Customer Service
Customer service is consistently meeting the customers’ expectations
What is customer service?
U.S. law enacted in 1996 to improve the portability of health insurance and to establish national standards for safeguarding sensitive health information
Staff who are responsible for registering, scheduling, and obtaining demographics to include insurance
What is Registration Access Specialist (RAS)?
The primary person who enrolls in an insurance plan, is responsible for premium payments, and manages the policy, often serving as the main contact for the insurer
What is subscriber?
Joint federal–state program that provides free or low‑cost health coverage to eligible low‑income people, including children, pregnant women, seniors, and people with disabilities.
What is Medicaid?
Communication framework that we can use with the patients, their family members and one another to reduce anxiety and improve perception of care and service
What is AIDET?
Federal law ensuring emergency care regardless of a patient’s ability to pay
What is Emergency Medical Treatment and Active Labor Act (EMTALA)?
________ is a measurable metric—such as patient throughput, clinical quality, or financial performance—that organizations track to monitor operational effectiveness, quality of care, and improvement over time
What is Key Performance Indicator (KPI)?
The amount a patient must pay OUT-OF-POCKET before insurance starts paying for a covered service
What is deductible?
Private insurance that helps cover costs not paid by (traditional) Medicare
What is Medicare supplement?
Outstanding customer service relies on six core behaviors called _________ which form the foundation for effective training
What is the Six Pillars?
MRN, diagnosis codes, lab test results, and treatment plans are all considered ________
What is Protected Health Information (PHI)?
Holds the insurance, guarantor, and charges for a specific date of service
What is Hospital Account Record (HAR)?
The questionnaire was developed by the Center of Medicare and Medicaid Services (CMS) to help determine if Medicare is a primary or secondary payer for the patient
What is the Medicare Secondary Payer Questionnaire (MSPQ)?
HMO, PPO, POS, EPO
What are insurance plan types?
Sharing how long the registration process will take and keeping patients informed during wait times is part of _______ in AIDET
What is Duration?
Federal law that protects patients from unexpected medical bills, particularly in emergency situations or when receiving care from out-of-network providers at in-network facilities
What is No Surprises Act (NSA)?
Legal name, date of birth (DOB), Social Security Number (SSN), and phone number/address
What is 4 Patient Identifiers?
Rules determine the claim filing order when a patient is covered by more than one health plan
What is Coordination of Benefits (COB)?
Plans offered by private companies contracted by Medicare; these plans work in place of (traditional) Medicare coverage and may cover doctors and services that Medicare doesn’t
What is Medicare Advantage Plan?
Name of company founded in 1985 that provides patient experience surveys, performance measurement tools, and data analytics used by over 26,000 healthcare organizations to evaluate and improve care quality
What is Press Ganey?
A series of laws and regulations designed to increase clarity and competition in healthcare, making it easier for consumers to understand and compare costs
What is Price Transparency?
Tipsheets that can assist in registration and different workflows can be found here
What is the Patient Access Learning Home Dashboard?
The person within household who is financially responsible for the healthcare bill
What is guarantor?
Federal health insurance program available to people 65+ or with certain disabilities
What is (traditional) Medicare?