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What does HRO stand for?
High Reliability Organization
Should you enter a P.O. Box address as the permanent address for a patient?
No, P.O. Box addresses can be entered as a temporary or confidential address.
What type of guarantor account would be used for a work related injury?
Workers Comp
If a patient does not have any documentation from their employer, add the Pending W/C payor plan and enter the patient's employers name, work address and phone number in the subscriber demographic section. The subscriber ID name can be NA or the patients SSN. Enter NA for the insurance ID.
If an inmate has Medicare, Medicaid or any other type of medical coverage, would you attach these coverages to the appointment at check-in?
No, you would use the appropriate inmate payor coverage.
When completing the MSPQ, if the patient does not remember their retirement date what date should be used?
You can enter the Medicare effective date.
What are we doing to become an HRO?
We are striving to become a High Reliability Organization (HRO) by introducing safety behaviors and error prevention tools, that if practiced as habits, will reduce errors and prevent events that can harm our patients and workforce.
Who is responsible for verifying/update the patient demographics including Employer & Emergency Contact(s)?
All of us/The person checking in the patient. At every visit all information should be confirmed/updated to ensure we are sending out clean claims. You should be asking the patient to tell you this information. Do not provide the information then ask the patient if it is correct.
If a patient does not have active medical coverage, what do you do?
Identify which county the patient resides in, then add the SPCD 4 payor plan (for Dallas County residents) or SPCD 8 payor plan (for non-Dallas county residents). Enter the service date as the effective/start date and leave the end date open. Member ID would be NA and Verification Status would be Verified.
Patient type should be updated to Inmate. This is in registration under the additional information tab.
If a patient has PFA or SPCD how would you determine the co-pay or down payment amount for a visit?
Use the payment grid
Name 2 Patient Identifiers that should be used at every point of contact with a patient.
Name & Date of Birth
Define guarantor
The individual or entity that is ultimately financially responsible for the encounter.
What should you do if an active coverage is not applicable for a visit?
Click on the X to remove the coverage from the account.
If a patient has Medicare and Medicaid, which coverage would be primary and which coverage would be secondary?
Medicare would always be primary and Medicaid would be secondary coverage.
Once everything on the checklist is completed, what will display on the checklist?
The checklist will display a green check mark/Everything checks out!
How do you determine if you need to utilize a language interpreter?
If the patients spoken language in EPIC is something other than English the you will need to use ALVIN to complete the registration process.
At what age does person become their own guarantor?
18 years old
Can a patient have PFA and SPCD at the same time?
No, one of these coverages will need to be termed in EPIC.
What is a MSPQ?
MSPQ stands for Medicare Secondary Questionnaire. It is designed in determining who should be the primary payor of the account so the bill will be sent to the correct insurance payer.
Before placing an armband on a patient, what should you do?
You must verbally verify the following with the patient: Patients Name and Date of Birth. The patient must verbally state their Name and Date of Birth. Do not verify by showing the armband to the patient and asking if it is correct.
In a clinic setting, how do you know when consent forms need to be completed?
A message will appear on the checklist indicating that consent forms need to be obtained.
Ambulatory Patient Statement of Responsibility not collected in the last 365 days. Please obtain and updated Amb Pt Statement of Responsibility from the patient.
If someone has insurance, who is entered as the subscriber?
The individual who pays the premiums, or a person whose employment makes him or her eligible for membership in the plan.
Can a patient have commercial insurance and PFA at the same time?
No, once the patient insurance becomes active the PFA should be termed.
Can you complete the MSPQ on your own?
No, when completing the MSPQ or Medicare patients you must ask the questions in order to obtain the correct answers.
What tool would you use to determine if an insurance plan is Out of Network?
Payor Plan List-located in the Intranet