Policies,Administrative,UWMF,UWMF-wide,Patient Business Services

Unresolved Accounts (113.037)

Unresolved Accounts (113.037) - Policies, Administrative, UWMF, UWMF-wide, Patient Business Services




University of Wisconsin Medical Foundation
Patient Business Services
Policies & Procedures

__X __ New ____ Revised

If Revised, Supersedes Policy Dated:

Effective Date: 7/1/2007

Policy Number: 35
Approved By (Name): Connie Kinsella, VP, Patient Business Services

To define a process that will allow the opportunity to assist patients who may be unable to pay
their medical bills. These patients will be identified by the presence of accounts totaling greater
than $500.00 that have been placed with a collection agency. Many of these patients do not
respond to Business Office calls and mailings. They are not unwilling to pay their bills; they are
unable to pay their bills. This opportunity for intervention allows us to assess eligibility for
government programs or community care, or to establish mutually acceptable payment
arrangements to resolve their accounts.

1. UWMF is committed to identifying and assisting patients who may have difficulty paying for
their medical care. To that end, UWMF will identify patients with unresolved account
balances and require that these patients be transferred to Patient Financial Services prior to
being allowed to schedule a non-urgent visit. A hard stop in scheduling will be implemented
to support this intervention opportunity.

2. Patient Financial Services will work with the patient to determine:
a. If the patient qualifies for any government program such as Medicaid, SSI,
BadgerCare, etc. and/or
b. If the patient qualifies for Community Care, and/or
c. If a mutually acceptable payment arrangement can be developed for the patient.

3. Patients will be cleared to see UW Health providers once they have spoken with Patient
Financial Services and an action plan, based on the above, has been developed.

4. Patients who refuse to cooperate with Patient Financial Services may be refused further non-
emergent service at UW Health.

1. A hard stop will be programmed in Cadence to prevent receptionists from scheduling an
appointment (IMC will be exempted) for a patient with a personal/family account status of


“MF Unresolved Account.” A message will appear requiring the receptionist to transfer the
patient to Patient Financial Services.

2. The Receptionist must use the following scripts:
a. Reception to Patient - I have received a message on my screen indicating our
Business Office needs to speak with you before I may make this appointment. I
will transfer you to that office now.
If the patient persists in knowing why s/he must speak to the Business Office, the
Scheduler should state: "The Business Office can explain. I have no information
other than the Business Office needs to speak with you before an appointment
may be scheduled."
b. Receptionist to Patient Financial Services - There is an ‘unresolved accounts’
message on the screen indicating PATIENT NAME (PARENT, if patient is a
child) must speak to the Business Office before an appointment can be scheduled.
I am trying to schedule an appointment in CLINIC NAME and my name and
NUMBER.". The patient’s MRN is XXXXXX.

3. Patient Financial Services(PFS) will speak with the patient, obtain a financial statement over
the phone to ascertain:
a. Whether s/he may qualify for a government program.
i. If so, the patient will be referred to UWMF Patient Relations to complete
the necessary application.
ii. Staff will add an accounts status of “pending” for the appropriate
government program to the patient’s account and change the existing
account status of “UWMF Unresolved Account” to “UWMF Unresolved
Account – Cleared” will be added. The patient will then be allowed to
schedule any necessary appointments.
iii. Staff will place a tickler in the system to check with Patient Relations and
the patient regarding the status of his/her application.
b. Whether s/he may qualify for Community Care.
i. If so, a tickler will be placed in the system to confirm receipt of all
supporting documentation required with the financial statement has been
received and processed.
ii. Staff will change the existing account status of “UWMF Unresolved
Account” to “UWMF Unresolved Account – Cleared” and transfer the
patient back to the clinic to schedule the appointment.
c. If they can pay the outstanding account balance or if they are willing to set up an
acceptable payment arrangement.
i. If so, the PFS staff will document the account with the promised payment
or established payment plan.
ii. Staff will change the existing account status of “UWMF Unresolved
Account” to “UWMF Unresolved Account – Cleared” and transfer the
patient back to the clinic to schedule the appointment.



4. If the patient refuses to cooperate with Patient Financial Services staff, the patient will be
informed that s/he will not be granted appointments for non-urgent services until acceptable
resolution to the account has been negotiated.

5. Continued failure on the part of the patient to resolved outstanding balances may result in
termination of the patient from UW Health.

6. If, for some reason, an appointment does get scheduled, when the patient presents at sign-in
(sites with a hub) or check-in (sites without a hub), a message will appear indicating the
patient must speak with the Business Office. The patient should be moved to a private area
and connected to Business Office by phone.


Community Care Policy