Recovering unpaid bills: Ways to recover the dues

February 16, 2012

Every hospital takes action to increase hospital’s revenue and rein in costs. Unpaid bills and dues from patients constitute major part of potential bad debts and accounts receivable. Timely recovery of these bills and management of debts is important for the financial health of all hospitals.

Unpaid hospital bills increases the woes of the hospitals along with patients. There are certain categories of patients who may be admitted as an emergency or have been discharged or abandoned in terminal stages or have expired or who, after incurring a hefty bill, have developed dishonest intentions. Such category constitutes up to 10 per cent of hospital clientele.

Further, the CE Act 2010 mandates that all emergency cases have to be rendered first aid treatment, irrespective of the patient’s paying capacity.

In view of the above problem faced in realisation of unpaid bills, each hospital must develop a well-defined policy and a step wise ethical approach based on sound strategy to address this issue. A properly implemented policy and sound strategy not only minimises bad debts and avoids unnecessary litigation but also ensures healthy patients and bottom line for the hospital. Here are some tips to ensure the same.

1. Prior to admission: Hospitals should provide complete information to patients regarding the fees and prominently display the schedule of charges. Even otherwise, this is a requirement in terms of Indian Medical Council Regulations, 2002.

2. On admission: On admission assess patient’s paying capacity and verify insurance coverage, if any. Collect certain sum as advance payment from the patient and replenish it periodically. It is best to obtain undertaking from the patient/attendants to the effect that they would clear all bills. NABH standards also state that ‘the patients are explained about the expected costs on admission. In case of packages it should clearly state the terms and conditions and also the exceptions if any.’ From the legal perspective, do not refuse emergency treatment to any patient.

3. During hospitalisation: Develop a mechanism whereby the patient is daily updated about his condition, expected duration of stay and interim bill position accurately and promptly. Ensure that patient pays separate bill at each costing unit of hospital like pharmacy, diagnostic tests; prior to receiving drugs or disposables or undergoing lab tests. However, when it appears that the payment may not be forthcoming, discretion may be exercised to minimise expenses that may be avoidable, without clearly endangering life.

4. When patient or attendants are genuinely unable to pay: Refer such patients to charity or NGOs. Finally, hospitals should be prepared to write off up to 10 per cent of bills as bad debt and serve humanity. Hospitals could assign a percentage of budgets as carrying and delinquency cost as a necessary evil based on experience, locality and major patient profile.

5. When patient or attendants refuse to pay: Give some time limit and flexible options to patient to pay through installments, credit card or post-dated cheques as an exception. It is better to have accounts receivable than bad debt in hospital books. If they still fail, issue a legal notice demanding payment of bill irrespective of the fact that the patient has filed a complaint in the consumer court alleging deficiency in services.

6. On discharge: Ensure that the final bill handed over to the patient is easy, simple, flawless, itemised and transparent.

7. It is a different matter that the hospital may not always choose to take the legal approach for reasons of practicality. From a practical point of view, the billing process should be made simple and above measures shall minimise bad debts. Eventually, patience, ethics and negotiation skills pay.

Gp Capt (Dr) Sanjeev Sood