Demographics, HIPAA and Insurance
HIPAA requirements for a) assisting patient and b) assisting a 3er party on behalf of the patient.
a) Request the individual's full name, DOB and Phone number. -> Confirm Address, Insurance name and email.
b) Request the individual's full name, DOB and Phone number. -> ASK Address, Insurance name and email.
Where can we find if a patient is web-enabled?
eCW -> Search Pt -> Info tab -> Email on file
Alternative: Hub tab -> Top summary
When scheduling a new patient what should be your first step prior to booking the appointment?
Use the exhaustive search function to locate the patient before creating a new record.
What is a TE and how do we find out if it’s required?
Message sent to the facility’s TE Designee for further follow up. Information in PIC, booking style, buzz words, and TE reference guide.
To whom we offer a selfpay quote / Good Faith Estimate?
Patients without insurance, Enrollement issues or Job transitions, Personal Choice, Premium deductibles too high, Prefer to pay out-of-pocket.
Case: If a patient calls and the patient chart does not appear in the quick search, what are the steps we need to follow?
-Verify the spelling of the name and DOB. -Do an exhaustive search before creating a new patient. -Follow the New Patient process and move forward with the scheduling.
Where can we find the workflows and additional guidelines?
KMS LightHouse
What additional information and steps should we follow if an established patient calls in to book an appointment with Dr. SIDDIQUI, ZARA and complains about mild abdominal pain?
In the PIC:
Read the announcement banner.
Read under additional information
When do we send a High Priority TE?
See important notes under TE.
What tools and resources are required before starting a a GFE?
GFE Tool, GFE CPT Code Summary, PIC and eCW. Additional: eCW GFE Workflow Job Aid
Case: A new patient calls to get an appointment with Dr. NEVLE, DAWN in Windrose Family Medicine. The patient has is Aetna HMO PO Box.981106. Can we book this patient?
Insurance is Out of Network (OON).
After explaining to the patient that the insurance is not in network, we could offer to selfpay. If the patient agrees, we can proceed with the GFE process.
Genesys: What are the three CALL identifiers we can find in Genesys?
Caller's phone number, Practice's name and Region number.
What are time-sensitive appointments? Where can we find the information? Provide examples.
Under booking style.
HOSP FU - Within 7 days of the hospital discharge.
ER FU - Within 7 days of the ER discharge.
PRE OP - The appt will take place 2 weeks before the operation.
Physical / AWV - At least one year and a day after the previous year's physical / AWV.
Categories of Telephone Encounters. (Name all 10)
CC: Chemo*
CC: Information / General Questions
CC: Labs / Clinical Questions
CC: Medical Records
CC: Referrals / Prior-Authorization
CC: Rx
CC: Scheduling / Rescheduling
CC: Surgery Scheduling
CC: Nurse Triage
CC: Telehealth*
What is the appropriate CPT Code for a New OB self-pay ultrasound?
CPT 76817
What should we do if a patient says they changed their insurance last month and they have already an appt scheduled for next week?
Verify in provider in network tool if new one is in network.
Mark as inactive the old insurance and add the new one.
Mark as inactive the old insurance and add the new one.
eCW: What is the CAB and what can we do in that section? Name 4 items.
CAB: Centralized Appointment Booking
Search for patient / INFO / HUB / See provider's availability / Book appointments / Send TEs
Case: Established patient, Michelle Brown DOB 03/21/1968 calls into Internal North because she needs an appointment with provider Dr. Igor Intern for an IUD insertion. - Demonstrate step by step.
Follow back-to-back process
Case: Patient calls in with a trembling voice, says that had surgery with Dr. DOWD, GREGORY C last week and is experiencing pain, and has been vomiting. How should we proceed and what type of appt?
BUZZ WORDS - RED! Immediately warm transfer to clinical staff. Remember the Nurse triage line/After hours line and High Priority TE if no contact.
Case: How much will it cost for a new selfpay patient to book an appointment with Dr. Vaugh, Troy M in Alexandria Neurosurgical Clinic? - Show process.
$307.20
How do you know that a patient's address has been validated in eCW?
Address is in ALL CAPS.
Visually explain the call cycle.
Patient calls -> Genesys inputs practice details —> Genesys routes to Parallon Scheduling –> Agent access eCW to locate pt record –> Appt scheduling, TE, Waitlist, Cancelation, etc. –> Agent select wrap-up code in Genesys to end call.
Case: A new pregnant patient is calling to see any OBGYN that is available for the same day. Patient complains of pelvic pain. Ask proving questions and demonstrate Step by Step.
Confirm if the facility has providers taking new patients. Confirm if the condition is treated and the booking style. Confirm provider in network. Use the OB calculator. Create new patient profile. Book an Appointment without an specific provider. Create a TE for same day appt.
Steps for a Medication Refill TE.
Follow the Warm transfer and TE reference guide
Case: Step by Step: (Role-Pay)
A new patient calls in and wants to book an appointment with Dr. Igor Intern in Intern North for pain management. Patient advises the agent that his insurance just ended, and he is currently in between jobs. He wil not have insurance for the next 6 months.
* PIC validation (Selfpay + Accepting new pts + Treats condition + Booking style)
*GFE amount provided
*Exhaustive search
*Creation of new patient
*Booking appt. (+3 days + Ins GFE + Case)
*Attaching GFE to Appt. Sending GFE.