Self Pay
What are the additional charges to a case rate?
High tech add on and observation charges
What is the visit type for a patient that requires diagnostics only?
MSE
What is the process when a patient provides insurance but we cannot determine benefits or eligibility?
Offer Self Pay!
When would you change the "illness" to "injury" in the condition tab?
"Injury" is only to be used when patient is MVA/WKC/LIA.
What are the 3 requirements for a passing call?
Friendly, encouraging, inviting!
What is the cost of a 72 hour return case rate?
1/2 of the assigned case rate
What is the visit type and process for an uninsured emergent patient that receives treatment but does not pay ATOS?
ER-FFS with an email to billing CC Supervisor.
What benefits would you use?
Individual OOP: $0
Individual OOP Remaining: $0
Family OOP: $6,000
Family OOP Remaining: $6,000
Individual Deductible: $0
Individual Deductible Remaining: $0
Family Deductible: $3,000
Family Deductible remaining: $3,00
Copay: $200
Coins: 10%
OOP: $6,000 Deductible: $3,000 Copay: $200 Coins: 10%
What are the steps when a patient "waives PP discount"?
1. Prior to presenting this form offer the patient financial assistance, promissory note, or the option to contact a friend or family member for payment
2. Have the patient sign the attached form after explaining to them in detail that they will receive a bill for all services completed
3. Flag the patient’s chart
4. Email Pending Charts and CC Supervisor
What does the acronym AIDET stand for?
Acknowledge, Introduce, Duration, Explanation, Thank You
Complete the script: "Our self pay rates start at $___, most people pay between $___ and $____, the cost varies based on the ____ and _____, we will keep you informed of the ______ ______."
"$199" "$300 and $400" "severity and treatment" "treatment options"
What is the visit type for a patient that returns for a suture removal?
ER Visit / ER-INS or ER-FFS
What should we do when we receive an "other insurance" alert through OneSource?
Press the patient for more information about the other insurance! Failure to do so can result in a denied claim.
What documents should PAS provide when patient is self pay?
Copy of self pay agreement & Radiology handout (if applicable)
What is our front desk mantra?
Stand Up, Smile, Greeting, Be Patient, Explanation, Sell our Services, Well Wishes, Be Thankful
What is the case rate, cost of triage, exam/assessment, and consultation ONLY?
Case rate 1 - $99
What is the visit type for an Employee/Employee Dependent with non company sponsored insurance?
ER-INS
When in doubt if we honor an insurance, what verbiage should you look out for on the insurance card?
"STM - Short Term Medical"
"Limited Benefit Plan"
"MEC - Minimal Essential Coverage"
"This is not an insurance"
What steps do you take when a patient calls and requests an itemized receipt and/or clarification regarding a statement?
1. Verify the name and DOB of the patient to confirm the patient was seen at our facility.
2. Verify the statement the patient is referring to is not an EOB3. Verify the statement the patient is referring to is of Complete Care and is not from receiving labs and/or radiology
4. Verify the patient was not self-pay. In the instance an itemized receipt is being requested we cannot provide one. (This information should be reviewed with each patient when they choose to self-pay.)
When we receive questions about wait times? Do not say: "We are an ER, we do not give out wait times." But, DO SAY:
"We don’t have anyone in the waiting room right now. We usually have amazingly short wait times."
"We have a couple of patients here now, but we usually get people back quickly. Do you know where we are located?"
When the facility is “busy” with 3 or more patients in the lobby: "We currently have X patients waiting to be seen. It is difficult for me to say exactly how long it will take, but we always get everyone back as soon ASAP."
What level of care is in lieu of Case Rate?
Critical Care
What is the visit type for an Employee/Employee Dependent with company sponsored insurance, no insurance or insurance we do not accept?
ER-EE
A patient is over age of 65, but is still employed. Patient has Medicare and an insurance plan through employer. Is Medicare still Primary?
No, if patient is still employed or spouse is still employed, Medicare is secondary to their employers insurance.
Patient walks in and walks out of our facility, what should we do?
Document on MSE Decline Log!
Respond to the callers question: "Do you take medicare/tricare?"
Medicare and Tricare do not currently pay for services provided at freestanding emergency centers like Complete Care. We are working with legislators to get this changed. In the meantime, we offer very affordable cash-pay rates. If you come in for treatment, we can let you know the cost after the doctor evaluates you. Would you like to hear more about our cash pay rates?