HIPAA
Every phone call involving a patient requires this, regardless of whether any PHI will be released.
Verification of the caller’s identity
Where do you click in Athena to view the patients dunning level?
Current Statement Balance
What does Medicare Part A cover?
Medicare Part A helps pay your costs as a hospital inpatient, it also includes Skilled Nursing Facilities, Hospice, Facility charges and some home health care.
What banks does USAP use to issue refunds?
Bank of America and Fifth Third
If an account is in collections, can the patient still provide their insurance or charity information?
Yes!
When a minor’s parent calls but is not the guarantor, the agent can discuss the account but cannot make changes to this type of information.
Patient demographics
Where do you notate in Athena if there is no UI available?
Under demographics - comments
What does Medicare Part B cover?
Medicare Part B includes Office Visits, Screening, Vaccines, Counseling, Physical Therapy, Anesthesia, and some medical equipment
The patient prepaid more as a quoted patient than the bill they received, why won’t they get a refund?
When patients are quoted an amount as a package bill account, they are entering into a contract for that amount with USAP. Sometimes a duplicate account is created
What do you do when a patient requests medical records?
Medical records are maintained by the facility. If the patient is requesting records, they will need to contact the facility where their procedure was completed.
If a third-party caller requests information about a patient’s date of service, provider, or facility but is not authorized, what can the agent legally release?
Payment details and insurance payments only
Where can you view documents in Athena?
Patient summary - documents
Why can’t Medicare Advantage be billed with Medicare Part B?
Medicare Advantage plans are considered Part C and cover services under both Parts A and B, the private insurance carrier pays for their medical care instead of Medicare. Therefore, Medicare is no longer responsible for paying their claims.
What do you tell a patient when their eligibility is inactive for Medicare of Medicaid?
Patients will need to contact insurance, we cannot submit to either of these with an inactive eligibility response.
What to do when insurance denies for timely filing?
Submit dispute
According to Cedar’s policy, at least four unique identifiers must be verified before releasing PHI. Name these.
Full legal name, date of birth, account number, address, telephone number, insurance ID, or last 4 of SSN
If you receive this message when trying to run eligibility "Trading Partner not setup to send requests", what does this mean?
Eligibility cannot be ran in Athena
Why can’t USAP bill dental insurance?
Although a patient may have a dental procedure requiring anesthesia, USAP still provides a medical service which is not covered under dental insurance.
What do you do when Athena shows Invalid member/patient ID - member ID is incorrect?
Request front and back of patients insurance card
What to do when insurance denied for non covered services?
Patient should follow up with insurance to determine the reason insurance did not cover
If a patient is unable to verify their account over the phone, what is the correct next step according to Cedar’s policy?
Directing the patient to the Patient Dashboard/portal
Where do you go in Athena to view EOBs?
Ecomm Management
How do we bill Blue Cross Blue Shield?
Blue Cross Blue Shield bills to the local plan so if the patient has BCBS of Illinois but the service was in TX, BCBS TX would be billed.
What do you do when Athena says Invalid patient name - patient's name is listed differently with insurance?
Patient will need to update name with either USAP or insurance depending on which entity has the name that matches the patient's photo ID/Driver License
What to do when insurance denied for missing authorization?
Patient needs to contact insurance to resolve. Authorization is obtained by the surgeon. If the patient has the authorization information they can provide these details and a dispute be submitted for USAP to review.