Insurance
If you are verifying coverage on RTE and the patient is not assigned to HealthPoint, what does the hard stop at check-in require you to do?
Switch form- Patient must sign. We get 600 per patient if not more. We won't get paid until the patient signs the other entity will.
What is a FA case?
Financial Assistance - Sliding Scale
What is standard work?
In lean manufacturing, standardized work is a system for documenting the most efficient and effective methods for performing tasks, ensuring consistency and minimizing waste. It involves defining the precise steps, sequence, and timing for each process, promoting safety, quality, and continuous improvement
Who am I? I don't have insurance I'm running from my country I don't have active coverage in One Healthport? What is my patient type?
Asylee
What is the correct filing order if someone has Medicare and they also have a private commercial plan?
Commercial is primary Medicare is Secondary
How can I delete a coverage entered by mistake or in duplicate?
Add in the effective dates 01-01-1900 to have it sent to the background.
Who can apply for the sliding scale?
Anyone and everyone - Even if they have insurance!
What is a Good Faith Estimate - Which one of our population gets one?
A GFE- Something by law we have to give the patient due to the No Surprise Act! Patients who are not insured are required by law to receive one.
I want to update my email so I can log into Mychart what is required of me at the front desk?
Identification and chart verification.
I have active Medicare I also have an Advantage plan what do I need to attach to visit encounter when checking in?
The Advantage plan!!! We are contracted with Molina And CHPW. Unless previously established with Healthpoint we dont accept new patients with other plans.
What is the Patient Matrix?
A tool used to see if we accept their insurance plan?
What are the requirements to apply for the sliding scale?
(POI) of everyone 18 and above in the household- One month of stubs or a letter. Also SSA must be filled out!
What is a STAT call? And what do I do if I answer a phone and it's a STAT call? What shouldn't I do?
You should always identy your self and site location- Get MRN also never put on hold and GET the Nurse or MAS STAT!
What is the purpose of using the Welcome tablets? Are there any advantages?
Paperless!! No reg form needed :) Also back office gets to be more prepared on patient's history!
Patient has Molina insurance and they are seeing the acupuncturist. Should I attach insurance? What other important conversations should I have with the patient.
No, you should NOT attach insurance - Moilna dones't cover acupunture. Waiver is not required patient should have a FA case to get the lowest rate-
Do we need to upload insurance cards, Photo IDs and why?
Yes - Because sometimes we need to refer to these items to ensure billing and payments.
If a patient wants a one-day discount, what must we obtain in the chart?
A registration listing the household size and minors included, and an amount in the income section with staff and patient signature.
What is a 123 switch form?
123 switch form: a form that patients use to switch to a Medicaid plan we accept, such as Molina, Coordinated Care, or CHPW and get off a plan we’re not contracted with like United or/Wellpoint.
If they are not willing to switch and have an Apple Health plan we’re not contracted with, they must find a new doctor.
Can we accept New patient for a dental appointment? What insurances can they have? What criteria do they have to meet?
Patients who are refugees
Patients who are pregnant
Patients with a diagnosis of hypertension
Patients with a diagnosis of diabetes·
Patients who are receiving SUD care
Patients with CHPW Medicare
Also must be unisured or have CHPW
When should you use the Payor Returned Section
When the return in portal or RTE is different than what we have on file for the patient. Why do we do this? So we get paid and doesn't fall in claim edit workque
Can someone with Medicare only see an ND or a Natropath provider?
Attach Apple as primary,
only if Apple plan is only CNP/QMB or CNP
They will fall into a workque if not completed or denied. Patients cannot receive their discounts or even be billed until completed.
What is a PCP switch form?
1.PCP switch form: for Molina, Coordinated Care, and CHPW plans. Patients use these forms to change the clinic and primary care provider (PCP) they are assigned to. For example: if a patient has Molina Apple Health but they are assigned to SeaMar, the patient must sign the PCP switch form. We MUST have this done to process referrals, prescribe medications and get paid for the visit.
How do you verify a patient- 3 Point check
Verify First Name, Last Name, D.O.B-
If a patient has Medicare, what portal should I be using? What should I be collecting and scanning into chart?
Noridian? PAtients insurance card and ID