Collections Tools

Contents on these pages can be viewed by hovering over the icon to the left of the links with your mouse. They can also be printed.

They can also be downloaded directly, by right-clicking on the link with your mouse and opening to a new window.

Most of these can/should be modified for your office use.

2009 ABN from CMS -- CMS link for all the new ABNs

ABN - CMS-R-131, effective 3/2009 - Did you even wish you could have the 2009 ABN in a PDF Fill-able format? Well, now you can.

Aging Review - Line by Line Form

Collections Blank Form - Generic Fill-in the blank form - Created and donated by Maria Shadmehr

Collections Letter- "Balance Due"

Collections Letter - "Balance Past Due" - Created and donated by Maria Shadmehr

Collections Letter - Desceased Patient Estate Query - Created and donated by Maria Shadmehr

Collections Letter - "Payment Not Yet Received" - Created and donated by Maria Shadmehr

Collections Letter - "Please Call To Arrange Payments" - Created and donated by Maria Shadmehr

Collections Letter - "Please Call To Arrange Payments"

Collection Letter - "Promissary Note" donated by Barbara Colburn

Collection Letter - "Thanks for Your Payment" - Created and donated by Maria Shadmehr

Collections Letter - "Warning: You're About to be Reported to Collection Agency" 

Collections Process- Workflow Sheet

Collections Productivity Flow Sheet - Created and donated by Maria Shadmehr

Credit Card Form

Physician's Notification Form - "Dr., we're sending your patient to collections' agency..."

Scheduling Form - "Insurance Verification & Scheduling" Created and donated by Maria Shadmehr

Self Pay Policy