Insurance Basics
What are the 3 important pieces of information you should verify when checking a patient's insurance eligibilty?
Subscriber information, member/ID number and active eligibility.
Where can you typically find the important claim-submission on many insurance cards?
The back of the card
What doe MA usually stand for when discussing Medicare plans?
Medicare Advantage
What does the PO Box on an insurance car often tell us?
Where claims should be sent.
In what year did The Columbus Arthritis Center open?
1955
What should you do if the insurance information in the chart is outdated?
Update the insurance information and hide/deactivate the old insurance.
The patient's insurance card is already scanned into the chart? Should you automatically scan another copy?
No. First check whether the card has been scanned for the current calendar year.
Does every Medicare Advantage plan have the exact same requirements?
No requirements vary by plan.
Why shouldn't you assume the PO Box is the same for every insurance plan from the same company?
Different plans/products may have different claims-processing addresses
What physician has been working at CAC the longest?
Dr Schlessel
Why is it important to verify insurance before scheduling a new patient?
To make sure the plan is accepted and the provider is credentialed for that insurance.
A patient's name is correct, but the name entered in the chart doesn't match the insurance card. What do you do?
Correct the name to match the insurance info using the card and verify eligibility.
If a patient presents Anthem through their spouse and and Medicare, which plan is primary?
A patient's insurance compnay is corrct , but the wrong PO Box was entered. What could happen?
A claim could be misrouted or delayed.
What date did the Taylor Station location see their first patient?
3.16.26
If a patient has their own insurance and is also covered under their spouse’s insurance, which insurance is typically primary?
The patient's insurance
What do you do if a patient gives you a new Medicare Card with a new ID number?
Enter it as a brand new insurance.
A patient says," I have Medicare, so every provider here accepts my insurance " Is that enough information to schedule?
No, Verify the specific Medicare plan, provider, location, and current credentialing.
When entering insurance, should you verify only the insurance company name?
No. You should verify the applicable plan and other required information, including the claims address/PO Box.
Over 10 yrs ago what manager started as a Front Desk team member?
Denise Tibbs
What is one of the biggest mistakes a PSR can make when entering insurance?
Entering insurance without verifying the card, member ID, subscriber info, plan and other required details.
Why would you compare the insurance card to the information already in the chart instead of simply assuming it is correct?
Small differences in ID numbers, subscriber information, plan details, or claim addresses can cause eligibility, scheduling, and billing problems.
What is the difference between Medicare and Medicare Advantage?
Original Medicare is the federal Medicare program administered through Medicare, Medicare Adv. plans are offered by private Medicare -approved insurers and have their own plan rules and networks.
You notice that the insurance company name looks correct, but the claim address doesn't match the patient's card. What should you do?
Stop and correct the information before proceeding.
What manager used to work for Hondros College?
Sarah Williams