Analyzing Accounts
What does Analyzing an account means?
Analyzing an Account is the act of applying all of your skills to answer questions about the account and determine what steps need to be taken next.
What is a Contractual Allowance?
The amount the provider agrees to take as a discount.
What does HMS stand for?
Hospital Management Systems.
Before escalating a caller, the Customer Service Representative (CSR) should first attempt to?
(CSR) should first attempt to de-escalate the call. Successful de-escalation can lead to better one-call resolution and often can help resolve the caller’s issue faster.
What does EOB stand for?
Explanation of Benefits
In order to know exactly what is being worked on, on an account you will need to do what?
"Thoroughly read the notes!!!!!"
What is a Deductible?
Amount patient must pay before insurance coverage begins (starts to make payment).
What is HMS used for?
An HMS is a comprehensive software solution designed to manage various aspects of a hospital's operations, including patient information, scheduling, billing, inventory and more.
If CSR is unable to de-escalate caller, What is the next step.
Then call should be forwarded via a warm transfer (meaning the CSR transfers the call to the next level and introduces the caller and explains the situation) to next level up (Team Lead, CSR Point) via whichever escalation forwarding method is most appropriate for the situation.
What is an EOB/REMIT?
It's a document from the health insurance plan that explains the details services that was received, the total cost, and how much the insurance covered, as well as what the patient owes.
What are the five types of notes on an account?
Collector notes
Artiva Alerts
System Notes
Front end notes
BARRT Notes
What is a Co-insurance and give an example?
A percentage amount between the patient and insurance.
Insurance % of charges and patient pays % of charges
80/20
90/10
70/30
What are the steps to cancel a Time Pay in HMS?
Go to the Collection Follow-Up screen for the patient.
Press F15 to bring up the MONITOR Time Payment System screen.
Press F23 to delete.
Press F23 to confirm deletion.
When notating the account, CSRs should document What?
The source of caller frustration and their solution in as much detail as possible. It is just as important to capture what the caller wants as much as what was done on the call. This can reduce caller frustration if further calls are needed.
What is the General information on and EOB?
Patient Name and Policy Information: Patients name, policy number, and group information.
Claim Details: The claim number, date of service, and provider information.
Date of Statement: The date the EOB was issued.
Contact Information: Insurance company's contact details
When doing a Deep Dive on an account there are eight important things to pay attention to ,What are they?
Read the notes Thoroughly
Is a payment posted?
Review the Remit
Were total Charges processed?
Is the contractual posted Correctly
Does the patient owe the balance?
Is the payer requesting additional information?
Are there non –covered or denied charges?
What is Out of Pocket Maximum?
The maximum amount the patient has to pay under their insurance policy. Covered services above this limit paid at 100% by the insurance company.
What are the steps to logging into HMS?
Sign on screen key in username and password
2)On Patient Accounting Menu key in (pass)
3)key hospital of choice name.
4)Find hosp and type 3 in front
5)Then Enter
Escalations may be forwarded in any of the following
-Direct Transfer - Calls should be warm-transferred to the next supervisor or management level.
– Email - Issues will be forwarded via an email that captures the caller’s contact information (i.e. name, contact information, patient information) and information summarizing the complaint or issues and the escalation / actions taken thus far. A template providing guidance for email escalation requirements is recommended.
– Voicemail - Calls will be warm-transferred to the voicemail of the next level (warm transfer means the caller is told they are being transferred to a mailbox, not a live person).
What are the Service Details on the EOB?
Date of Service: When the medical service was provided.
Provider Name: The name of the doctor, hospital, or facility that provided the service.
Service Description: A description of the medical service received, often including a code (e.g., CPT code).
Billing Code: A code that identifies the service performed, diagnosis, equipment used, or facility type.
When analyzing the account what are the eight quick glance areas?
Account age
Facility
Total Charges
Account balance
Financial Class
Current Payer
Phase and Status
Service codes
What does the UB in UB-04 stands for?
Also what is that form also known as?
“Uniform Billing” also known as the Form CMS-1450
How Many steps are there to set a Time Pay in HMS?
16
If the Team Lead / CSR point is unable to resolve the caller’s issue, What is the next step?
Then call is forwarded to next higher level (i.e. supervisor / manager) via whichever escalation forwarding method is most appropriate for the situation.
What are the "Financial Breakdown" on an EOB?
Total Charges: The amount the provider billed for the service.
Allowed Amount: The amount the insurance company has agreed to pay for the service.
Amount Paid by Insurance: The amount your insurance company paid for the service.
Deductible, Coinsurance, and Copay: Your share of the costs, if applicable.
Amount the Patient Owe: The amount the patient is responsible for paying, which might be the remaining balance after insurance has paid.
Not Covered: Amount that the insurance company has designated as not covered within your plan and therefore not eligible for payment.