Self-Pay/OON
Why does Fox PT like SP and OON pts?
Potential answers:
- Increases revenue
- No/easier ins verification
- Easier notes for PTs
- No auth
- More patient types
- Patient reimbursement
What percentage does MCR pay at? What policy picks up the remaining 20%?
MCR pays Physical Therapy services at 80%
Supplements and secondary policies pay the remaining 20%
Why does Fox PT charge cancellation fees?
Potential Answers:
- Consent for Treatment
- Negative punishment
- Waitlists and evaluations
- Filters out patients who can't make commitment to regular PT
- Keeps schedules full!
- More $ for raises and bonuses
YES! Online at the Tricare website, and at the tricare.mil/costs website!
What are the 3 points that everyone needs to know about laser?
Relieves pain
Decreases inflammation
Heals tissues
Explain "knowing your caller"
Some patients are looking ONLY for IN NET coverage. Some patients are open to OON or SP coverage to be seen at our office!
How can I submit auth for visits or auth for additional visits with Tricare?
Tricare Humana Website! Find the patient in the system and press "Request Update." Enter in the necessary info, and wait for Tricare to fax you a response!
What should you do if you are nervous to tell a patient about a cancellation fee?
Potential Answers:
- Blame on Iris or Brett!
- Have a PT help you
- Talk about policy first, and then go into cx fee
As soon as you book an eval, what should you do?
Make an IVF, run them through Availity, and make the pt a profile (w/ address obtained from Availity)
What is the Assignment of Benefits Form?
- Insurance company pays Fox PT directly
- Fox PT can release pt info
- Insurance to pay claims within state statutes
What can you offer if a patient is resistant to making a SP or OON appointment?
Consult! Tour + talk to PT for 15min
How can you obtain more visits for a worker's compensation case?
1. Patient obtains new script from doctor
2. Fox sends PN to referring doctor, referring doctor signs POC and send to W Comp or back to Fox PT. Send to W Comp
3. Continued auth form
4. Coordinate w/ nurse case manager
When should you waive cancellation fees?
Potential Answers:
- Sick (but not EVERY time you cancel...)
- COVID-19
- Hospital admission
- Some extenuating circumstance that has already been discussed
What should you do if your eval for the next day is not confirmed before you leave?
Send a text that says: “Hi [Patient Name] this is [Your Name] from Fox Physical Therapy. We still do NOT have confirmation for your appointment TODAY/TOMORROW at [TIME]. Please call the office to confirm at ___-___-____ or reply “C” to this message.”
What is the notice for the initiation of treatment?
- Formal notice to insurance that patient has started treatment for accident related injuries
Does Fox PT bill Cigna?
NOPE! Patients submit claims themselves using notes and the Cigna Customer Appeal Form
What is the MCR ABN form?
ABN = Advanced Beneficiary Notice
Use when a pt is doing home PT (usually before they start OP pt)
What should you do when a patient has a balance?
Old Answer: Contact billing
New Answer: Try to figure out answer yourself (most common reason is missed copays or increase pt responsibility) + tell patient to call insurance or billing!
What is one type of call we added to the LPL?
Wellness calls! (optional)
What is the Medical Report and Doctors Lien?
- Fox PT can share pt info with attorney office
- Attorneys office must pay Fox PT for treatment
What are other ways to increase cash-based revenue at Fox PT (aka, what are the other items we charge extra in addition to copay)?
DN! Laser! Alter-G! Supplies!
When should you call Worker's Comp?
Non-compliant, update them on DOS (cx, NS, and attended), or absolutely anything related to the pt!
How do we prevent issues with patient insurance and balances?
How often do MCR pts need prescriptions, and how should you keep track of this?
- Every 30 days if no specification on prescription
- Honor highest # of visits if specification
- Keep track in WebPT "Patient Info"
What does the new LOP law say (HB 837)?
Providers will no longer be paid for treatment billed. They will be paid at the rate that insurance would reimburse the provider at through that patient's regular health insurance.