Medicare/Medicaid
Patient comes into store with Medicare insurance card show she has Part A and she is looking to get a Nebulizer machine. How do we assist?
The patient would not be able to get Neb through Medicare as Part A only covers hospital stays. There would be an OOP cost and patient would have to sign an ABN.
A family member of a Hospice patient is calling in to order more tanks. What is our first step to help?
Direct them to call the Hospice nurse. We are not allowed to touch anything Hospice related. EVER.
What must a patient have to get a POC from our company?
They must be actively renting Oxygen from us. Not only that but they have to have portability through us as well.
You are to notify both the referral and patient aware but also attempt to assist with finding someone who can take the order.
True or False
30 day mask exchange program is for both New PAP setups and RePAP patients.
FALSE.
Only for New PAP setups.
True or False
Patient who has Medicaid is looking to replace their walker that they got 4 years ago. All we would need is a new RX and notes.
Correct.
Medicaid will cover a same or similar item once every 3 yrs.
True or False
If a patient has Synapse insurance pays 100%
TRUE
Synapse is a 3rd party billing company with UHC. So the patient will NEVER have a bill with us directly, and if they owe anything it will come from Synapse directly.
What is the difference between
POC VS TOC
POC - Portable Oxygen Concentrator (Purse O2)
TOC - Travel Oxygen Concentrator (Travel O2 w/ wheels like a suitcase)
Do we obtain emergency contact numbers for all referrals?
Yes. All information is collected at the time of setup in the patient documentation.
Patient comes in stating their PAP machine they rec'v last year is not working. How do we take care of them?
We need to check when the patient got the machine and then verify if they are still under warranty.
If they they are still renting and under warranty we can send the machine back ResMed and provide a loaner at no cost to the patient.
If the patient is no longer renting and need to get a loaner machine it would be $75 for the loaner per month. If the machine is no longer in the warranty it would cost $75 to rent the loaner and $25 to send the machine off. (This does NOT include any costs that ResMed will quote to fix the machine)
If a patient is Medicare and they are still ACTIVELY renting the machine we are to exchange for a new machine no matter what.
What are the 4 parts of Medicare?
Part A covers in Hospital stays ONLY
Part B covers DME
Part C is for Medicare advantage plans
Part D is for Prescription coverage
Humana patient comes in needs to pick up equipment. However, when we POD the order to service them it keeps kicking back. How do we figure out and fix this issue?
When the order kicks back it will show 2.5 OTL kick back. We need to check the "Note" section in the patient account for a message as to when it is kicking back. Usually, it is indicating that a DC date needs to be added or that we need to add a waiver down in the custom fields section to say "Scheduled as agreed upon with member." Then re-POD it.
Patient calls in to order tanks. What do we need to look for when placing the order?
1. Make sure Insurance is valid
2. Patient is ACTIVELY billing for Oxygen
3. Make sure we have valid address/number on file
How are patients informed of their finacial obligations prior to service?
Customer service speaks to patients prior to delivery and payment options are discussed such as autopay that is ALWAYS needed.
Patient comes into the store stating they are having issues with their pressure is too much and need it adjusted. What can we change the settings to?
We CANNOT change any settings without an updated RX stating to change it and what to change it to.
Where do we check same or similar history for Medicaid?
Tricare, Medicaid and Tricare for Life.
*Other insurances will say they cover it but we are not able to bill them due to their reimbursement rate*
What are the 3 SATS needed to get setup with Oxygen?
Room air at rest
Room air with exertion (88% or lower)
Recovery O2 SATS on O2 with liter flow
EX:
Room air at rest 95%
Room air with exertion 87%
Recovery O2 sat 95 w/ 3 liters
What is our on-call process?
All calls that come in after hours will roll to an answering service. Staff is assigned to cover any orders or patient calls that come in from the answering service.
A patient who is brand new to us is wanting to get PAP supplies. How do we help them?
We need to check to see if they are already in the system. If they are not, then we need to give them a list of what is needed to go through insurance and even OOP.
*Prescription
*Sleep Study (only through insurance)
*CUB notes (only going through insurance)
*Demo info to create account
Patient with Medicare is wanting to bill Medicare for a wheelchair when they got one last year. How do we help them?
We need to explain the Medicare coverage timeframe. However, if they still wish to try to bill Medicare and we have the proper docs, the patient will need to sign an ABN acknowledging they would be responsible for the cost if it gets denied.
If a patient is calling to get their information faxed over to a different company, what do we need to complete this request?
We need a release of records filled out and signed by the patient.
When a patient gets setup with Oxygen how long do they have to qualify for a POC?
Patient new to Oxygen has 90 days to get setup with a POC.
It is an AdaptHealth policy due to the reimbursement rate.
If a patient has an infectious disease, how are you notified?
What is the difference between the PAP machine and the BiPAP machine? How do you qualify for them?
PAP - Positive Air Pressure means air is being pushed into the body. You have to have a sleep study in-lab or at home.
BiPAP - Bi-Level means the device works with their breathing giving them a pressure when they inhale and then a second pressure when they exhale. Usually, you have an in-lab study showing you tried to PAP but failed to control your AHI levels and were successful with the BiPAP.