MEDICARE
True or False: Only the elderly get qualify for Medicare.
False.
True or False: Every patient is their own guarantor.
False
Name 3 different Blue Cross plans.
BCBSM PPO
BCBS OOS PPO/TRAD
BC Complete
BCN
BCN Advantage
Medicare Plus Blue
Blue Cross Federal
True or False: A child is their own policy owner on their Medicaid plan.
True
Patient is calling with Medicare Part A only. How should we proceed with scheduling.
They could be a self-pay.
Remember: Part A is hospital only.
An 18 year old patient is covered under their parent's insurance. Who is the guarantor?
The patient.
True or False: Can a patient have Medicaid and Medicare?
True
What should you do when you get a Data Mismatch for Blue Cross Complete with the Alpha prefix of XYU.
What is verify active coverage and manually e-verify account.
When delaying scheduling due to the need of authorization, what rule should you follow when counting out on the calendar?
What is full business day(M-F). We do not count weekends or holidays or the day of making appointment.
Patient has Medicare A & B and they also have Blue Cross through their employer. What is the filing order for these insurances.
1. Blue Cross (primary)
2. Medicare A & B (secondary)
Name at least 3 different types of Guarantors besides Patient/Family.
Workman's Comp
Auto Claim
Mental Health
Package Price
TPL
Name at least 3 Medicaid plans.
Aetna Better Health
Blue Cross Complete
Meridian
Molina
United Healthcare
Total Healthcare
HAP Mi Healthlink
Spendown
Patient is calling to schedule an appointment and states they have Medicare and Aetna insurance. Your response history indicates:
Aetna Better Health MI Healthlink OON
How do you proceed with scheduling?
Self-pay. Because it is Out of Network (OON)
True or False: It is recommended that we print of a copy of the Authorization Grid to keep at our desk and reference.
False.
Can we bill Medicare A & B and Medicare Plus Blue for a patient?
No, a patient can not have both insurances. Medicare Plus Blue is a dual policy.
Walter Reuther is calling to schedule a patient for an appointment. Patient has Medicare and Medicaid. What is the guarantor for the visit?
Also: What insurance would be billed for this service?
Guarantor: Mental Health
Insurance: Walter Reuther
A patient has Blue Cross PPO and a Medicaid. The patient wants to have Medicaid billed only. Can they do that?
No, Blue Cross would be billed first and if necessary, the Medicaid would be billed after.
When should you use 'Other Payor' plan and what must you collect from the insurance card and add into the coverage?
What is a MMCR and the Claims Address.
What is the difference between terming coverage and removing coverage?
Terming coverage deleted the coverage.
Removing coverage removes it from the appointment.
Patient calls to schedule an MRI of their knee. The insurance on file is Medicare A & B and HAP HMO Open Delivery. The response history indicate a coverage mismatch. The mismatch indicates the patient has HAP Senior Plus. What action needs to take place and why?
The Medicare A & B and HAP HMO needs to be termed. HAP Senior Plus needs to be added at the Registration level prior to the Order being created.
The why? It won't flag for authorization properly if you change it during the Registration of the appointment.
Patient is shopping at Kroger. They slip and fall in the store. What guarantor would you pick when scheduling an appointment based on this fall?
TPL (Third Party Liability)
A patient is coming in for an abdominal ultrasound. They have Medicaid ESO insurance. How do we bill this insurance?
The patient only has Emergency Service Only insurance. If they do not have any other type of insurance, it would be self-pay.
Mom is calling to schedule her 5 year old daughter an Ultrasound appointment. Dad will be bringing the child in for the visit. The child is covered under the mom's Blue Cross and mom's date of birth is 2/12/1974. The child is also covered under father's HAP. The father's date of birth is 5/15/1968. The child also qualifies for Medicaid. Who is the guarantor for this child? What is the filing order of the insurances.
The dad is the guarantor- he is bringing the child to appointment.
1. The mother (2- month)
2. The father (5- month)
3. Child's Medicaid
Patient is calling to schedule an MRI and indicates she has her authorization number already. Do you input the authorization code in the HAR note and proceed with scheduling without delaying the exam.
What is True. Reminder to check the umbrella to make sure you are staying at a same facility.