Healthcare Administrative Writing Part II: What would you do?

Viola Robinson, Faculty,  Kaplan University School of Health Sciences

Note: This is a follow-up blog to Healthcare Administrative Writing.

In high school you were introduced to the eight parts of speech: nouns, pronouns, verbs, adjectives, adverbs, prepositions, conjunctions, and interjections. Some of the lessons taught may have escaped you, so you may have to revisit that information. It’s especially important for healthcare administrative professionals to use the eight parts of speech correctly.

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The administrative employee represents the healthcare organization internally and externally when corresponding orally and in writing. In any given situation, a collections letter must be drafted, and billing and coding, credentialing, and insurance coverage issues must be addressed. Interpreting complex forms and instructions also require timely responses.

As an example, I would like to introduce you to Suffolk University Physicians Practice (SUPP). It is a group of medical practices owned and operated jointly by The University and Suffolk Healthcare System located in Suffolk, Virginia. The practice is made up of 25 medical groups. My name is Myrtle LaSquasha Higgenbottom. I’m the Practice Administrator for the centralized administrative division overseeing Medical Billing, Coding, Credentialing, Scheduling and Registration, Medical Records, and Customer Service.

I must note that SUPP is an extremely busy practice logging approximately 250 encounters daily. It is my responsibility to ensure data is collected correctly, and the staff communicates effectively with the patients.

Issues constantly arise that must be addressed via writing, so the information can be added to the patient’s medical chart. Twice a week, I observe the Customer Service staff for training and auditing purposes, and in this setting, the use of proper grammar is critical. Properly spoken English helps when it is transformed onto paper.

Situation

Mr. Welton approached the Customer Service desk when his name was called.

“I have a bill for $375.00, and I refuse to pay it!” he shouted.

The Customer Service Representative said, “Mr. Welton, when you called, you specifically said that you were sick, and you needed to see Dr. Cleotis. You are scheduled to see him at 9:45. We do not handle billing in this department. I can see if someone in the billing office would be willing to speak with you.”

Mr. Welton replied, “I have been talking to three different people in your billing office for the past 11 days, and nobody has given me a straight answer yet! Look at this bill!” He shoved the paper in the representative’s face, shocking her with his deliberate behavior. She studied the printout and frowned. Confusion registered on her face.

“Mr. Welton,” she said, “it appears that your managed care plan has applied this bill to your deductible. That’s why the amount due is in the patient column.”

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“I don’t have a deductible,” said Mr. Welton. “We are not supposed to pay this much money out of pocket before our insurance will pay. Something is wrong here! When my wife switched over to this HMO, we read the policy real good. It didn’t say anything about a deductible! The policy said that we would have a co-payment, which I pay each time I come into this office to see a doctor. The policy says that we have a co-insurance where they pay 80% and we pay 20%. I don’t understand. I just don’t understand!”

“The only thing I can suggest, Mr. Welton, is that you call the insurance company. The insurance company can clear things up for you. We only know what they tell us,” said the Customer Service Representative. Mr. Welton is one of SUPP’s mental health patients, so the representative did not want to upset him further.

“My wife can call. She’s the policyholder!” he said as he grabbed the paper, stuffed it in the back pocket of his pants, and stormed away.

It’s easy to read this information and comprehend the situation with the patient. A quick review of the story should also permit you the opportunity to recognize the 8 parts of speech.

How should the Customer Service Representative handle Mr. Welton’s situation? Should she draft a letter to the insurance company and his wife explaining the problem? How would you draft a formal letter using any of the 8 parts of speech correctly with proper sentence structure and punctuation?