Ending Care
Why do we ask someone to come in for a financial appt when they want to end care?
We require practice members to come in for a financial appointment so we can try and save that practice member, to clear up any balance/credit on the account, and to get a signature from the practice member in order to legally change their finances.
What do we say to a PM when their payment declines?
"I'm sorry, we had trouble processing your payment, do you have another payment method we can try?"
How do we determine whether someone can receive a family discount?
25% Family discount applies to PMs who are on the same tax return (aka spouses & dependents).
What type of payment methods can be used for automatic monthly payments?
Credit/debit, HSA, ACH(Check/Bank Account)
*Bonus Points: Which payment method requires an additional form?
Someone signed on to care with option 1 (monthly installments). What form should they sign if they decide to switch to option 2 (PIF)?
Payment Plan Change Form
Why do we need a reason when someone wants to end care?
We need a reason because we need to know if we can try and retain the practice member and come up with a solution to get that practice member to continue care. Different reasons will cause us to put together different paperwork and we need to be prepared before we go in to the financial appointment. (Examples: Different financial options, have a Doctor talk to them about their health and provide additional education, have our hours readily available, and any applicable forms prepared.)
How do you do a family balance transfer?
If you are doing a family balance transfer you would:
1. Go to the PM's account you are transferring the balance from and you would add the transaction "Family Balance Transfer" and do a negative payment " -210.00 "
2. You would then go to the practice members platinum account that you are transferring payment to and then add the transaction "Family Balance Transfer" and add a positive payment. $210.00
Always put an F10 Note that says who the transfer is from and who the transfer is to.
How long does a PM have to switch CP options after they sign on to care?
30 days
If someone wants to BPI, what do we need to get from them?
BPI form FULLY SIGNED AND INITIALED and a payment method on file.
Explain a UHC wellness form.
This is a form required by your insurance company. It's an acknowledgment that we are no longer able to bill your care to your insurance. It doesn't change any of your prices moving forward.
What do we do if someone ghosts us and has a credit on their account?
Follow discontinuation cheat sheet:
If they only came in for their NP appt but didn't sign on, you can refund the credit if they have a card on file.
If they ghosted us partway through their CP, make a note of the credit amount in their file and write it off. You can then follow the steps to make them inactive.
How do we create new financial options for someone who can’t afford their current monthly payment?
We are going to add up remaining balance and spread it over additional payments.
For example: If they have 8 payments left we would add up the total left and divide it into 9, 10, and 11 payments to give them options.
We never want to SIGNIFICANTLY spread the payments out.
In wellness/lifestyle care, what payment options should be set up for recurring payments?
Monthly or PIF
A PM misses an initial or a signature on a form we gave them to sign. Why is that such a big deal?
We have nothing legally binding and have no way to prove the practice member agreed to the terms.
Explain a Medicare ABN to someone with a supplement.
This is a form required by your insurance company in order to continue billing Medicare.
For members with a supplement insurance: "Most practice members with your insurance usually choose option 1 which means we will continue to bill Medicare. "
What do we do if someone ghosts us and has a balance on their account?
Use the discontinuation cheat sheet.
Make sure their name is on the "Declined Payment Tracker" Monday.com board.
(Make Account Specialist aware of their name if not.)
NEVER DELETE RECURRING BILLING IF PM HAS A BALANCE ON ACCOUNT.
Someone from Zocdoc comes in for a NP appt and we haven’t verified their insurance yet. What is the procedure for their exam charge?
We are supposed to verify insurance as soon as they arrive and then give a post it note to the CA doing the appointment and let them know before we do the nerve/muscle assessments.
How many days can someone “pause” care before we need to go over their account with them?
30 days
A PM ends care early and has a balance on their account. They don’t agree because they chose the monthly payment option and have paid for all the months they’ve been here. What do you say?
We would let the practice member know that the payment plan was for all of their services added up together and then divided by 12.The amount of care you receive in a month doesn't necessarily match up with the amount you pay. In the beginning phase of care it is "intensive" and the practice member is usually coming in 2-3 times a week, meaning they have more services rendered in the beginning phase of care which leads to a balance on the account.
A doctor decides we need to increase frequency for a PM who had a flare-up. What form do we fill out and have them sign?
Change in CP frequency form
What do we need to change if a couple signed on together but then one of them ends care?
If a family member ends care and there is only one person from the family still coming in, we need to remove the discount for them moving forward. All prior services can retain the discount.
We should schedule them for an F appt so we can sit down and show them their new prices.
What happens if someone continues getting adjusted beyond their plan end date in Platinum?
It stops counting their adjustments and they have the potential to go over their care plan and stop managers will not go off.
If someone with monthly payments wants to know how much they still owe, how do we calculate that number?
We multiply the number of payments left by the monthly payment amount.
A PM tells you that they talked to their insurance who told them they have unlimited coverage, and they don’t understand why we only gave them 12 visits. What do you say?
"Under federal medical necessity guidelines your insurance has strict rules about what is active care versus maintenance/wellness care. When you begin care you will be in active care until your insurance deems it no longer medically necessary. After that we are unable to continue billing unless you present with a new injury. We have a letter explaining medical necessity that we can provide upon request to practice members when they have questions."
A PM tells you that they are going out of town for a month and wants to pause their account. What do you do/what form do they sign?
Schedule them for a "C" appointment and have them sign the defer payment form.