The Voice August 2000
Vol. 36 No. 4

Presidents Message
Wow! It doesn't seem possible, but when you read this, summer will be half over. The baby robins have left the nest in my hanging basket and the family of 5 raccoons in our backyard have been relocated to a wildlife preserve.

Like most of you, our hospital is working hard preparing for the coming of APCs. I hope all of you will be joining us August 9, 10 and I I at Fox Hills in Mishicot for our Annual Conference. Medlearn is one of our scheduled programs oil APCs. It will be interesting if the August I st date is pushed back or not. Either way, the annual is a fantastic opportunity to network with our peers and learn from them.

I recently heard from Anne Dill and Teena Wigleg of United Government Services. Look for the answers to Medicare questions raised at the May WNICA meeting ill this issue of the Voice.

This is my last President's message as I step down and let Deb Gustafson from Beloit Memorial Hospital take over in August. I want to thank all of you, for your support, kindness and attendance at the quarterly meetings and workshops. Thanks to the people at St. Joseph's Community Hospital as well as my staff for allowing me the time needed for the duties and responsibilities that come with being a part of the WMCA board. Special thanks to our dedicated WMCA board and staff who worked diligently behind the scenes. Finally, thank you to Associated members for their generous support of our organization.

As WMCA starts a New Year, consider this, "Be selfish, become active in WMCA." It is fun and very rewarding. I look forward to seeing you in Mishicot for the Annual Institute. Enjoy the rest of the summer.

Jackie Lippe

WMCA President

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Payment Sheet Review An Essential Component of Receivables Management

Mark Hollan is a consultant in the Health Care Division of Eide Bailly LLP. He has 19 years of Health Care experience; 17 as a manager of hospital Business Offices. Mark provides a variety of services including Reimbursement Studies, Business Office Assessments & Integrations, Cost Report Completion & Analysis, and Chargemaster Analysis. Mark has a BS from North Dakota State University and is a past president of the North Dakota Chapter of HFMA. Mark can be reached by telephone at 701-255-8475 or by e-mail at mhollan@eidebailly.com.

Over the past several years much emphasis has been placed on reducing accounts receivable, and rightfully so. As demands for cash flow increase, receivables management has become more and more important to an organization's survival. However, one often overlooked but essential process in the management of accounts receivable is the review of payment sheets (or remittance advices, EOB's, etc.)

In today's world of varying and often complex payment methodologies, there is an ever increasing chance that inappropriate payments will be made. In short, we can no longer take for granted that insurance carriers will pay claims correctly.

Payment sheet reviews should focus on 3 different categories of payment reductions.

These three are:

  1. Denial of Services
  2. Errors in Applying Payment Methodologies
  3. Intentional Payment Reductions

Denial of Services
There are many reasons why insurance carriers deny services, and often times only a portion of a claim or service will be denied. Additionally, the reason for the denial will dictate whom the insurance carrier will designate as being responsible for the unpaid portion of the claim.

Typically the payment sheet will have a code which indicates the reason for the denial. If no explanation is given a call should be made to the insurance company for clarification. Some of the most common reasons for denial of services are:

1) Information was Requested from the Hospital but Never Received.
2)Information was Requested from the Subscriber but Never Received.
3) Information Provided by the Hospital did not Provide Adequate Documentation for the Services Provided.
4) The Services Provided Exceeded the Maximum Benefits Allowed by the Policy.
5) The Services Provided were not Covered by the Policy.

Almost all denials can be appealed and ultimately reversed. Sometimes a phone call will be adequate, but at other times a written appeal will need to be made usually with accompanying documentation. The Business Office should assure that any additional information sent to the insurance carrier is sent timely and is addressed to the appropriate person or department. In the case of larger accounts, a follow-up call should be made to be sure the information was received.

In general, if services are denied because of lack of documentation or information provided by the hospital, the hospital is responsible for the unpaid portion of the claim.

Likewise, if the services exceed policy maximums or are not covered under the policy, the subscriber is responsible for payment. At times you may have to appeal whom the insurance carrier has designated as liable for the denied services.

 

Errors in Applying Payment MethodologiesThese are the hardest areas to spot on a payment sheet because they are true errors and are not flagged in any way.

For insurance companies who pay based on a DRG, be sure to verify that the DRG listed on the payment sheet is the same as what is in your internal records. Remember, you are sending the insurance carrier diagnosis and procedure codes, not DRGs. If the claims are manually keyed, code numbers could be missed or transposed. Likewise, electronic transmissions have been known to occasionally lose data. The same concept applies to insurance companies who pay services based on a fee schedule applied to CPT or HCPCS codes.

The staff doing payment sheet review should have a 11 cheatsheet" or listing of all of the hospital's contracts and the payment provisions of each. This includes fee schedule amounts where services are paid under a fixed fee for CPT or HCPCS codes.

Often Preferred Provider Organizations (PPOs) will contract with hospitals using various payment methodologies. Be sure that they are paying your claims based on your contract and not another hospital's contract. Remember if your payment provisions are keyed into a PPO's computer system incorrectly, every claim may be paid incorrectly. Always verify the first fewpayment sheets when a new contract is signed or a new payment methodology is agreed to.

Per Diem contracts will often have different per them rates for different levels of service (i.e. Med/ Surg, ICU, OB, Psych, etc.). Be sure you are receiving the appropriate per them based on the level of service provided.

Some contracts will have a base payment methodology and then "carve out" certain services. An example of this would be a DRG contract that excludes OB services and pays those at a percentage of changes. Watch these payments carefully.

Occasionally you may negotiate with an insurance company for certain services to be provided at a special rate. Typically a "one time" contract may be signed. Be sure to check the payments on these claims.

Remember, if it's hard for you to keep track of all of your contracts and the provisions of each, it's hard for the insurance carriers also. Mistakes will be made.

 

Intentional Payment Reductions
The most common type of payment reduction occurs when an insurance carrier, with which you do not have a contract, pays an amount that is less than billed charges. The payment sheet will usually indicate that these payments are based on amounts that are "usual and customary" for providers located in your area. Typically usual and customary reductions occur on surgical claims or on line items with identifiable CPT or HCPCS codes.

Remember, if you do not have a contract with the insurance carrier you are not obligated to accept the amount they pay as payment in full. When this situation occurs a call should be made to the insurance company. Ask for a copy of their usual and customary fees. In almost all cases they will find a reason why it would be inappropriate for them to send that information to you. Next, ask them if they paid more for those services than your hospital has priced below their usual and customary screens. Third, inform them that because your hospital does not have a contract with them, you will not accept any usual and customary reductions and will be billing their subscriber for the difference. The insurance company will normally try to negotiate for a smaller discount if they pay the difference. Stand your ground. You can always negotiate with the patient over the remaining balance. That way you have not set a precedent with the insurance company. When negotiating with insurance carriers it is beneficial to have board adopted policies and procedures in place which indicate what level of discounts that the hospital is willing to live with.

Unfortunately, some insurance carriers now sell policies that only pay "usual and customary" charges (as determined by the carrier itself). Often the subscribers are unaware of this provision or what it means.

Another common type of intentional payment reduction is a prompt payment discount. Some insurance companies will call and try to negotiate a 5% - 10% discount if the claim is paid within 10- 14 days. However, other carriers will take a prompt payment discount on the payment sheet without calling for approval. Again, you are not obligated to accept this reduction.

As PPOs are becoming more prevalent we are seeing payment reductions as a result of "Silent PPOs". A silent PPO is a term used to describe a situation where an insurance carrier, with whom you do not have a contract, has an agreement on the side with a PPO. The agreement gives the carrier a payment discount but does not obligate them to comply with the other provisions of the PPO contract (such as timely payment provisions or provisions which call for reduced co-pays for using selected providers). If you have PPO contracts make sure every PPO discount is for an insurance company covered by that contract.

There are myriad of reasons why you may not be getting the correct amount of payments from the insurance carriers. Some are legitimate but many are not. In most cases the cost of doing payment sheet reviews is easily covered by the additional payments received. Remember: appeal, fight and stand your ground.

 

 

state of Wisconsin
Share your experiences! A wedding? A significant Anniversary or Birthday? A job change? An unusual vacation?
A new baby? An unusual experience? A promotion? Commentary!
Are any of these events going on in your life or of anyone we know?

on the Move
... or in the case of Rae Ann Danner, "not on the move." Although unconfirmed, it is rumored that she didn't retire. She is reportedly back at Watertown Memorial.

Other movement reported includes Brad Taylor to State Collection Service, Ed Novak to OSI (formerly Payco), Martha Henes to Outsource, Inc. and Judy Nelson now doing physician recruiting for Aurora.

Tom Hajny, formerly of West Allis Memorial and late of Zimmerman & Associates, has accepted a position as manager with First Consulting Group, an IT oriented firm of 2,000 consultants headquartered in Long Beach, California. Tom will remain a resident of Wisconsin.

Oops
In June, I reported that Steve Basely recovering from surgery probably wouldn't be dancing at son Tyler's wedding in May. In one sense I was right because it wasn't Tyler's wedding, but rather Stuart's ... And just for the record, he did dance. Amazing!

Out of the Mouths of Babes
Dear god,
If you watch me in church on Sunday, I'll show you my new shoes. Mickev

Dear God,
I read the Bible. What does "begat" mean? Nobody will tell me. Alison

Dear God,
Are you really invisible or is it just a trick? Lucy

Dear God,
Did you mean for the giraffe to look like that or was it an accident? Norma

Dear God,
Did you really mean "do unto others as they do unto you?" Because if You did, then I'm going to fix my brother. Darla

Dear God,
I want to be just like my Daddy when I get big but not with so much hair all over. Sam

Dear God,
I think the stapler is one of your greatest inventions. Ruth

Dear god,
My brother told me about being born but it doesn't sound right. They're just kidding aren't they? Marsha

 

Let Us Give Thanks
I am Thankful for:

• The mess to clean up after a party because it means I have been surrounded by friends.
• the taxes I pay because it means that I'm employed.
• the clothes that fit a little too snug because it means I have enough to eat.
• MY shadow who watches me work because it means I am out in the sunshine.
• the spot I find at the far end of the parking lot because it mean I am capable of working.
• all the complaining I hear about our government because it means we have freedom of speech.
• that lady behind me in church who sings off key because it means that I can hear.
• the piles of laundry and ironing because it means my loved ones are nearby.
• The lawn that needs mowing, windows that need cleaning and gutters that need fixing because it means I have a   home.
• my huge heating bill because it means that I am warm.
• weariness and aching muscles at the end of the day because it means that I have been productive.
• The alarm that goes off in the early morning hours because it means that I am alive.



Public Gives Hospitals Low Scores in Customer Satisfaction
Poor Service Could Equate to Lost Revenue
By Christina Zimmerman,
Executive Director, Zimmerman Communications

As growing evidence of a loss of public trust in hospitals, patients rank hospital service at 69 out of a possible 100. Scoring 69 on the American Customer Satisfaction Index puts hospitals just above airlines and publishing-newspaper and below telecommunication and the U.S. postal service.

Poor patient satisfaction at your hospital equates to lost revenue. If patients feel they received poor service, two things may happen; 1) they won't pay their bill or 2) they won't come back to your hospital. Neither are what you want.

This customer service ranking is not a favorable rating for hospitals. There is a message here. Consumers are fed up and voicing their concern. There is a wake-up call for providers. Your customers are telling you they are unhappy and unsatisfied with the services you are providing. Industries across the board, live and die by their satisfaction ratings, but for some reason, hospitals have not gotten the picture. Year after year, hospitals score lower and lower on the satisfaction index, yet minimal efforts for improvements are made.

A scattering of hospitals are taking on customer satisfaction initiatives, but the majority play lip service. Patients will not allow hospitals to get away with this much longer.

Rising Consumer Influence
Empowered consumers are the biggest forces healthcare must contend with over the next decade. They are changing the healthcare marketplace as never before. As

consumers become more informed, they are making their needs known and gaining unprecedented power in the shaping the care they receive. It' s a trend that all signs indicate will continue, increasing consumers' clout considerably in the coming years. How healthcare organizations respond could determine their future success.

There is a new era in American medicine: the age of the self-educated patient. With the rise of managed care, patients have become increasingly distrustful of doctors, and so they are busily arming themselves with information from newspapers, books, the Internet, and even television ads.

The individual consumer I s new predominance in the healthcare marketplace is increasingly influencing policy, strategy, operations and investment decisions of healthcare organizations within all segments of the industry.

Healthcare organizations will provide education and readily accessible data to encourage and empower consumers to be direct purchasers of healthcare. Hospital executives are realizing that self-pay is their most profitable financial class. If patients are your best source of payment, it only makes sense to treat them with "white gloves."

Room for Improvement
According to the Picker Institute, almost 90 percent of patients experience service problems of some kind per inpatient visit, with 40 percent identifying more than six problems during their hospital stay.

Problems per patient during hospital stay
Best Hospital 4.2 problems
Average Hospital 6.6 problems
Worst Hospital 11.2 problems

In the survey results, no hospital has more than 62 percent of patients rating overall excellent care.

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Service Key to Recommendations
Picker results also conclude that the frequency of service problems shape patient evaluation of your hospital, A patient who experiences multiple problems gives lower ratings of care and is less willing to recommend your hospitals' services.

Hospitals have a few options; sit back and continue to watch customer satisfaction scores plum pay lip service to what a tragedy it is for the healthcare industry or commit to transforming the healthcare industry into one that is known for it's care, compassion and Customer satisfaction. That takes a vision from top executives and initiatives lived out by the staff. What are the things most likely to

cause a positive patient reaction? The answers are very fundamental. When combined, human compassion and friendliness are the key aspects of the "best" customer service experiences. The situation almost sounds too obvious. You have an opportunity to change the perception of the entire healthcare industry by just returning to the basics of human etiquette. *

This article appeared in the June issue of Customer Service Revolution newsletter. For additional information, please con tact Zimmerman Comm unications at 888-577- 7445.

About the Author
Christina Zimmerman, Executive Director

Zimmerman has an extensive background in hospital revenue lie cycle and customer service, in addition to marketing, public relations and advertising. She has been executive director of Zimmerman Communications since its inception and serves as editor of three healthcare publications.

Specializing in healthcare customer service and leadership, Zimmerman has successfully launched a newsletter publication dedicated to transforming patient satisfaction in healthcare. In addition, she has done extensive research, interviews and case studies in the field of patient satisfaction. She has worked oil numerous video training programs that focus on patient relations and revenue cycle operations.

Zimmerman's background also includes an assignnment as marketing director of Zimmenerman &Associates of Milivaukee, Wis., where she was responsible for overseeing all marketing activity conducted by the national consulting firm. Zimmerman graduated from the University of Dayton with a bachelor degree in Communication Management.

Zimmerman Communications

Zimmerman Communications is the healthcare media group that focuses on improving customer service, collection effectiveness and management of the revenue cycle. Our newsletters include Customer Service Revolution, Collection Expert and Hospital Receivables Management.

 

 

WMCA May's Quarterly Workshop Follow-Up Questions/ Answers From UGS

1. When are the providers going to receive information on the remittance advice? Providers need to change the system to be ready for APCs.
Answer: The changes to the remittance advice can be found in the Outpatient PPS manual, chapter 5.

2. Patient involved in a one car accident, how should the provider submit claims?

A. Occurrence code 05 or 01
B. Medicare Prime
C. Should value code 14 be present

It depends on whether or not the patient files a claim with their insurance company or not:
A) If the patient did not file a claim with the insurance company, bill Medicare as prime and use condition 05 along with the accident date and explain in the remark field why there is no liability involved.

B) If the patient did file a claim with the insurance company, Medicare can be billed for a conditional payment. A provider must wait 120 calendar days before submitting the request for payment. The only time a request can be made before 120 days is if the provider received information that the settlement will take a longtime (more than 120 days) or that the benefits have been exhausted under the other policy.

3. Should the provider complete the MSP questionnaire every time?
Answer: Publication 10 (hospital manual), section 301 and 301.2 address the type of questions that should be asked at every admission, outpatient encounter, and start of care.

4. The patient has a Medicare HMO; they are charged the balance. Once claims are submitted Medicare rejects for Medicare HMO. How should this be handled?
Answer: The type of Medicare HMO determines how bills are submitted. The value can be found on HIQA on page 1. If the Medicare HMO is option C, a bill is never submitted to United Government Services, LLC. The HMO pays all claims. This rule would not apply when a hospice patient elects an HMO, refer to publication 2 1, section 204.3.

If the type of Medicare HMO is option 1, HCFA intermediaries process all hospital and SNF bills. Bills from approved dialysis facilities for dialysis and the intermediary also processes related services.

5. Retirement date on the MSP form? Why is it on the form? Beneficiary does not remember the retirement date.
Answer: The MSP questionnaire was prepared by the HCFA. The retirement date information would help in updating any open records we may have as valid records. If the beneficiary doesn't remember and we have an open record, the provider should try to obtain the information from the employer.

5. Define retired? If patient retired at 55 what is Medicare looking for?
Answer: A patient is no longer working if they retired from their employer. We need a specific example to answer the second part of this question.

6. Per provider, UGS, LLC indicates if liability insurance made a payment after Medicare made a payment (as prime), should the payment be submitted back to the liability insurance company? Or should they give Lis our payment back?
Answer: The provider should adjust the original claim to change Medicare from primary to secondary.

 

WMCA 8/2000 by Joan Carr

Joan Carr is President of]. Carr, Ltd. health coverage & reimbursements specialist. She holds an MBA and has 20 years in both the clinical and financial aspects of health care. She is a national member of the Medical Group Management Association and a member of the Wisconsin Medical Credit Association. You can Phone Joan at 414-764-7743 or-fax 414-764-6708.

There it is, staring you in the face. Your first thought is to call the producers of "Fashion Emergency"-you have no desire to wear orange or horizontal stripes-but you are now facing a billing problem where Medicare has overpaid. You now have to self-disclose.

In everything you have read, you already know that HCFA guarantees nothing when it comes to leniency. You know the risks are high and this must be done very carefully.

In the 6/23/2000 letter from HCFA to the ARA, the OIG lists the 6 factors, which will be considered:
1. Clarity of relevant issue (is this a basic issue like billing Medicare for services not provided)
2. The complexity & novelty of the billing system at issue (billing APC's, which are new, vs. billing SNF PPS which has been around for a while)
3. HCFA/FI guidance - manuals, memos, transmittals (how long have the instructions been available to providers, has the provider been to seminars where the information was covered, has the provider called in and received telephone instructions - yes, Medicare does track provider calls)
4. Provider ability to understand the issue itself (will be evidenced in your self-disclosure write-up).
5. Provider re-training efforts of billing personnel (ensure this is also written into your self- disclosure)
6. Effectiveness in compliance program (did the issue surface because of compliance efforts - if not, a review & adjustment of the compliance plan should also be included in your write-tip)

In addition to these, HCFA instructs fiscal intermediaries & carriers to address the following:

• How was problem identified
• How was internal audit performed - sampling size, etc
• Corrective processes
• How was $$ amount calculated - represents total problem
• Time frame involved

If the refund is over20% of the total Medicare annual payment, additional analyses are performed by Medicare (see PM AB00-41.60) At this level, activities are coordinated between the

Fl and any other Medicare contractors the provider submits claims to - carrier, DMERC, HHA FI

The focus of this article will be on how to do the internal audit & how to write it up.

The Audit:
There are 3 basic components to be addressed in the audit: past, present, future:

Past:
• How far back does the problem go
• What factors contribute to it - including external factors

Note: The ability of Medicare's claim adjudication system to correctly process your claims can be an important factor here. For instance, the MSP module was not working correctly earlier this year and providers were to hold claims until the module was working. If you did send in claims & they were processed incorrectly, note this in your write-up (not as an excuse, just as a legitimate factor in the situation)

• How many claims are involved
• The $$ amount involved
• Single or multiple providers, diagnoses, procedures - or a combination of these
• The universe of claims within the time frame (all the possible claims where the problem could have occurred)
• The percentage of claims in error

NOTE: Extreme care must be taken here to identify your status. If, for example, your write-up states that you reviewed 107 claims and found problems in them, you are stating that 100% of your sample is in error. If you reviewed 2,345 claims after identifying that this is your universe and found 107 of these claims to be in error, that is 4.56%. Quite a difference!

Correctly identifying your universe is critical.

Present:
Work backward through your claim process to identify process inefficiencies. Immediately fix these or suspend the process until you can - it is very important to have an "end of problem" in your time frame.

In doing the above, were any other issues discovered - you may be looking at multiple self-disclosure issues

NOTE: For multiple issues, perform the audit and write- upon each and then an additional write- up incorporating all. Multiple issues are an indication something has happened in your compliance plan, it has a weakness or part of it is not working effectively. Your compliance officer/department should be apart of this activity early on.

Future:

What will prevent this (these) from happening again? - the biggest question to answer in your write-up.

The Write-Up:
As a former Medicare employee with much experience in auditing, I can tell you that the provider write-up which answered ALI, the questions I had or might have had, was the one that was successful. Auditors question everything The strategy in the write-up is to anticipate questions and supply accurate information to answer the questions. For instance: an auditor might be looking at the technical component issue mentioned earlier (as you know there is I technical component & I professional component per total procedure). The auditor may be wondering "how could this be missed, it's basic reg's." The provider may have had a software bug that coincided with the cross training of a biller who was learning radiology but was proficient in DME billing. If the provider doesn't put this information in the write-up, the auditor cannot take it into consideration.

Medicare auditors do not have an agenda against providers, but the information has got to be available -- like the pediatric cardiologist who documents an E & M visit as "condition improving". Everyone knew the doc did an exam, reviewed the test results and H & P from the surgeon. Everyone knew this physician could verbally give you a detailed statement - but all he wrote was "Condition improving" RULE-of-THUMB: If you didn't document, you didn't provide the service. Use this same rule for these write-ups - keeping in mind, your documentation is under review as well.

Follow the basic format - past, present, future and include exhibits from your audit (keep copies for yourself). Outline the issue (and sub-issues if necessary) and make it as easy to read as possible, including font size, and clear copies for the exhibits. Ensure it is readable by having someone in the organization read it (i.e.: FIR Director). Address any questions (for example, acronyms and abbreviations). If your compliance officer has not already done so, have it reviewed at that level as well.

Again, you want to address any part of the write-up that is confusing - including AND especially the calculations. If 107 claims are in error and you will be repaying Medicare for primary coverage, show the amount. If you are refunding Medicaid as well, calculate & show that amount separately.

Address any program memos & transmittals that impact your situation. If you don't answer the question internally, it will be asked externally- probably with the additional question, "Why didn't you address these?" Section 206, HCFA Pub. 10 (Hospital Manual) and Section 207, HCFA Pub. 12 (SNF Manual) both state it is the responsibility of the provider to read & follow all manual instructions as well as to keep updated on the memos & transmittals, bulletins, etc.

One last note, if you hire a consultant to do an internal audit

or write-up (through your attorney for lawyer-client privilege), you might want to ask them how to do a write-up (now that you have the info). If they don't know, think about another consultant. There is no room for error in this.

 

 

 

How To Double Your Debt Collections

By Jim Finucan, author: Past Due! A Debt Collecting Manual

Proper Collection Call Format
Believe it or not the success or failure of your attempt to collect a debt is usually decided right at the beginning - with the very first words you utter after the other party says hello. Knowing exactly what you're going to say and approaching the call in an organized, professional manner is the foundation upon which your collections success is built.

There are four elements in a professionally executed collections call:

Part One: The Open - This is the specific way in which you identify yourself, your company and the debt problem. Next comes the vitally important question of how you place that problem before the debtor. Don't ask him when he's going to get around to paying you, or why he's putting you off. If you ask a question like that you've made your move too early and you'll find yourself at a disadvantage right off the bat. It's much more effective to put the debtor in the position of having to explain himself. Instead, say something like "What are your intentions toward this bill?"

Part Two: The Facts - If the debtor doesn't agree to pay the bill early in the conversation, move into the next part of the call: asking the debtor a series of questions aimed at getting information about his situation - his job, whether the spouse is employed, any outstanding loans he may have, credit cards, etc. It is very important to make the transition into this part of the call as smoothly as possible because you don't want to alarm the debtor. Say something like "Let me just fill out an extension form."

Part Three: The Dun - Once your questioning has given you the information you need, you move into the "dun" (the demand for payment). With the information you've obtained you can now show the debtor away in which he or she is, in fact, able to pay the debt. You know, for instance, that he can afford to put it on his MasterCard, or that she could qualify for a loan. Now you're in position to make your demand for payment.

Part Four: The Close - Whether or not the debtor has agreed to pay the debt, there is also a specific way you should end the call. And I don't mean "Gee, Thanks, have a nice day!" or "You've got your nerve..." Use an open-ended question designed to put the debtor on the spot; something like "Do I have your word on that?" If he has refused to pay or continues to dodge and delay remind him of how serious the situation is and make it clear that this isn't going to go away; the problem must still be resolved. Above all, be professional; don't lose your cool, don't insult, don't threaten. Save any threats of legal action until you've contacted the debtor several times without success and see no further options. And never threaten legal action unless you fully intend to follow through otherwise you can be accused of harassment.

Collection calls are the bedrock of bill collection. It's well worth spending the time and effort necessary to learn and use as many techniques as you can.

Jim Finucan manages the collections department at Badger Creditors in Wausau, WI. He also teaches and gives seminars on bill collection techniques. His debt collection manual - Past Due! is available for $44.45 (including shipping) from Limelight Books, P.O. Box 493, Lake Geneva, WI 5314 7. Visa/Mastercard orders; 1-800-420-0579 9 am - 7 pm EST. (The book is not available at bookstores.) More info at www.tiare.com/pastdue.htm.

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