Reconciliation Policy

 

Patient Account Reconciliation Process

Statements

Policy

1st statement

Patients with Insurance:  Patient Charges are filed to the insurance company.  If the insurance company does not pay, then UTPA starts the appeal process and a patient statement is not generated. The issuance of the first patient statement will vary based on when the insurance company makes a final decision on the claim submitted.   Once the claim is settled by the insurance company the balance becomes patient responsibility and a statement is then issued to the patient.  This starts your 30 day notice.  Private pay patients: responsibility does not follow the insurance process and statements will be sent immediately. 

2nd statement/ 60 days out

The account is now 60 days past due.   The 2nd statement goes out to the patient 30 days after the first statement which is 60 days after patient responsibility has been established.  

3rd statement/ 90 days out

The account is now 90 days past due.   The 3rd statement goes out to patient 30 days after the second statement and is 90 days after patient responsibility has been established. 

91 days out

 1st Letter is a Past due notice:  initiating collection process which includes letters and phone calls to the patient.   

120 days out

2nd Letter is a Collection Notice:  Staff alerts provider.  Patient is given the opportunity to settle the account within the practice which prevents the account from being turned over to an outside collection agency. 

150 days out

3rd Letter is the Final notice: Patient is given 15 days to reconcile the account to prevent it from being turned over to an outside collection agency.  After the 15 day period, a collection agency will then continue collection efforts. Provider will determine if patient is to be terminated from the practice.