Exceptionally Different
We are able to provide a customer discount to all regions, except this one.
What is Texas?
Explain to a patient what copay is.
What is payment made at the time of service, varies by insurance carrier and may be applied to services received by the insurances after claim is processed?
This company sends out letters to help patients if they deem the services were related to W/C or TPL.
What is Paratus LLC with phone number 855-995-3345?
Department Liaison Review are for which type of accounts and also known as
What is Hospital billing and charge reviews?
A patient assist is
What is:
an internal review service we offer to our PMG/PMI patients regarding their clinic and outpatient hospital related charges?
Medical records can be sent to workqueue 357, except for this Region and type of billing.
What is California for Physician Services?
Explain to a patient what deductible is.
What is a specific dollar amount that must be paid by the insured before a medical insurance plan begins covering health care costs. This cost applies annually?
This Genesys wrap up code supersedes all other wrap up codes.
What is payment?
Explain the difference between the reviews we provide and the order of which reviews should be done if patient is escalating.
What is:
Patient Assist- charge review, DX or CPT code review, dispute for referred HB services, cost of care higher than quoted. Submit to excel sheet until management has approved to submit to AA 270
Dispute for patient assist- Dispute made on decision, no need to resubmit to PA excel.
Patient care concern- Patient having issue with care provided; route to AA 240. Details sent in email and note should state sent to email box of PCC regarding DOS XX/XX/XXXX
Department Liaison Review- HB Accounts; charge review, dx code review or review of ER level of care, disputes hospital admission/status type. AA 381
Process if patient disputing PA:
The three categories or disputes that qualify the DOS/charges for a patient assist review
What are:
a. Diagnosis Coding Dispute
b. Procedure coding disputes
c. Charge/Level of Care Disputes
There are almost no urgent cares within Providence. We instead of this alternative for patients needing care for walk ins. Explain the difference to a patient.
What is immediate care? Patients sign a form at the beginning of the visit stating they are aware they are at an intensive care and not urgent care.
Urgent Care- Better equipped facilities able to handle serious conditions, but not appropriate for severe emergencies. Better equipped to handle serious conditions than immediate care centers. Can provide basic labs and imaging tests, such as x-rays, to help them provide diagnoses and develop treatment plans.
Immediate Care- Condition or reason would not be life-threatening. Reason for visit does not warrant a visit to the ER. No appointment is needed and walk in is expected and accepted for non-emergency cases. Not recommended for emergency conditions.
What is a cost-sharing requirement under a health insurance policy that the insured assumes a percentage of the costs of covered services?
A patient calls in regarding being billed for a balance due from an office visit which the patient states the physician advised there would be no charge for. Reps should advise the patient as so.
What is:
Advise the patient that all office visits are charged, however, if the physician advised the patient there would not be a charge, you would send for review to verify with the clinic.
Mom brought the patient in as she felt patient was dehydrated and needed medical attention. Patient’s physician called up to the ER prior to patient being seen and was told the wait was only 45 minutes. Mom is upset at the time spent in the ER. The wait was 3 hours not 45 minutes. Mom said the doctor only spent about 5 minutes with the patient and was told she was fine and is now being billed for $1400 at a level 3. This warrants what type of review.
What is submit for department liaison review? Reasoning: mom disputing billed amount and not care provided.
If a patient is disputing a patient assist result, the rep would put in this AA code.
What is AA 270- patient asssist - with "DISPUTED PATIENT ASSIST" at the top of the note?
If patient was disputing with a patient care concern after patient assist resolution dispute and dispute on the first patient assist resolution was provided, then they want to just pay it. This code removes the contested status and from patient assist.
What is the AA 1261 to remove from the queue?
Insurance usually cover one preventative visit per year, but if the patient is new to the provider, it is consider this kind of visit.
What is an establishing care visit?
These visits may result in patients having a charge, even if they were not physically in the clinic or hospital.
What are:
- telehealth visits
- readings and interpretations: for example x-rays and electrocardiograms
- remote readings: pace maker
Patient came in for a CT Scan and is being charged for dye and patient claims she did not have dye with her CT Scan. This was already reviewed by Dept Liaison and came back that patient did have the dye with her Ct Scan as the order was in the patient’s chart. A letter was sent to the patient advising of this determination of the review and patient is now upset and adamant that she did not have the dye administered to her. This warrants what type of review.
What is patient care concern? Reasoning: The physician order was still in the chart, but the Diagnostic Imaging Dept. decided against the dye. Patient should reach out to QRM for dispute.
The patient is disputing the diagnosis code used on a PMG/PMI referred lab charge. Explain how this would be disputed.
Patient pays prior to visit for services. Explain this type of discount vs. patient not having insurance.
What are:
- Pre-payment: 10% discount on the estimated PR
- Uninsured discount: varies across services, but is only for patients without insurance to bill.
Write off for undocumented FA is listed. Please explain to patient.
What is a discount applied to the account as there are charges not being fully paid and were written off by Epic?
Patient is stating newborn was not in nursery and remained with mother in the room all time. Please explain to patient the nursery charge on HB.
What is:
- Healthy babies will often stay in bassinets with the Mom. Even though the baby was not in the nursery, they still received the same care which is assigned as a facility fee. The fee covers the care, supplies, time and attention we provide to the baby and mother. Charge is the same whether the baby stays in the nursery or the room.
Patient had an MRI on her head.
Patient stated the MRI was poor quality and she was asked to return for a repeat MRI. Patient is now being charged for both MRI’s. This warrants what type of review.
What is submit to patient care concern? Reasoning: Patient did receive both services, but patient was not at fault for second visit. QRM phone can be provided.
Patient calls in saying they were charged for a 30-minute office visit with their physician, but is disputing it was only 15 minutes. They want it to be reviewed as they feel they are being overcharged. Explain how you would assist the patient.
What is educate the patient that time frame being charged is not only the time the patient spent face to face with the provider? Time is calculated by time prior to appt for provider reviewing medical chart, face to face time, and post visit when the provider is documenting the patient's medical record. If after education the patient is still adamant, you may put on Patient Assist sheet.