The management of accounts receivable is a complex process that allows practices to be accurately, ethically, and legally reimbursed for services provided to patients. During the checkout process, the practice’s front office personnel are responsible for collecting copayments, coinsurance, and deductibles from patients, and for scheduling follow-up appointments.
At the Renal Practice Associates, Sylvia is a front office clerk who knows the practice’s patients very well. She is so observant that she knows when patients are having difficulty paying copayments and other medical-related expenses. Some patients are experiencing life-threatening end stage III renal failure, and they are on dialysis. Sylvia is aware that the practice is large and successful, and she believes no one will mind when she excuses one or two patients from making copayments during the checkout process. Sylvia has become so compassionate about patients’ financial circumstances that she also marks a patient’s account as paid in full even when the patient has not made the appropriate payments. When patients with acute or chronic conditions check out at Sylvia’s station, she often tells them they owe no balance and that she is happy to reschedule them for their next appointment.
After a few weeks of observing Sylvia’s behavior, a co-worker becomes concerned. Lily has only been in her position for six months, while Sylvia has worked at the practice for ten years. Lily is not sure what to do or how to approach what she views as a problem. It is obviously raising a “red flag” for her, but she can’t afford to lose her own job. She is not sure what to do, and determines that her options include:
Not saying anything to anyone and ignoring what Sylvia is doing.
Asking Sylvia if there is a special policy and procedure that allows some critically ill patients to be exempt from paying for copayments, coinsurance, and deductibles. If that is the case, Lily would ask to be provided with a copy of the policy and procedure so that she is aware of it in writing.
Meeting with her supervisor to share what she is witnessing about Sylvia’s processing of some patients during checkout.
Which of the above options should Lily choose? Why?
Why should Lily follow through on her observations about Sylvia?
