PQI Process
Accounts are approved for financial assistance via PQI based on the patient's __________ and _________.
Household size (aka family size) and income.
What is a pool?
A pool is a collection of accounts grouped together by criteria.
At what point can a patient apply for Hardship?
Patient can apply for Hardship FA after formal application was denied and if the patient is still expressing financial difficulty.
What is our monthly abandonment rate goal?
At or below 5%
You have a call stuck in Contact Pro. What do you do first?
After entering the fields for family size, income, source, and program, what must you click next?
The SAVE icon.
Payment plans cannot be set up for less than $____ per month
$25 per month
What is evaluated to assess the patient's eligibility?
The patient's debt to income ratio.
If expenses are greater or equal to 75% of income, the patient will qualify for Hardship.
Who do you email for Self Pay FA adjustments?
MelvilleCashTeam@northwell.edu
Mrs. Jones calls to apply for FA. You take her through the PQI process and determine she is NOT eligible. Mrs. Jones tells you she'll set up a payment plan with FS. An hour later, she calls back and says she gave the wrong income last time and she wants to go through PQI again to see if she's eligible now. What do you do?
Mrs. Jones' application would need to go FORMAL at this point so she can provide documentation to support the numbers she is giving. Please refer her to apply online to provide her income documents.
Actual FPL must be less than ____%, set balance must be less than $______, and TU variance must be less than ____ to approve PQI.
500% , $50K, and 50.
What 3 websites are directly linked from HCx for your convenience?
HP24, PAI (Medeanalytics), and ePaces.
After determining that the patient qualifies for a balance reduction, what must you click to finalize the application?
The "Approve App" button
Children can qualify for coverage under Child Health Plus up to what birthday?
Mr. Smith calls and states he has a bill from a recent ER visit. He had been in a car accident. You review the host system and see No Fault information was never obtained. What do you do?
Obtain NF claim information from patient. All efforts to receive payment from insurance must be exhausted before we can pursue FA.
What will happen when you click on New Payment to open HP24?
There will be a brief delay while HP24 loads. (Don't panic, the system is working, just be patient)
Record history now lasts for _______.
The full day. It also adds helpful info, like the exact time you viewed the account.
The patient wants to make a payment. What do you click and where is it?
Left hand toolbar, under Account Information, click on New Payment.
Name two things Emergency Medicaid covers
ED visits, emergency admissions, chemotherapy, radiation therapy, cancer related surgery, dialysis.
Mr. Marshall calls on behalf of his daughter, Breanna (a minor). His ex-wife is listed as Breanna's guarantor. He claims he pays the bills and wants to discuss Breanna's bill and financial assistance options. What do you do?
Advise Mr. Marshall you cannot discuss this account with him as he is not listed as Breanna's guarantor. If he wishes to discuss the account, he'll need to call with his ex-wife on the line to provide verbal authorization.
What do you do if you see a date under the "Atty" (attorney) column on an account?
This indicates that this account has gone to legal. This account cannot be included in PQI. This must go formal.
What goes in the PROGRAM box (it's a dropdown) when updating the account status for a Medicaid app?
Marketplace or DSS
Finally, you need to document the account. What do you click and where is it?
Left hand toolbar, under Financial Assistance Admin, click Financial Assistance Notes. Then on the right hand toolbar, click Add Note.
To be eligible for Medicaid Spend Down program, patient must be over income for regular Medicaid AND.... (Name 2 more criteria)
Under 21, parent of a child under 21, over 65 years old, certified blind/disabled, or pregnant.
Mrs. Thomas calls to discuss account# 123456789001. It's showing in the host system, but not in Artiva. Patient wants to proceed with Financial Assistance. What do you do?
Email Tari Deliberti and request the account be pushed into Artiva so you can proceed with FA screening. Advise patient you will call them back when you are able to proceed, and set yourself an Outlook reminder to follow up.