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Do we have to note the insurance template if we just confirm what is on file?
Yes- If it's discussed with the pateint we are to include in our notes always and use the insurance template
What You CANNOT Discuss with a Non-Patient Caller?
What are we to do if an incorrect payor has been billed?
Incorrect payor billed - If an insurance pays on an account and it is the wrong Ins, please send to RS to assist with billing the correct payor.
side note: verify the correct insurance and add it to your notes :)
KB https://xifin.helpdocsonline.com/undefined-3
What are the next steps we advise the patient when the accession is in posting status?
Please advise "Your account is currently updating at this time, if there is a balance due you will receive a statement in the mail with PR as well as an EOB from your INS". If the account errors or EOB show that the INS will error out please gather the correct INS information. We can escalate the account for all customers to close posting so we can update INS.
please share your screen and show us where you located this informaiton :)
What is the expected time frame for answering calls?
Expectation: All calls must be answered within 10 seconds.
Once insurance is updated and you get an accession error of Unbillable/Unpriceable errors, what does this mean?
RS will handle the errors listed below; there is no requirement to include an RS override. These issues will be automatically addressed by RS and will be categorized accordingly. *** EXCEPTIONS APPLY so it is important to ensure that when making calls for your Line of Business (LOB), you follow the guidelines outlined in the Knowledge Base (KB).
If the caller is not the patient, do we need to document the caller's name and relationship?
Yes- Document Relationship: Note the caller's name and their relation to the patient in your records.
KB https://xifin.helpdocsonline.com/regulations-compliance
What steps do we follow if a patient states the claim was processed OON?
LA056 Payor:
If a patient calls in and states we are OON- check the insurance prefix against below list.
If the prefix is on the list - we can adjust in FULL uses adjustment code: LA056.
If the prefix is not on the list and patient is stating we are OON, escalate to RS to confirm if prefix is LA056.
**If the EOB states PR100 (oa100), we cannot adjust balance in full and MUST bill the patient the OA100 payment. If you have questions, escalate to RS team**
Please show us where to locate and open the spreadsheet :)
Do we escalate via email on the first call?
***Always escalate via override unless otherwise indicated or 2+ calls or Grievances. ***
Does path bill for non-covered charges?
Path Does not bill for non covered charges - If the patient is billed for noncovered charges we should escalate to RS to review.
Note if the noncovered charges was already reviewed and took in adjustment we would refer to the insurance to further discuss.
Do we bill the patients straight Medicare or straight Medicaid plan separately?
NO -
Dual plan - If the patient has a Dual Plan, it means they have Medicare and Medicaid rolled into ONE plan. We would Not bill the PT's straight Medicare or straight Medicaid plan separately.
KB https://xifin.helpdocsonline.com/types-of-insurances-
What You CAN Discuss with a Non-Patient Caller?
What steps do we follow if a patient states that she is an employee and should not be billed?
HCA Employee discount
Please pull up the KB and show us the steps we need to take :)
What are the steps we take if a patient is calling to make a payment?
Confirm the statement number shows in the portal, then advise that you are going to transfer to the automated system.
What are two parts to pathology billing?
26 -The professional component is provided by the physician, and may include supervision, interpretation, and a written report. The written report is the Pathology Report. The report may include the documentation of the following three items: The Gross Description such as color, weight, and size of tissue as seen by the naked eye; The Microscopic description, how the sample looks under the microscope and how it compares with normal cells; The Final Diagnosis, the pathologist makes a diagnosis determination based on the review of the specimen.
TC -Technical Component refers to the preparation of the slide that the pathologists review by microscope. This service is usually performed by a technician which includes staff, equipment, and supplies.
Please share your screen and show us where you found this information :)
Can we bill the insurance if it's at a zbal?
What are 2 questions we ask the caller to ensure we can disclose PHI?
Here's how to ensure you're speaking with the patient:
What are our metric monthly goals?
Average handle time per call and seconds?
QA Score average?
Average handle time - Goal is 390 seconds or below 6.5 minutes per call
QA Score average - Goal is 95% or above
No - deny for a duplicate claim
We should be checking for eobs, were any adjustments made
What is the Standard Operating Procedure (SOP) for Call Center Agents: Escalating Calls to Supervisors?
How do we handle PR-OA100 denials? Do patients owe a balance?
OA100 payments
Payments made to the patient directly; patient’s must forward to us signed by patient and stating, “Endorse check to customer name.” If an EOB is not on file, proactively ask for an EOB. No payment plans are accepted for OA100 accounts.
Patients may also pay via personal check or credit card.
Please locate accession # PGN26PS027218 as an example to review eob :)
Path core example
Can you disclose PHI to a legal guardian if the patient is 17 or under at the time of the call?
No-
If the Caller is NOT the Patient:
Document Relationship: Note the caller's name and their relation to the patient in your records.
Age Matters: We can only speak to a legal guardian if the patient is 17 or under (15 or under for BRLI). Always double-check the DOB to confirm the patient's minor status at the time of the call.
If a patient shares a grievance for the balance due, what type of payment options can we offer?
FAP and Other Payment Option Process (25 points) with quality
Fap / payment plans / prompt pay discounts
If discussing PHI is necessary to address the caller's concerns, what steps do we take next?
You must obtain verbal authorization from the patient.
Please share your screen and show us where to locate this information on the KB :)
Are we required to leave notes on the account?
Yes!
At all times. Every accession should be noted. Even if you are discussing multiple accessions with the pateint please ensure those are also noted.
Reminder: Failure to do so and double-check your work and that your notes are saved will result in an AUTO FAIL