Scheduling
How do you answer the phone?
By greeting the caller with a smile
Sign in, Clock in, Open waiting room, create batch
What needs to be completed in the patient registration form?
Everything!!
Insurance name, Id# and policy holder name.
PCP information
Does Tricare Prime need an Auth?
YES
What does HIPAA stand for?
Health Insurance Portability and Accountability Act.
What information is needed to search for a patient in NextGen?
When a patient check in for an appointment what information should you be asking for?
Name and DOB, Insurance cards, co-pay/balance due, NP PK,
How often should the patient complete a ne registration form.
Yearly
Does Tricare Select need an Auth?
No
Why should the waiting room be monitored regularly?
to ensure all patients have been helped and not forgotten.
Why is it important to schedule according to the template?
To avoid bottlenecks in clinic and allow providers to dictate.
What do you do after you collect and post the balance owed?
Clear the alert.
What do you do if a patient states they have met their out of pocket max?
Do not collect co-pay, add an alert "per patient they met their OOP max"
Do you need a referral for APIPA UHC Community Plan?
NO
How often should you check your voicemails?
Regularly. Return calls no later than the next business day.
When should you decline to schedule a patient for an appointment?
If the patient does not have Insurance information, referral or Auth.
What should you do if a patient comes in for their appointment and they have a new insurance that needs a new auth/referral?
Reschedule the appointment/ call PCP to obtain a new copy.
what should you do if the patient's account show they have a credit?
Confirm with billing it is a true credit, before disclosing the information to the patient.
If a patient has two insurances. One from their employer and one from their Spouse. which one is primary?
the one from the patient's employer
What should we do with patients who did not show up for their appointment?
call them at the end of the clinic and r/s them
Before you complete scheduling the appointment what should you do?
Include the reason for the appointment and confirm the appointment date, time, and instructions (ex. bring ID, NP packet, co-pay)
What are you looking for when checking in a patient?
1. they have an appointment 2. We have a valid referral 3. we have their current insurance information on file. 4. if the patient has a co-pay or a balance
Eligibility is ran daily, the day before each clinic. What do the following colors indicate:
Green, Blue, Red
Green: Active Ok to be seen
Blue: Limited coverage. Call insurance/web to verify coverage/eligibility.
Red: Inactive coverage. Ask patient for updated insurance information. If no new ins patient will be self pay.
True or False
Lifeprint Optumcare HMO (Medicare Advantage) does not require a referral #
FALSE
PCP must submit through UHC website and provide us with a referral #
Why are PSR's so important to the office?
Because you are the face, the first impression, and the last person they see or talk to.