INSURANCE
What should you do if a patient gives you an insurance card, same carrier but different ID/Group number?
Treat it as if it was a new insurance. Add a new Insurance and and uncheck the old insurance.
***DO NOT CHANGE THE INS ID NUMBERS***
by doing so it affects claims that are in process.
Also, patient MUST fill out a new Registration Form.
When is the co-pay due?
Copays are due at time of service.
Who needs to complete a Registration Form?
All New Patients, Once a year (anniversary date from the last time it was completed) AND
Anytime they have any changes ie. new insurance cards, new address, name change
What do you look for when batching out?
Verifying that your cash, checks, credit cards match the reports and that you don't have unapplied funds.
And verify that you did not collect money for any other OAZ provider/companyWhat is the Global Surgical package?
The global surgical package is a single payment for all care associated with a surgical procedure. The payment is based on three phases of a surgical procedure. 1. Preoperative evaluation. 2. Intra-operative procedure. 3. Postoperative care for either zero (0), ten (10), or ninety (90) days. **Other names for the Global Surgical Package include: Postoperative Period, Global Period, Global Services, Surgical Period, Global package and Global Surgery.
If a Child has dual insurance, how do you determine which one is primary?
Primary insurance will be which ever parent's birth month is first in the year.
Do we collect co-pays for pre-op appointments?
Yes. Unless, the pre-op appointment is scheduled the day before surgery.
True or False?
When entering the address in GE, it is OK to use symbols (., #, -)
FALSE
How do you check if you have unapplied funds?
-Go to transaction management (the candy)
-Look for your batch
-Verify the unapplied column is 0.00
What is a DME?
Durable Medical Equipment. Any equipment that provides therapeutic benefits to a patient in need because of a certain medical condition and/or illness.
When Medicare comes back as "Inactive" what steps do you follow to ensure it is truly inactive?
Check the Insurance Eligibility Notes box (double click) if it notes there's an advantage plan proceed to the web. If the Web shows an HMO plan the patient doesn't have a "medicare" they have a replacement plan.
*click the inactive coverage box
What information needs to be verified to avoid a claim denial?
Insurance Info/ID, Name , DOB, Insured.
In the Insurance Tab what needs to be updated/verified?
-Correct Insurance is selected
-Ins ID number matches the card
-Group Number is entered
-Insured (policy holder is entered)
What metrics are we currently capturing?
Co-pay collections
Balance collections
Errors captured at check in
What is the difference between a Referral and an Auth?
The referral is written document and an Auth is a number generated by the insurance at the PCP's request.
What lines of business for Allwell can we see?
Does Ambetter need a referral?
AZPCP only. We cannot see any Direct or Equality patients.
Ambetter patient's do not need a referral, but do require an Auth. An auth must be submitted at the time of chart prep.
What is the difference between a co-pay, Co-insurance, and Deductible?
Copays are similar to deductibles, in that it is usually a fixed amount of money you have to pay each time you need to use your insurance plan. Coinsurance is the percentage of a covered health care service. ex. (pt. is responsible for 20% of cost after deductible is met)
If the patient is not the policy holder what information do you need to obtain?
-Insured's Name
-Insured's DOB
-Insured's relation to patient
-Insured's Social Security Number
What is the chain of command?
It's a hierarchy of reporting relationships to establish accountability. Front Office Staff---> Front Office Lead---> Management
What do the following Acronyms stand for?
HIPPA
DME
MRP
Health Information Portability and Accountability Act
Durable Medical Equipment
Medical Replacement Plan
As of 4/01/18 we will be participating in a new network. Can you tell me what it is called and if we need a referral?
Cigna SureFit Plan for Maricopa County. This plan is part of the Arizona Care Network
Yes a referral is required ( must be submitted to Cigna by PCP)
How do you post a Bad adjustment?
Post the payment, then post a negative adjustment for the same amount.
What tabs are you completing when you are entering the Registration info?
Name what you are completing in each tab.
Patient- Demos
Guarantor- If the patient is a child complete name address, relationship, DOB..If patient select "GUARANTOR SAME AS PATIENT" you should never leave this as "no guarantor selected'
Additional- Make sure you complete the signature lines. ( this affects billing)
Insurance- Ins info / insured info
Contacts- enter pharmacy (always add before the patient gets roomed) and emergency contact.
Financial- Check for balances and collect.
What information is needed in the case?
If you have an auth number , where do you include it?
Which takes precedent the number of Auths or number of office visits?
OV/Insurance Type/Body part/Dates good through/OV allowed/initials
The auth needs to be included in the case/
number of Auths trumps the number office visits when creating a case.
What is the standard work flow to check in an established patient?
patient walks in-> Greet patient-> Put in Registration status-> (Established patient) Ask for Ins card-> visual verify ins info-> update if needed-> return cards to pt->collect copay-> take pic if needed ask pt to have a seat.