Chart Colors
MISC
Insurance Basics
Misc Part 2
WC/Auto
100
BCBS
Blue
100
Who do you email for a float PT request to be added onto your clinic's schedule
pac.trainers@team-rehab.com (The Trainers)
100
What is an Authorization?
The amount of visits the insurance approves for PT. This can be less than or up to the visit limit
100
When should we use the paper admission forms?
Only if we cannot use the electronic intake forms for any reason. These should be used very sparingly
100
Can you take a WC patient without a script?
Nope!
200
Medicare
Red
200
What date do we enter here?
This is the date you are entering the insurance into prompt
200
What is a Copay (CP)?
A flat rate amount that the patient is responsible for at every visit.
200
If a patient has an HRA do we collect a CP from that patient in clinic ?
No! we only collect once insurance has processed the claims
200
Where can you find the documents that a WC Adj/Cm wants sent to them?
In the WC Insurance Policy Notes!
300
WC
Purple
300
What are the components of policy notes?
Initials, Where you got the information, Eff date, DD, CI or CP, Moop, VL, Auth (if auth is required when is it needed, and how do we obtain)
300
What is a coinsurance
a percentage of our billed charges that a patient is responsible for. Will not be the same every time
300
Does an HMO have any OON benefits?
No
300
What is the most important information to get for a WC patient if they do not know their claim information?
Who their employer is, and a point of contact for the claim (Usually their HR department or whoever they reported the injury to).
400
Anything besides WC that requires auth
Green
400
How many times should a patient exist in prompt?
Once!
400
What is a deductible
The amount a patient has to pay before insurance will pick up anything
400
Do we accept insurances that we are OON with
Yes, if they have any OON benefits.
We will not turn a patient away unless the CD decides to
400
When a WC/Auto/PI patient cancels, do you have to get a reason why?
Yes!
500
Auto
Yellow
500
What information do you need to get from a new WC patient
Employer
Adjuster/Case Manager info
Claim Number
DOI
Attorney Information
500
What is a MOOP
The maximum a patient will pay in a calendar year for medical expenses before insurance picks up 100%
500
If you don't know who your mentor is where can you find it?
ADP-the team rehab Org chart
500
What do you need from an auto patient when they call to schedule?
IL: DOI (Date of Injury), State of accident, Personal Auto ins name, Claim #, Adj/CM info, Attny, other drivers auto ins, claim #, Adj/CM info
GA: Ask if they have an attorney, if they do then only get the attorney's info. If not follow same rules as MI:
MI: PHI (Personal Health Insurance), DOI (Date of injury), State of accident, Personal Auto insurance, Claim #, Adj/CM info, Attny