Collecting your fees when a patient dies

Post-mortem accounts receivable made easier

If your company serves a predominantly elderly or technology-dependent population, sooner or later you may be faced with uncollected account balances following a patient’s death.

While private duty agencies are well-equipped to meet patient’s medical needs, they are often less prepared to address financial issues with their client’s survivors. Providers understandably "don’t want to intrude on people’s grief," but have little choice when a patient dies leaving a large outstanding balance, says Darien Zimmerman, RN, vice president of long-term care, Visiting Nurse Association of Greater Philadelphia. But upfront planning can make this difficult task easier if you follow these tips:

Closely manage accounts receivable.

Zimmerman advises "very intense receivables management" to minimize the agency’s exposure in such a situation. Requiring a deposit and billing weekly on private pay or large copay cases may eliminate having to approach a family at all. Deducting the last days or week of service from the deposit may leave only a small account balance which many companies write off. Zimmerman also recommends establishing a financial responsibility policy outlining acceptable outstanding balances and enforcement actions the agency may pursue.

Document financial and service agreements.

Glen Jett, BSN, RN,C, division manager, Home Health Plus in Kansas City, MO, suggests a clearly worded service agreement outlining both the provider and patient’s expectations, along with both parties’ responsibilities.

Patient complaint procedures should also be plainly defined. While these are standard start of care documents, financial agreements particularly should be explicit and not open to interpretation. Clarity is important because family members may see the records for the first time when they are overwhelmed with grief and have no baseline understanding of the care process.

Include family members in front-end service planning.

Because relatives often have difficulty addressing complex medical claims in the aftermath of a loved one’s death, Jett suggests, with the patient’s permission, including family members in service planning before care begins. This is especially helpful if the patient is very ill and likely to accumulate large charges.

This may involve a case conference if the family members live locally or phone calls with accompanying service agreement transmission if they are far away. Family members may also need to guarantee or co-sign financial responsibility documents.

However, Elizabeth E. Hogue, a health care attorney specializing in home care in Burtonsville, MD cautions that this strategy may backfire for both the patient and provider if not handled correctly, potentially compromising patient autonomy.

Protect patients’ treatment choices

Family members, suddenly cognizant of the cost of services, may attempt to intervene in the service agreement even though they have no legal standing. To counteract their "reinforced expectations and desires to be part of the decision-making process," Hogue recommends including family members only if they are clearly informed that treatment and financial choices belong to the patient.

Approach family members with the right timing and message.

Jett says there is a "narrow window of opportunity" for the agency to resolve outstanding balances with family members. He suggests phone contact seven-to-10 days after the patient’s death, approaching the receivable as a mutual problem the two parties can resolve. The first contact may be made by a company manager to both convey sympathy and address the financial situation.

"It may make [the process] a little more palatable knowing someone is overseeing the collections, and it’s not just being conducted by some anonymous corporation," Jett says. After initial supervisory contact, Jett suggests following normal account collection procedures.

Both Zimmerman and Jett strongly recommend attempting settlement with the family before an estate is opened to avoid potentially lengthy payment delays, voluminous paperwork, diverted staff time, and legal involvement if the claim is disputed.