Reference no: EM133398298

Case: The management of accounts receivable is a complex process that allows practices to be accurately, ethically, and legally reimbursed for services provided to patients. During the patient checkout process in a physician's office, the practice's front office personnel are responsible for collecting patient copayments, coinsurance, and deductibles, and for scheduling follow-up appointments.

At the Renal Practice Associates, Ricardo is a front office receptionist who knows the practice's patients very well. He is so observant that he knows when patients are having difficulty paying copayments and other medical-related expenses. Some patients are experiencing life-threatening end stage III renal failure, and they are on dialysis. Ricardo is also aware that the practice is large and successful, and he believes no one will mind when he excuses one or two patients from making copayments during the checkout process because they are usually small amounts, such as $20 or $30. (Ricardo does collect coinsurance and deductible amounts from patients.) Ricardo has become so compassionate about the patients' financial circumstances that he also marks a patient's account as paid in full even when the patient has not made the appropriate copayments. When patients with acute or chronic conditions check out at Ricardo's station, he often tells them they owe no balance and that he is happy to schedule them for their next appointment.

After a few weeks of observing Ricardo's behavior, a co-worker becomes concerned. Lily has only been in her position for six months, while Ricardo has worked at the practice for ten years. Lily is not sure what to do or how to approach what she views as a problem. It is obviously raising a "red flag" for her, but she cannot afford to lose her own job. She is not sure what to do, and determines that her options include:

• Not saying anything to anyone, and ignoring what Ricardo is doing.

• Asking Ricardo if there is a special policy and procedure that allows some critically ill patients to be exempt from paying copayments. If that is the case, Lily would ask to be provided with a copy of the policy and procedure so that she is aware of it in writing.

• Meeting with her manager to share what she is witnessing about Ricardo not collecting copayments from some patients during checkout.

Question 1. Why should Lily follow through on her observations about Ricardo?

Question 2. Why should Lily follow through on her observations about Ricardo?