Practice Management Q&A

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Overdue accounts; test results; hiring part timers

When to write off an overdue account

At what point should I give up on collection efforts? How old and small does the balance have to be?

Don't waste too much time chasing down small balances of $25 or less. After 90 days, write off uncollectible balances under $15, and turn over the rest to a reputable healthcare services collection agency.

Occasionally, my office has trouble reaching patients whose test results are positive. If I haven't heard back from a patient after leaving three phone messages, what should we do next?

Check your records for anyone who may be able to help you connect with the patient: someone authorized to receive his healthcare information, for example, or listed in his chart as a contact in case of emergency.


If you can't find any leads, then send the patient a letter by regular mail instructing him to call you. You can include the test results and recommendations if you're sure he'll understand them and follow up appropriately.

If that fails to prompt a response, resend the letter by certified mail, return receipt requested. If that's unsuccessful, try one more certified-mail letter in which you directly spell out what the test results revealed, your recommendations, and what might be the result (including death or permanent disability, if they're possibilities) if the patient fails to get treatment.

Document each phone call (date, time, name of caller, and number called) and letter. Keep a copy of all letters and "return-receipt" cards from the post office.

If all attempts to reach the patient fail and the medical situation involves a potentially fatal or disabling condition, contact your medical malpractice carrier and follow its recommendations. Also contact them for guidance if the certified mail service confirms delivery but you doubt the patient's competence to act on the advice in the letters you've sent.

Does hiring part timers make sense?

Our practice needs another full-time medical assistant. Our office manager suggested we consider hiring two part timers instead because they'll save the practice the cost of benefits. Is this a good idea?

Yes, you'll save on health insurance, sick leave, and vacation pay. But if you have a retirement plan for your employees, you'll have to make contributions for the part-timers, too, if they work at least 1000 hours a year.

In this issue, the answers to our readers' questions were provided by: Gregory Hood, MD, Drs. Borders & Associates, Lexington, KY; Barry S. Pillow, CHBC, Healthcare Consulting Inc., Greensboro, NC; Gray Tuttle Jr., CHBC, The Rehmann Group, Lansing, MI.

Do you have a practice management question that may be stumping other doctors, too? Write: PMQA Editor, Medical Economics, 123 Tice Blvd., Suite 300, Woodcliff Lake, NJ 07677-7664, or send an e-mail to (please include your regular postal address). Sorry, but we're not able to answer readers individually.