HD2007 - Billing and Collecting for Services Performed at the Speech and Hearing Clinic
College of Health and Human Development
Policy Steward facilitating procedure: Dean, College of Health and Human Development
Table of Contents:
- ENTRY AND TREATMENT
- BILLING AND COLLECTION
- The Client Pays at the Time Services are Rendered
- The Client Does Not Pay at the Time Services are Rendered
- Pennsylvania State University Students
- Geisinger Health Plan Members
- Clients Sponsored by the Department of Vocational Rehabilitation (OVR)
- Full-Time Speech Therapy Clients - Residential Adult Therapy Program (RATP)
- SALES OF ASSISTIVE DEVICES/HEARING AIDS AND OTHER RELATED ITEMS
- DAILY CASH/SALES RECONCILIATION
- PREPARATION OF THE REPORTS OF CASH RECEIPTS (ROCR)
- RETURNED CHECK PROCESSING
- AUDIT COORDINATION - FINANCIAL AND PROCEDURAL
- RECORD RETENTION, DISPOSITION AND DESTRUCTION
- CONTACT INFORMATION
- CROSS REFERENCES
The Speech and Hearing Clinic is a practicum - research facility provided by the College of Health and Human Development for advanced students specializing in speech language pathology and audiology within the Department of Communication Disorders. The Audiology program provides individuals with professional service for hearing diagnosis and rehabilitation. The Speech Pathology program provides individuals with professional speech and language diagnostic service, as well as treatment for communication disorders.
For each program and/or service provided by the Clinic, the client is charged a fee which has been approved by the Corporate Controller. The Speech and Hearing Clinic also engages in the sale of assistive devices/hearing aids, as well as other related items (e.g. batteries). The Clinic maintains a change fund that has been established with the Bursar in accordance with University Policy FN04 . Access and responsibility for the fund will be limited by the Coordinator of Clinical Experiences at the Speech and Hearing Clinic.
The record keeping system utilized at the Speech and Hearing Clinic is a computerized system entitled HearWare Computer System. The HearWare Computer System provides an information profile on all clients and a history of all visits and payments. The HearWare Computer System also allows the Clinic to manage clinical information which is not addressed in this procedure.
The Department Head for Communication Disorders shall be referred to as the Department Head and the Coordinator for Clinical Experiences shall be referred to as the Clinic Coordinator in this procedure.
This procedure details the controls and responsibilities of the Speech and Hearing Clinic personnel required to properly record and protect the University's interests as associated with the fees collected for services rendered at the Clinic.
Appointments for services are made in advance and entered by the Receptionist in an appointment book. A history file and client number will be initiated for new clients, as are already established for previous clients. The client number consists of the first three letters of the client's last name and the next consecutive number as indicated on the client master list. The master list of client numbers is maintained in the Clinic's Office for reference as required.
NOTE: At the time the appointment is made, the Billing Clerk will quote the fees and inform the client (or guardian) that they are responsible for payment at the time of service. If the client has insurance coverage, it is the responsibility of the client to submit the claim to their company for reimbursement. Two exceptions are noted which include Penn State University students and Geisinger Health Plan members which are outlined later.
The Speech and Hearing Clinic, in conforming to the accreditation standards of the Professional Service Board (PSB) of the American Speech-Language-Hearing Association (ASHA), cannot deny service to any individual because of their inability to pay. If the client demonstrates a financial need based on a scale of family income which factors income with number of dependents, the Supervisor will authorize a waiver or adjustment of a fee by preparing and signing the Fee Waiver/Adjustment Form ( Exhibit "A" and Exhibit "B" ). The completed form will be given to the Billing Clerk.
The Fee Waiver/Adjustment Form will be field alphabetically by client name in the Clinic's Office.
When clients arrive at the Speech and Hearing Clinic, the Billing Clerk will prepare a pre-numbered Service Record/Billing form ( Exhibit "C" ).
Prior to being admitted for diagnosis or treatment, the Billing Clerk will give the Clinician the Service Record/Billing form to sign and indicate the appropriate service provided.
The Clinician will perform the appropriate service only upon presentation of a Service Record/Billing form. The performed service(s) will be identified on the Service Record/Billing form by the Clinician, who then signs the form.
The Billing Clerk will access the Invoice Screen in the HearWare Computer System and enter the services rendered to the appropriate client as indicated by the Clinician on the Service Record/Billing form. Information entered includes the date of service and the service code which provides a description of service(s) performed and the attendant fee. The balance due the Clinic is calculated by the HearWare Computer System, verified by the Billing Clerk and payment is requested from the client. The information entered (including payment information) on the Invoice screen automatically updates the Client Ledger List and the Open Receivable Report. The Billing Clerk also updates the Add/Edit Client Screen with the services rendered.
Service Records will be the basis for collecting payments at the conclusion of sessions, or making billings to clients who do no immediately pay in full. The Service Record/Billing forms will be filed in numerical sequence by Service Record number in the Clinic's Office.
Several situations exist regarding the billing and collecting for services because of the involvement of sponsoring agencies and insurance companies. The Billing Clerk will attempt to collect any balance due from the client at the conclusion of the session. Each billing/collection situation is detailed below.
If the client pays in full at the time services are rendered, the Billing Clerk will mark the three-part Service Record/Billing form "paid", date and initial the form. The Billing Clerk prepares a Pre-numbered Receipt per the instructions on GURU for the client acknowledging receipt of payment. The Billing Clerk also gives the client a copy of the Service Record/Billing form which can be used to prepare a claim to the client's insurance company if appropriate. The original copy of the Service Record/Billing form, a copy of the Pre-numbered Receipt, and the payment, will be secured. The Billing Clerk will enter the payment using the Invoice function in the HearWare Computer System, which computes the current balance due (if any) and updates the Client Ledger List. Cash and checks are secured in the Clinic's safe until transferred to the bank. The Speech and Hearing Clinic also accepts MasterCard/VISA as a means of payment.
NOTE: If the client has insurance coverage, it is the responsibility of the client to submit the claim to their company for reimbursement. Two exceptions are noted which include Penn State University students and Geisinger Health Plan Member which are outlined later.
Checks must be made payable to "The Pennsylvania State University" and restrictively endorsed when receive per requirements outlined in Policy FN01 - Processing Cash Revenues
If the Client does not pay in full at the time services are rendered, the Billing Clerk will give the client the third copy of the Service Record/Billing form showing the amount due or the amount waived. The fee remains outstanding on the Invoice screen which also is reflected on the Client Ledger List function in the HearWare Computer System which will calculate the current balance.
The Billing Clerk will review the entries made to the Client Ledger List, the Open Receivables Report and the amount due indicated on the Service Record/Billing form and prepare an invoice.
The Invoice instructs clients to make payments directly to the Speech & Hearing Clinic. Checks received for payment of invoices will be restrictively endorsed per requirements outlined in Policy FN01 - Processing Cash Revenues, and put into the safe. For checks that the Billing Clerk forwards to the Bursar's Office, an Accountability Transfer will be prepared per the instructions at Accountability Transfer on GURU.
Full-time Pennsylvania State University Students are eligible for specific waiver of fees for services as defined below:
- one speech/language evaluation
- one complete audiological evaluation
- one hearing aid evaluation
- five treatment sessions (a session is defined as no less than 30 minutes of treatment).
At the time of service, the Billing Clerk confirms the full-time University student status on the AIS System. A Fee Waiver/Adjustment form ( Exhibit "A" ) is prepared and signed by the Supervisor. The Fee Waiver/Adjustment form is forwarded to the Billing Clerk and an entry is made to the Add/Edit Information Screen List in the HearWare Computer System indicating the waived status. The use of waived services is tracked by the Billing Clerk on the Add/Edit Office Visit screen, which lists all services rendered to date, in the HearWare Computer System.
An invoice is not prepared for services rendered to these qualified students. If the student has insurance, the insurance company is billed for the services. If no insurance or incomplete coverage, the charge is waived by the Billing Clerk using the Credit Memo function in the HearWare Computer System. The waived status and the reason are indicated in the "description" section.
Part-Time University students may use the clinic services on a fee-for-service basis consistent with other Clinic policies. Part-time students and full-time students who have exhausted waived services may request to have fees adjusted per Clinic policy.
The Billing Clerk will insure that the client presents a Geisinger Outpatient Referral Request ( Exhibit "D" ) authorizing that services rendered by the Clinic can be billed to Geisinger Health Plan. If the client does not have the referral form, the Billing Clerk will instruct the client to obtain the authorization from their physician and reschedule the appointment.
The Billing Clerk sends Insurance Claim Forms to Geisinger Health Plan for payment on a monthly basis. Further details regarding the processing of Geisinger Health Plan members are outlined in the Letter of Agreement to Provide Speech and Audiology Services from Geisinger Health Plan to the Pennsylvania State University Speech and Hearing Clinic.
Prior to evaluation or rehabilitation, OVR will send an Authorization Order ( Exhibit "E" ) to the Speech and Hearing Clinic for clients that OVR is sponsoring. OVR specifies that they be billed on an OVR Invoice ( Exhibit "F" ). Authorizing Orders will be filled in the Clinic Office. For Clients with Authorization orders on file, the Billing Clerk will complete an OVR Invoice.
The majority of RATP clients attend intensive full-time programs conducted during the academic year. Clients may live in University residence halls, or commute.
Clients are charged based upon a RATP fee schedule, which is approved by the University Corporate Controller. Clients living in University housing are charged standard Housing and Food Service Fees. Clients may pay fees themselves, be sponsored by the OVR which has given advanced approval of the fees they will pay, or have fees paid by other third parties.
Prior to the beginning of therapy, clients who are not sponsored by OVR will be requested to make an initial payment. When the client pays, the check will be made payable to "The Pennsylvania State University" and restrictively endorsed per Policy FN01 - Processing Cash Receipts. The Billing Clerk will also record the payment (identifying it as a prepayment) on the next consecutive Service Record/Billing form and process as previously described with that day's business. The Billing Clerk will note the date, amount of payment and Service Record number on the Client Account List in the HearWare Computer System. The monies will be processed as outlined in the Client Pays at Time of Service section , and a ROCR will be prepared as outlined in the Preparation of the Report of Cash Receipts (ROCR) section.
At the start of regular therapy sessions for RATP clients, the Billing Clerk will reserve a block of Service Records each work for full-time RATP clients that have scheduled appointments. Each time RATP clients arrive for treatment at the Speech and Hearing Clinic, the Billing Clerk will give that week's reserved Service Record (see special section to track daily visits for the week on the Service Recored) to the Clinician to indicate the appropriate service (clients may receive several sessions each day). The Service Records will be processed at the end of each week as previously described. No payments will be received until the end of the semester.
At the conclusion of each semester, the Billing Clerk will review the Client Ledger List and the Service Records, and prepare an Invoice to be mailed to the client for payment. For clients sponsored by OVR, an OVR-208 Invoice ( Exhibit "F" ) will be prepared and mailed to OVR for payment. This amount is encumbered in IBIS and a Penn State Invoice is prepared with three (3) copies sent to Bookkeeping and one (1) copy to the Financial Office. When the check is received, an Accountability Transfer Form is filled out in accordance with instructions on GURU and the funds are deposited through the Bursar's Office. The Accountability Transfer Form and check are sent to the Bursar's Office. Upon receipt, the staff assistant will verify it, sign it, and mail the original back to the clinic. The original Accountability Transfer Form is attached to a copy of the check and filed in a notebook.
Following an audiological examination, the Audiologist will determine if the client is in need of a hearing aid. The Audiologist will determine which type of hearing aid device will be most effective for the patient, in-the-ear or behind-the-ear.
The Audiologist may prepare an ear mold impression and order the hearing aid device(s) from the manufacturer per guidelines established by Department of Purchases Services. The Audiologist will notify the client of the cost of the hearing aid device(s) and that payment is expected at the end of a 30-day trial period or before if the client has decided to keep the hearing aids.
Upon receipt of the hearing aid device(s), the client will return to the clinic for a fitting. The Billing Clerk will prepare a Service Record for the Audiologist and update the service information in the HearWare Computer System as outlined in the Entry and Treatment section. The Audiologist will fit the device, give the client instructions for the care and use of the device and a contract is signed by the client to cover the cost of the device(s). The Audiologist will then indicate on the Service Record that hearing aid device(s) were issued and the client is instructed regarding the 30-day trial period and makes an appointment to return in one or two weeks for any adjustments that may need to be made. When the client decides to purchase the device(s) at the end of the 30-day trial period, the Billing Clerk accepts payment and marks the Service Record "paid," issues a Pre-numbered Receipt for the client, and updated the HearWare Computer System as outlined in the Billing and Collection section.
Clients may also purchase related hearing device items (e.g., batteries, moisture guards, dry aid kits, etc.). The Billing Clerk will prepare a Pre-numbered Receipt for the client. Checks must be made payable to "The Pennsylvania State University" and restrictively endorsed when received per requirements outlined in Policy FN01 - Processing Cash Revenues.
The client is entitled to a 30-day trial period for hearing devices by Pennsylvania State Law. If the client decides to return the hearing aid devices prior to the end of the 30-day trial period, the Audiologist will notify the Billing Clerk and the sale will be voided on the client's account on the HearWare Computer System. The Audiologist will pursue a refund or credit for the Speech and Hearing Clinic from the respective hearing aid manufacturing company.
After the last client of the day has been seen, the Billing Clerk will total the monies on an adding machine tape and enter the monies breakdown on the "Cash Count" section of the Sales Summary and Cash Reconciliation form ( Exhibit "G" ). The Billing Clerk will initial and date the adding machine tape, attach it to the Sales Summary and Cash Reconciliation form, and forward it along with the Pre-numbered Receipts to the Staff Assistant. (Voided Pre-numbered Receipts used that day).
The Staff Assistant will count the monies and verify the total with that recorded on the adding machine tape and the Sales Summary and Cash Reconciliation form.
The adding machine tape and the Sales Summary and Cash Reconciliation form will reference the beginning and ending Pre-numbered Receipt numbers. The Staff Assistant will record all sales or services by object code as indicated on the Pre-numbered Receipts on the Sales Summary and Cash Reconciliation form. The Staff Assistant will balance to the "cash count" figures entered on the Sales Summary and Cash Reconciliation form. The established change fund will be separated from the cash on hand to arrive at the cash for deposit. It not in balance, the Staff Assistant will attempt to resolve the discrepancy with the Billing Clerk. If the discrepancy cannot be resolved, the Staff Assistant will enter the discrepancy in the "over/short" section on the Sales Summary and Cash Reconciliation form. If in balance, the Staff Assistant will prepare a Report of Cash Receipts ( ROCR ) as outlined in the Preparation of The Report of Cash Receipts (ROCR) section.
The Clinic also receives payment by means of credit cards. MasterCard and VISA are the cards accepted. A ROCR or credit cards receipts is also prepared.
The Staff Assistant will prepare an ROCR in accordance with instructions at the AIS web site, and Policy FN01 - Processing Cash Revenues. Monies collected for services are credited to Budget 03-023-77 (Speech and Hearing Clinic), Fund 10010, Object Code 030 (Sales Income). Any cash over or cash short will be charged or credited to Cash Over or Short, Fund 0752. The Department Head of Communication Sciences and Disorders will review and approve overages/shortages per guidelines outlined in Policy FN01.
The Staff Assistant will prepare a deposit slip for the bank, place the monies in a deposit bag and call Policy Services to puck up the deposit and transfer it to the bank. The Police Officer will sign the courier log which includes the date, prepare of the deposit and bag number. The Staff Assistant/Billing Clerk signs the Polices Services courier log acknowledging transfer of the funds.
The credit card receipts are printed from the Penn State ePay History and faxes to the Financial Office.
Original deposit slips are sent to the Finance Office, verified by a Staff Assistant, approved and forwarded to the Assistant Financial Officer for final verification and approval. The Billing Clerk is copies on the ROCR .
The numeric sequence of the Service Records will be examined to insure its continuity on a daily basis.
It is the responsibility of the Financial Officer to monitor the financial activities of the department and to perform audits at least quarterly.
The Financial Officer is responsible for ensuring that procedures pertaining to the accountability and safeguarding of all cash receipts, cash funds, and other assets are established and followed in accordance with approved University policies and procedures. Regular audits relating to advances, cash, travel, equipment accountability, and other expenditures provide a means to protect University assets. The Financial Officer is responsible for working with Internal Audit when audits are being performed in the administrative area.
Record retention must be managed in accordance with Policy AD35 - University Archives and Records Management , and records schedules approved by the Records Management Advisory Committee, Office of General Counsel, and Office of the President. These retention requirements are the University's retention criteria, either derived or based upon federal, state, and local statute or regulations, industry standards, and business needs. Retention beyond recommended time periods require justifiable reasons and warrant review by the Records Management Officer or designee. All documents must be maintained in such a manner so as to provide ease of access for review, and to provide a suitable audit trail for all transactions.
- Documents subject to a Legal Hold (see AD35, Legal Hold). A legal hold will remain in effect until it is released in writing by the Office of General Counsel.
- Documents under audit or review, either internally or externally. The retention period extends until released by the Corporate Controller's Office. The Financial Officer will be notified regarding any accounts which are under audit; the Financial Officer will be responsible for contacting the department.
Additional questions may be directed to the University Archivist or the Records Management Officer.
- Exhibit A - Fee Waiver (University Program)
- Exhibit B - Fee Waiver (Speech or Audiology Program)
- Exhibit C - Services Record/Billing Form
- Exhibit D - Outpatient Referral Request Form
- Exhibit E - Authorization Order
- Exhibit F - OVR-208 Invoice
- Exhibit G - Sales Summary and Cash Reconciliation
For questions, additional detail, or to request changes to this procedure, please contact the Dean, College of Health and Human Development
- Policy AD22 - Health Insurance Portability and Accountability Act
- Policy AD35 - University Archives and Records Management
- Policy FN01 - Processing Cash Revenues
- Policy FN04 - Petty Cash and Change Funds
- Procedure CR2002 - Processing Returned Checks
- Blue/White Shredding Program
Date Approved: 8/15/2007
Most recent changes:
- Revision 3 - 5/18/2007
Revision History (and effective dates:)
- Revision 2 - dated 8/17/1992
- Revision 1 - dated 5/1/ (Previously ED2001)
- Original - dated 7/6/1982