Virtual Care
What are the three types of virtual care?
AND
How can you tell what type of visit the patient had?
Amwell, MC Provider, and VPC
The type of visit will be in Epic on the Chart Review Screen
What should you do if a Lab calls in with results for a patient?
Critical Lab Procedure
Two claims are present for the same date of service with the same codes indicating an Office Visit on each, Athena, how do you proceed?
Send a coding review
What should you do to a CRM if you want to make the note present going forward on the chart for the provider to see?
(i.e. we do this whenever we attach images to the CRM that the patient send to us)
Create a clinical call
Caller wants to know if we accept walk in's. What should you advise?
“Appointments are not required to be seen at Minute Clinic. However, we would recommend that you schedule an appointment to guarantee that you can be seen. If you do not have an appointment the nurse would only be able to see you if there is availability between the scheduled appointments”.
You can schedule an appointment through Five9 as a first resort or on the Minute Clinic website as a last resort, and I would recommend writing down the confirmation code once the visit is confirmed and scheduled.
If the patient is calling to advise that they are running late for an existing appointment, please do not send a CRM to the location. Please advise the patient that there is no guarantee that they will be seen as the nurse will need to move onto the next patient and offer to schedule a new appointment.
If the Chart Review tab says:
EVC Eastern Scheduling, what type of provider saw this patient?
MC Provider
What should you do if a Physician calls on behalf of the patient to discuss a concern of the patients care.
Physicians Concern Procedure
The patient calls in to process a payment. They advise the balance is in collections but its showing in Salesforce how do you proceed?
Recommend the payment be made with TSI directly so the bills stop immediately.
If the patient declines, process the payment in SalesForce
If its not the patient calling what part of the CRM must be changed?
The Source Type
Patient calls upset that they were not given antibiotics after an evaluation. They know their body and know that they need an antibiotic.
What should you advise?
All Minute Clinic providers are expected to follow the evidence based clinical practice guidelines set forth by the organization.
Evidence based practice is best defined as an integrated, multi-disciplinary approach to patient care that relies upon the synergy between three essential components:
The best research evidence available
The clinical expertise of providers
The values and needs of the patient and family
If a patient states they are trying to schedule a Virtual Visit and cannot find their insurance, what should we advise?
We don't accept the insurance for Virtual Care. The patient would need to pay using a card on file, and self submit a claim after they are seen.
Should you give positive Strep lab results over the phone if there is no prescription issued?
No, attempt to reach the provider, set a high priority CRM if unavailable
If the insurance is out of network, can we submit to the DHHS plan for a COVID test and Office Visit Charge?
NO, the DHHS is only for Uninsured patients who qualify for the COVID Test to be submitted.
If you take a payment on SalesForce and stay on SalesForce for the duration of the call, where must you document the call?
SalesForce only.
If the call led you to go into the Athena or Epic chart than we would also document through CRM and on Athena.
Caller indicates that they need a TB Skin test. What should you advise during this informational call?
“Please be advised that tuberculin skin testing at Minute Clinic may be covered by some insurance plans. Please check with your insurance to confirm coverage”.
“This skin test is time sensitive. From the time that the injection is placed into your forearm you would need to return within 48-72 hours to have the reading of the test”.
What should you do if a patient is requesting a new VPC Provider?
Create a CRM and Attach and Task.
What is the next course of action if a patient has been diagnosed with and treated for strep, but their symptoms have not improved?
Advise a New Evaluation is needed
If the patient provides the following insurance plans, what plans would we need to bill and in what order?
-Traditional Medicare
-BCBS Medicare Advantage PPO
-Florida Medicaid
Primary: BCBS Medicare Advantage PPO
Secondary: Florida Medicaid
When routing a CRM to the provider after contacting them as a reason to call the clinic, what must we do with the CRM?
Mark as High Priority CRM
Daily Double
What should you advise?
“Under federal law we cannot charge a Medicaid patient out of pocket, nor can we bill them outside of the Medicaid amount unless it’s advertised as a self-pay service”
In addition, many services are excluded for minors such as vaccinations. We can’t currently accept cash for Medicaid vaccinations for children because they must be seen at a VFC (Vaccines for Children) Program Provider. MinuteClinic is currently not a VFC Provider so then administering the vaccination to a Medicaid patient would be going against Federal regulations.
What should you do if a lab calls regarding a Critical Result for a VPC visit and its after 5PM local standard time to the provider?
Call HD to request that they contact Dr. Calvo.
A patients parent calls stating that they need forms completed for the child to go into Pre-School. The child has not been seen by our provider, but would need a physical to complete this form. The patient has active Medicaid insurance.
You learn that the form does not require an MD signature, the patient is 4 years old, plans to be evaluated in VA, and does require vaccine records to be listed but did not receive the vaccines at Minute Clinic.
Can we provide the Physical and fill out the forms?
No, because the service is outside of Minute Clinic's scope
The patient came into Minute Clinic for an office visit and has Medicare as primary and Medicaid as secondary insurance.
We only billed Medicare.
The patients CCOF debited the card for the remaining $89.
How would you handle this call?
Bill the remaining balance to the secondary insurance, and place the patient on the valid refund spreadsheet.
What topic/subtopic should you select for a patient who was seen by an Amwell Provider and their Rx has not been received by the pharmacy?
Topic: Virtual Care- Amwell Provider Prescriptions
Subtopic: Rx Not on File/not received by pharmacy
Patient is disputing their balance of $90.97 due to the provider advising that they only had to pay $20 at the time of service.
Advise to dispute with insurance.
The provider can only see what populates on their screen to collect as an estimate. The insurance would determine the true balance after the claim is processed.