Chart Colors
Medicare
Red
Copay
A flat dollar amount that a patient is responsible for paying at every visit
If a patient calls today and tells you they are going on vacation next week and will not be back in the clinic until the following week; would you cancel those appointments for next week or would you delete them?
Delete
What is a concern report
Anything that a patient tells you, or a coworker that they are unhappy about
If a workers comp (WC) patient comes to you mid-treatment with a new PT script for a new body part what do you do?
Email WC before you do anything!
Blue Cross Blue Shield (BCBS)
Blue
A percentage of our billed charges the patient is responsible for. This is not a flat rate amount
If a patient calls today and decides to change their appointment from today at 2:00PM to tomorrow at 3:00PM. Would you delete that off of the scheduler and remake the appointment, or would you cancel that appointment and create a new one for tomorrow?
Cancel
Who do you email if a patient's doctor is not already in our Prompt system?
IT
If an auto patient comes to you mid-treatment with a new PT script for a new body part what do you do?
Email Becky Bullock before you do anything!
Purple
Premium
The amount that a patient has to pay to be covered by their health insurance
Within what time frame do you need to offer an appointment to a new Workers Comp patient
Within 24-48 hours
What are the things you need from a patient when they come in for their Evaluation
ID, IC, Script (if they have one), and Medications list (if they have one)
What do you need to get during intake for an Auto patient (other than basic demographic information and what body part/MD)?
PHI, Date of Injury, City/State of accident, Patient's Auto insurance, Claim #, Adjuster (if they know it), Case manager (if they know it), Attorney information
Any other insurance that does not require auth/Auto
Yellow
Deductible
The amount a patient has to pay out of pocket before their insurance will cover anything
What time frame do you need to offer an appointment to a Post-Op (patient who just had surgery) patient?
Within 48 hours unless the MD says otherwise
Do you have to get PHI (personal Health Insurance) from an Auto Patient?
What do you need to get from a new worker's comp patient during intake (other than basic demographic information and body part/MD) ?
Ask for PHI (if they will give it to you)
Date of Injury, Employer, Claim Number, Adjusters info (if they have it), Case Manager's info (if they have it), attorney info (if they have one)
Insurances (besides worker's comp) that require auth
Green
Maximum Out of Pocket
The total dollar amount a patient will pay for health care services within a year
Within what time frame should you be offering an appointment to a commercial patient who is not WC or Post Op
If a commercial insurance patient comes to you mid-treatment with a new script with a new doctor and says they want to add this new body part to their treatment, do you have to create a new case or can you keep the same case?
Same Case
If a worker's comp patient does not have any adjuster or case manger info, what should you try to get?
Their HR representatives information, or their point of contact information