0 Pre- Admission / Financial Considerations 3
5.0 InvoicingProcedures: 4
5.1 Non- Insured patient- 4
5.1.1 Corporate Patients 4
5.1.2 Self-pay 4
5.2 Insured Patients – Insurance Companies 5
5.3 Outpatients 6
6.0 Self-Pay /Non-Insured/ Balances after Insurance Collections 6
7.0 Insurance Companies - Collections 7
8.0 Cash or Cash Equivalent Collections 8
9.0 Reasonable Collections Efforts 8
10.0 Legal action 9
11.0 Write-Off Procedures 9
12.0 Internal Controls 9
Appendix 1 : Daman Insurance Process 10

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Credit & Collection Policy Code: CMRC - ---- - ------

1. Policy:
CMRC’s Credit and Collections Policy (“CCP”) is concerned with preserving assets and
maintaining a sound financial basis for operations while balancing the needs of our community
and the patients that we serve. Collection procedures are applied for all patients whether they
are:
 Self-pay.
 Insured (Valid Insurance card).
 Corporate Patients: Sponsored by any external bodies (Government authorities or
Private agencies, etc.).
2. Purpose:
This policy is intended to provide management with guidance as to acquiring and collecting
information and collecting payment from patients, their guarantors, third party insurance
companies and others financially responsible for payment of healthcare services.
3. Scope:
This policy applies to RCM department, Case Management, Business Development Department
& Finance Department, legal advisors, and any invoicingand collections related units.
4. Pre-Admission Financial Consideration:
4.1 Prior to admission, Admissions / Case Management / Business Development are
responsible for understanding how CMRC will be paid for patient services to be
provided and for ensuring that the relevant authorizations are obtained prior to
admission of the patient.

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5.0 Invoicing Procedures : CMRC’s Revenues are generated from:

5.1 Non-Insured Patients which include:
 Corporate Patients: their care is covered by Gov. Authorities, private agencies
and/or any other source that may include but not limited to Zayed Military hospital
(ZMH), the Royal family and others.
 Self-Pay.
5.1.1 Corporate Patients :

 An authorization needs to be obtained for each referred patient; a patient

assessment and quote is sent to the payer to formally approve the quote.
 Different Payers have different authorization processes and these must be followed
step by step.
 Patient admissions are conditional on the approval of the quote sent to the payer /
sponsor.
 On a monthly basis, the Revenue Cycle Management team produce and send an
invoice to the client (Payer) disclosing the number of patients per category per day.
 There is neither a rejection nor resubmission process with corporate clients, if the
invoice is not paid then the collection procedures are followed as described in
Section 6.0.
 A copy of the invoice is sent to the Senior Accounts Officer (SAO) who will post the
revenue entry journal voucher in Oracle and submit for approval.
5.1.2 Self- Pay:
 Once a patient has been medically accepted as a patient, a quote is prepared and a
deposit for 50% of the treatment and a post- dated cheque for the remaining
amount are requested.
 The deposit and cheque must be received on or before admission.
 The patient is then transferred to the facility. A census is carried out on a daily basis
at midnight. If a patient is present at midnight, he/she is invoiced for. The grading,
census and other information e.g. level of consumables and medicines used by the
patient, are captured into the system Clemittence by the Revenue Cycle
Management Team.
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 On a monthly basis the Revenue Cycle management team produce an invoice per
client based on the number of patients per category per day which is sent to the
client. A copy of this claim/invoice is then sent to the SAO.
5.2 Insured Patients : Insurance Companies:

 Once a patient has been referred and accepted, the patient is graded depending on
the level and type of treatment needed in accordance with HAAD guidelines. The
grading is proposed by the physician and needs to be approved by the Patient’s
Insurance Company.
 Once authorization has been obtained, the patient is transferred to the facility.
 A census is carried out on a daily basis at midnight. If a patient is present at midnight
he/she is invoiced for.
 The grading, census and other information e.g. level of consumables and medicines
used by the patient, are captured into the system Clemittence by the Revenue cycle
team.
 On a monthly basis, the Revenue cycle management team produce an invoice and
submit it to the Patient’s Insurance Company based on the number of patients per
category per day.
 The Revenue cycle team submits this claim together with all the supporting evidence
required to the Insurance Company, they then submit the claim to the SAO along
with a monthly revenue summary.
 The SAO then reconciles the revenue summary to the claim submitted to the
Patient’s Insurance Company and reports any inconsistencies to the RCM team.
 Once the Insurance Company receive the submission, they will either accept the
claim or reject it. If the claim is rejected notification is given to the RCM team along
with a reason for rejection.
 The RCM team then have 45 days to resubmit the claim; up to 2 resubmissions may
be made before a correction process must be followed.
 If all the aforementioned avenues are rejected then the amount is negotiated during
the annual reconciliation and closing process.

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 Authorization for patients is only given per a month at a time, therefore on a

monthly basis the RCM team apply to the Insurance Company for an extension of
the authorization.
 If the extension is approved then the invoicing process continues as described
above. If the authorization is rejected then the patient is given the option to become a
self-pay patient or be discharged.

5.3 Outpatient:
An outpatient practice has been created for rehabilitation services within the facilities
and for external patients.
 For every patient seen there are four payment methods available: credit card, cash,
cheque payment or Insurance Claim.
 If payment is made by cash or cash equivalent then no debtor arises, however if
Insurance Company cards are used then a debtor does arise.

6.0 Collections of : Self‐Pay/ Corporate Patients/Balance after Insurance:

RCM/Case Management teams will provide prompt and courteous financial counseling
to all patients in need and will assist these patients in obtaining available financial
assistance from government agencies in order to meet their financial obligations to
CMRC.
 In the case of self-pay, the patient is required to pay a “Pre-admission’’ deposit
and provide post-dated cheques in accordance with a payment plan to ensure that
services provided are always prepaid.
 For Corporate customers, responsible parties are expected to pay their full liability
for services rendered within 30 days of receipt of their invoices.
 Patients who cannot make payment in full within 30 days of the invoice are
required to contact the Revenue Cycle Management (RCM) department.
 The RCM team will work with individuals in establishing a prescribed monthly
payment plan until the balance has been paid in full.
 The payment plan or budget contract is based on the outstanding amount due and
is requested to be resolved within 6 months or less.

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 The RCM Department may contact patients via mail or telephone if payment is not
made or is less than the scheduled amount.
 If payment is not made due to a change in the patient’s financial position, the
patient must notify the RCM Department and renegotiate the contract.
 If no satisfactory response is received after 120 Consecutive Days, the account will
be placed with CMRC’s attorneys for the legal process to be followed to recover
the Service Fees.

7.0 Collections from Insurance Companies:

 Invoices will be sent to the Insurance Company on a monthly basis; these are
submitted via the HAAD e-claims system and the claims will either be accepted for
detailed review or rejected based on, for example, invalid authorisations
 Credit terms agreed with all insurance companies are for payment to be made
within 45 days.
 When payments of outstanding amounts are made, remittance advices are
uploaded to the e-claims software for reconciliation to the invoices submitted.
 The RCM team then cross check the remittances to the payment and finance
confirm, reconcile, and record in Oracle.
 After the close of the financial year, a reconciliation and closing process is followed
with Insurance Company where all remaining rejected claims are reviewed and a
settlement negotiated.
 Once a final amount has been negotiated the remaining amount that will not be
recovered are written off by the SAO once approved as per Delegation of
Authority.
 If amounts due are not paid, the Insurance Company will receive at least 3 invoices
within 120 days and a “final notice” indicating that the account will be referred to
CMRC’s legal counsel when the invoiced amount has not been received or when an
appropriate payment plan has not been established.
 The statement or invoices will be accompanied by telephone calls, collection
letters, escalation to management and any other notification method that
constitutes a genuine and reasonable effort to contact the party responsible for
the obligation.
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 Cambridge Medical & Rehabilitation Center

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 The designated Staff will document alternative efforts to locate the party
responsible for the obligation or the correct address on invoicing returned by the
postal office service as “incorrect address” or “undeliverable” that is otherwise
considered a “bad address”.
 The patient’s file will include documentation of collection effort including invoices,
follow‐up letter, and telephone calls.

8.0 Collection of Cash or Cash Equivalent Collection :

 Receptionist records patient information, cash and credit card payment details
daily on the “Outpatient Transaction Summary” sheet.
 At the end of each day, Receptionist takes a print out of the daily “Outpatient
Transaction Summary”, reconciles it with credit card receipts and cash and initials
it.
 Receptionist attaches the “Outpatient Transaction Summary” to the cash received
during that day and submit it to the delegated finance staff (who confirms the cash
received by counting, matching the physical amount to the register amounts and
then initialed the register) for deposit into the safe and subsequent deposit in the
bank on the next business day.
9.0 Reasonable Collection Efforts
 All reasonable efforts should be exercised and documented in purse of the
collection of unpaid Patient’s balances. Which include but not limited to:
 An initial invoice to the party responsible for the patient’s personal financial
obligations.
 Subsequent invoicing, telephone calls, collection letters, and any other
notification method that constitutes a genuine effort to contact the party
responsible for the obligation.
 Documentation of alternative efforts to locate the party responsible for the
obligation or the correct address on invoicing returned by the postal office service
as “incorrect address” or “undeliverable”. Sending a final notice by certified mail
for outstanding balances where notices have not been returned as “incorrect
address” or “undeliverable”.

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10.0 Legal Action:

In certain cases, it may be practical to pursue a legal action to collect patient balances.
Situations that Revenue cycle Department has exhausted all reasonable collection
efforts and patients who are unwilling or uncooperative to pay CMRC dues.

Authorization to initiate a legal action to collect unpaid invoices should be based on

Delegation of Authority Manual.
11.0 Write-Off Procedures:

 Write-off authorization should be documented as per the Delegation of Authority.

 Outstanding patients’ balances may be written-off to bad debts, based on RCM
Director Report briefing the efforts exercise to collect the outstanding debts, the
report should be submitted to the legal advisor for his/her opinion.

12.0 Internal Controls:

 Metrics to monitor and measure RCM department and efficiency in pursuing the
due and overdue balances and compliance with this policy:
- Time frame for claim payment and follow up.
- % of Monthly Collection in comparison to the Patient’s outstanding amount.
- Timeframe of claim submission (time spent to complete one claim.)
- Number of Outstanding claims submitted and accepted by Insurance Companies.
- % of the total debts which are overdue for each credit limit period (30 days; 60
days; 90 Days past the due date).
- % of patients’ outstanding balance which transferred to doubtful accounts or
legal action.
- Payer Turnaround (number of days to pay the agreed claim).
- & of claims returned / rejected from insurance companies of the total claims
submitted.
 Monthly report of RCM department collections efforts.
 Monthly Report of Installments plan agreed with the patients along with agreed
schedules.
 Total amount of discount granted to each self-pay patients.

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Appendix 1:
Daman Insurance Process:

 Sessions with clinicians are recorded by the Receptionist as they occur.

 During each session the therapist is required to complete the required documentation
for the session as required by Daman, this information includes an assessment form
with appropriate Daman invoicingcodes as well as the patient’s signature as evidence of
the visit.

 The medical files of all patients seen that day are collected by the receptionist by 9am
the following morning.

 The receptionist performs a reconciliation to ensure all files are accounted for she then
delivers the files along with a list of all patients and respective clinicians to Revenue
Cycle management (RCM).

 The RCM team then record the outpatient event, capturing the Daman codes as
indicated on the assessment forms.

 The patient files are then returned to the receptionist by the following morning. If there
is any information that is incomplete or missing from the files the files are immediately
returned from RCM to the receptionist who requests the clinical staff member to
complete the information within an hour and returns the file to RCM.

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Self-Pay Patient Invoicing & Collection Workflow

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Self- Patient invoicing & Collection workflow

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