Billing Basics
The term BPI stands for this.
What is Bad Patient Information (Insurance needs updating).
Name the ways that price estimates are sent to patients.
What is emails and text message.
True or false: We can submit prior auth for a patient whose sample we have not yet received.
False - we have to have a patient's sample on file to begin the prior auth process.
Where do we update a patient's insurance information?
Navigate to the Update Insurance support action, make the needed changes in eligibility and then choose update website and complete the insurance update.
In your own words, explain the Myriad Access Program.
Myriad's financial options patients can explore to address patient concerns regarding cost of testing (i.e. financial assistance, payment plans, and Myriad Promise).
These are the four main components that make up a cost estimate.
What is the Deductible, Co-Pay, Co-Insurance and Other Patient Responsibility
True or false: PAs can see if a patient has viewed their cost estimate.
True - the patient's "Estimates" tab on the test record will show if the patient viewed their cost estimate and when they did so.
If prior authorization is approved, what does this mean?
This means that insurance will allow us to file a claim for the patient's test. This does not guarantee that the patient will have a $0 out of pocket cost or that the test will be applied to their benefit plan.
True or false: We can update billing information after a patient's test has completed.
False - once a patient's test completes we are unable to make billing changes to their account.
What are the requirements for financial assistance?
Patient's household size and income.
These are the three billing types
What are Bill to Insurance, Self pay and Consignment
If a patient pre-qualifies for financial assistance, their estimate will be no more than this.
What is $295.
Will a patient's estimate change based on prior authorization approval?
No, the estimates are calculated assuming that prior auth is approved. The estimate amount does not change if prior auth is denied.
If a patient's insurance information is on file and the clinic calls to convert the order to consignment, describe the necessary steps.
Use the support action "Convert to Consignment" and include your SC notes.
Describe Myriad Promise in your own words.
If a patient is concerned about the cost of testing and has been offered financial assistance and payment plans, our billing team promises to work with our patients to find an affordable cost of testing. Once the patient receives their final invoice, they can call our SLC Billing Patient Advocates who will work the patient to ensure their cost is something they are comfortable with.
Explain OPR in your own words
What would you tell a patient if they received a high out of pocket price estimate?
Explain why the patient's estimate is high (unmet deductible, non-covered benefit, etc.), and offer financial options (FA, SPP, payment plans, MP).
Will we receive a patient's prior authorization determination prior to test completion?
It is difficult to determine when we will receive a response regarding prior authorization. Typically these calls with patients include reviewing our financial options and confirming that we will honor the patient's price estimate.
If you are unable to update a patients insurance information, what are some resources that you could use?
Check with your CS team or use the BET channel for troubleshooting.
True or false: A patient's bill could be higher than their price estimate.
False - our policy is to stand by our price estimates. Their estimate amount should be the most that they can expect to pay out of pocket.
What actions should we take for an email inquiry that requires both Prenatal CS and Prenatal Billing assistance?
Assist the patient with the CS actions, clone the email ticket, and assign the original ticket to the Prenatal Billing team to address.
Describe why it is important to discuss the cost estimate as detailed in the claims ID page, rather than based on the "patient cost" section on /billing?
The /billing page does not always take into account if the patient qualified for financial assistance. The claims ID page may indicate that the patient's financial responsibility is actually lower.
Describe the steps you would take if an insurance company calls with a prior authorization determination for a patient.
If the call is regarding a single patient, document the notes in your SC ticket. Our billing team receives this information via fax so the call is just a courtesy. If the call is regarding more than one patient, transfer the call to Revenue Ops Receptionist in Purecloud.
What are the steps to update a patient's insurance information?
Confirm subscriber information (member ID, full name, and DOB), query and save the benefits, then select "Choose Insurance".
If a patient is inquiring when they will receive their bill and their test has already completed, how should the call be addressed?
Warm transfer the call to the Billing Patient Advocate team for additional invoice information.