Patient Accounts Jeopardy #2

IPLANS

100

What are the Z-Iplans

Use for auto liability accounts 

200

What is 910?

Use this plan for uninsured accounts 

300

What is T01?

T01 is Commercial Other - Use this plan for commercial insurance that is not listed on the i-plan list 

400

What are the A-Iplans?

Traditional Medicare Plans -  Determine if the account type is inpatient or outpatient. That will help to determine if you should bill Medicare Part A or Part B

500

What is F35 used for?

Use this as a placeholder for the Medicare ID number. If a patient has a Medicare Advantage plan, we will add that Advantage Plan on the account as well as add the Medicare ID under I-plan F35, we are not billing F35, it should not be considered secondary, tertiary, etc., it's only a placeholder to represent that the patient has Medicare therefore having a Medicare Advantage Plan is warranted.

HIPAA

100

The (non minor) Patient is Calling?

We need to verify 3 points of verification on an account which include:

• Account number 
• First and last name
• Date of birth
• Last four of Social Security number (SSN)
• Guarantor Address
• Telephone number on file
• Insurance ID number

200

Executor of Estate is calling?

We will need the Executor of the Estate Documentation. 

300

Spouse, Friend, Family Member

 

After getting 3 points of verification. You will need to verify if we are authorized to speak with them.

Must have one of the following:

• HIPAA FORM (Check the expiration date of the HIPAA form to determine if you can speak with the caller)
• Verbal Authorization from the patient/guarantor
• ROI – Check the expiration date of the ROI to determine if you can speak with the caller.

*If the forms are expired, please have the caller send an updated form. 

 Guarantor will have to provide verbal authorization for us to speak with someone other than themselves, or we would need an ROI form on file. 

400

Third Party Administrator (TPA) 

You may get a call from third party administrators such as The Rawlings Group, Johnson and Roundtree, Cotiviti, Zelis, Records Retrieval Solutions just to name a few, they would state that they are calling on behalf of an insurance company. 

1. They would need to verify HIPAA
2. The insurance in which they are calling on behalf of can be listed on the patient’s account, if so, get the TPA to verify the member id/policy number
3. If the insurance they are calling on behalf of is not listed on the patient’s account, please ask the TPA what is there reasoning for calling and what information they are seeking?

If the TPA is seeking information that you suspect should not be provided to them, please reach out to your TL or escalate a callback for your TL.

500

Father Called but Mother is listed as the Guarantor, Father signed the consent forms?

**If there is a discrepancy regarding the guarantor please review the consent form and see who has signed them, that person would legally be the guarantor of the account** You would have to change the guarantor to the father. 

Systems

100

Medical Records

Cerner East/Central - Power Chart

200

Account Numbers starting with 5000000

Cerner - Revenue Cycle

300

Insurance Eligibility

One Source

400

Itemized Bills

Data Warehouse East/Central

500

New Timekeeping Software

UKG

Level of Care

100

Ear Pain

Level 2

200

Suture removal (uncomplicated)

Level 1

300

Administration of Blood Transfusion

Level 5

400

Receipt of EMS/Ambulance patient

Level 3

500

Administration and Monitoring of infusions or parenteral medications (IV, IM, IO, SC) NG/PEG

Level 4

Potpourri

100

UHC Medicare and UHC Medicaid Bundled 

UHC Dual Complete

200

BATCHCSH

Batch Remits

300

FC 5

Bad Debt

400

What is Needed to Change DX?

Amended Physician's Order

500

Patient Kept for 72 hours / Not Admitted / No Room Charges

Observation / Outpatient