Scenario Sandbox
An unauthorized caller calls and asks about a collection account, what information can be given?
The collection agency’s name and contact number or the balance
What types of charges are described as belonging to the hospital versus USAP?
The hospital/facility bills for use of anesthesia equipment, supplies, and medications; USAP bills for the anesthesiologist’s professional services
Why can’t Medicare Advantage be billed together with Medicare Part B?
Medicare Advantage covers services under Parts A and B through the private carrier, so Medicare and Medicare Advantage should not be billed together
True or false: Westhampton has a Financial Assistance Program that should be selected when a patient requests charity care.
False. Westhampton does not have a Financial Assistance Program
When placing a caller on hold, you must check back in with them every [ x ] seconds
120
You deliver the USAP greeting, but the caller does not respond. You repeat the greeting twice more, and there is still no response after 60 seconds. What should you say and do?
State that you cannot hear the caller, that you are disconnecting, and that they should call back when able. Then disconnect the call
In Care Team Billing, which providers may be involved?
A Physician Anesthesiologist and a CRNA or AA
True or false: An inactive Medicaid or Medicare eligibility response should result in a found-insurance escalation.
False. For inactive Medicaid or Medicare, the patient should contact the insurance carrier; a found-insurance escalation should not be submitted. For inactive Medicare, confirm whether the patient has Part B benefits
How often are Westhampton escalations sent according to the submission procedure?
Once per week
This term describes the psychological phenomenon where an agent subconsciously mirrors the negative, angry energy of a caller instead of remaining calm
Tone Matching
True or False: Verification is required on every call, even when no PHI will be released.
True
A patient asks why two similar claims were sent to the insurance company. What is the best explanation?
Explain that when an Anesthesia Care Team is involved, some insurers require separate claims for the Anesthesiologist and the CRNA/AA. The insurance company processes both claims and pays the contracted rate for each provider; the combined payment is similar to what would be paid for a single Physician Anesthesiologist when no CRNA/AA is involved
When billing Blue Cross Blue Shield, which plan should generally be selected?
The local plan for the state where services were provided
After signing in to the Lifepoint workspace and completing MFA, what should the user select next?
Apps. After MFA, select Apps, then use the ellipses under the Meditech Lifepoint LPNTBH LIVE icon and select Launch from Client
This is the specific soft skill that, when missing, often results in a negative audit score, even if all technical and procedural steps of the call were performed perfectly
Empathy - the ability to acknowledge the caller's feelings and situation to build rapport; it is often the only way to successfully "reset" a highly escalated interaction
A family member calls and asks whether the anesthesiologist or CRNA treated the patient. The caller has not completed authorization verification. May you identify the providers?
No. Do not identify the providers unless the caller is the patient or an authorized caller. Follow HIPAA verification before disclosing protected information
What disclosure must be included when completing a callback?
State, “I am calling from a recorded line. This call will be used for training and quality purposes.”
A patient asks USAP to resubmit a claim. The EOB is posted correctly, the billed insurance matches, and the insurance has already paid the claim. What is the correct response?
Explain that USAP cannot resubmit the already processed and paid claim because a second submission would be denied as a duplicate claim. The patient must contact the insurance carrier to request review or reprocessing
In Meditech, which menu path is used to begin working an account?
Billing/AR Main Menu → BAR Process Account
When a customer is explaining a complex problem, using small verbal cues like "Uh-huh," "I see," or "Right" is part of this fundamental communication method
Active Listening
The patient says the hospital told them the visit would cost less than the USAP statement. How should you respond without promising an adjustment or refund?
Explain that the hospital provided a calculated estimate based on expected services, not a guaranteed amount. If the procedure lasted longer than anticipated, the final cost may be higher
The caller asks whether you work for USAP and then presses for more detail. What is the approved response and escalation path?
State that you work in the USAP business office. Only if the caller asks again or presses, explain that you work for a third party as an extension of the USAP business office. If the concern needs USAP escalation support, advise the caller that you will transfer them to the USAP escalation team and place the transfer
What best distinguishes coinsurance from a deductible?
Coinsurance is a percentage of the allowed amount after the deductible is met. The insurance company determines and calculates the coinsurance amount
This is the phone number for the Meditech Helpdesk
833-571-HELP
An insurance representative is on the line, but the denial is unrelated to COB, eligibility, or accident information. Where should the call be connected?
Connect the insurance representative with the main office. If the patient is on the line instead, advise the patient to have the insurance company contact USAP directly.