Referrals
When a referral has no active visits left, this is the system’s automatic action.
What is the referral is closed and can no longer be used for scheduling
When you have questions about the BMI Reduction Program, this is your go-to Program Manager and resource.
Who is Kristy?
According to our scheduling workflow, this is the correct approach to double booking visits.
What is we do not double book visits?
This “trinity” keeps our communication clear, consistent, and effective.
What is phone, artera, and MyChart?
This happens if the provider declines to update the diagnosis.
What is moving forward with the referral as-is?
This is the action the team should take when a referral diagnosis ends in .9 or .09.
What is reaching out to the referring provider to request to review and update diagnosis to a covered diagnosis
This is a required step to help ensure accurate billing and compliance for BMI Reduction visits.
What is adding the attending provider?
Translation services are offered only under this type of visit.
What is in-person appointments?
DOUBLE JEOPARDY!!!!
Part 1 : When insurance does not apply or coverage is unavailable, this is who we can offer self-pay bundles to.
Part 2 : Self-pay bundle = deductible credit?
Part 1 : Who are self-pay patients, patients with non-covered benefits, and recipients of governmental insurance coverage?
Part 2 : What is nope! Bundles do not count toward deductibles.
When a patient calls with new insurance and is already scheduled, this role takes action.
Who is the team member who answers the call, will updates the patient’s account, and notifies the Office Coordinator at the scheduled location that reverification may be needed due to new coverage?
When a new referral is requested and not yet on file, this determines whether the patient stays on the schedule or is rescheduled.
What is following referral status and rescheduling only if the referral is not received by the required timeframe
To ensure accurate billing and compliance for BMI Reduction visits, this provider must be selected as the attending.
Who is Dr. Davis?
To ensure consistency and proper oversight, scheduling changes are routed through this group.
Who is leadership?
When a patient calls to check the status of their referral, these two places must be reviewed for communication.
What are the referral and the chart for a TE (telephone encounter) note?
This is what must be done with cash drawers at the end of each day.
What is closing the cash drawer at end of day?
DOUBLE JEOPARDY!!!!!
Part 1: This is what we do while waiting for a new referral
Part 2: This is when we reschedule the patient.
Part 1: What is keeping the patient on the schedule?
Part 2: What is when the referral is not received by the required deadline (24 hours prior to the scheduled appointment)?
This insurance coverage is required to qualify for the BMI Reduction Program.
What is Cigna Allegiance?
No room for one more!
This is the class limit for BMI Reduction MyChart sessions.
What is 20 patients?
This explains why we ask providers to update diagnoses.
What is to prevent denials and patient financial risk?
Direct desk lines should only be shared with patients under this circumstance.
What is when approved and appropriate per workflow?
These referral types distinguish medical weight management from surgical bariatric services.
What is REF 305 for Medical Weight Management and REF 71 for Bariatric Surgery?
When BMI Reduction visits are not covered at 100%, this plan type causes the patient to be responsible for deductible and coinsurance.
What is a High Deductible Health Plan (HDHP)?
This determines whether a visit is billed as ADA Diabetes Education or as an MNT appointment.
What is whether ADA is noted on the referral & has a DM diagnosis?
BONUS Answer (Extra Points)
What is it does not have a diagnosis ending with .9/.09
Verification is completed regardless of whether the patient is this.
What is scheduled or not scheduled?
These are all the points in the workflow when insurance verification must be completed.
What is upon referral receipt, following month prior to scheduled appointment, with new or changed insurance, and prior to the date of service if changes occur?