Estimate
Patient is coming in for a Nuclear Medicine test, what is the correct service type?
MRI/CT (High Tech Imaging)
Define Copay
A fixed amount the patient pays for a covered healthcare service. The amount can vary depending on the type of covered service.
During cash collection, the patient states, “My insurance will cover my co-pay.” What is the correct response?
Each insurance plan requires a co-payment for services provided.
Patient is coming in for a Surgery, what is the service type for the estimate?
Outpatient Surgery.
Define Coinsurance
A percentage of the allowed amount for the service that is the patient’s responsibility
Patient arrives for testing, the patient’s co-pay was collected during pre-reg 2 days prior to visit. They are canceling testing and requesting a refund. What is your process?
Direct the patient to contact customer service for a refund.
The patient is questioning their estimate (Provided in the back of your binder). What is their deductible and how is it driving the estimate?
Deductible is $3,000
$91.94 Already used
$2,175.82 Remaining after estimate
Define Deductible
The amount owed for healthcare services before the patient’s health insurance begins to pay.
During cash collection, the patient states, “I paid my co-pay at my Dr visit this morning.” What is the correct response?
For each hospital service there is a co-payment obligation that is your responsibility in addition to the co-payment collected for physician services. For your convenience, we accept cash, check, debit or credit cards. Which method would you prefer?
Present the estimate provided in the back of your binder. What is the Charge, Allowable and patient pays amount?
Charge: $4,196.50
Allowed: $732.24
Patient Pays: $732.24
Define COB
Coordination of Benefits. Identifying which coverage is primary based on COB rules.
Patient pays $100 copay during check-in, via check, what steps are followed?
Check is collected by Registrar, placed in the cash transmittal bag, all information is filled out on the bag and then sent to the Cashier for processing.
Patient presents for a walk-in Xray with an OON insurance plan, what is your work flow?
Create an OON estimate and collect 50%.
Define You-Pay
This is the patient financial responsibility according to their insurance plan
During cash collection, the patient states, “I won’t have a copay if I’m admitted to the Hospital” What is the correct response?
“I reviewed your health insurance benefits, and it looks like you have a $___copay for today’s emergency department visit. If you are admitted, we can apply your payment to your inpatient balance, or I can come back once we know if they will be admitting you or not.”