Best Practice
If someone asks you if you are in the office or the call center, what is the approved phrase to say?
What is.. "We are an extension of the office"
What are the 5 w's and what do they mean?
What is..
-Who: Who the patient is, who are you speaking to, who are they trying to see.. etc.
-What: What are they wanting done, what is their ailment, what they need.
-When: When would they like to be seen, when did symptoms begin, when do they need it by, etc.
-Where: Where would they like to be seen, where is their ailment, where are they trying to go, etc.
-Why: How/Why did this issue happen, why are they needing to be seen, why are you sending the message, etc.
When should a callflow be used?
What is:
If you need to get into the patient's chart for ANY reason.
What does a RED yield signal indicate in Epic?
What is..
You must ask and fill in that information or it will prevent you from proceeding.
List 3 RED FLAG words
What is:
-Difficulty breathing
-Chest pains
-Suicidal
-Bleeding more than 5 minutes
-Dizzy
-Confusion
-High/Low BP
-High/Low Blood sugar
On what days should we be posting questions SOLEY to the PODS?
What is.. Monday's and Tuesday's
What is:
-Urgent
-Red flag identified
You would choose this call flow if a patient ONLY wants to verify the date and time of their appt and nothing else.
What is.. Patient Specific Question
List 2 examples of when it is appropriate to swivel to Epic:
What is:
-To enter in new patient information
-To update insurance
-If we are unable to verify insurance in SF
-To enter guarantor notes
-To mark a chart for merge
Name 4 examples of patient safety violations
What is..
-missed red flags
-call avoidance
-improper handling of urgent appts.
-HIPAA violations
-Giving clinical advice
-falsifying information
-Using the wrong patient's chart
-foul language/cursing at a patient
What are 2 ways you can find out if an office is opened or closed?
What is..
1. Check orange banner
2. Check practice times in phone book
How long does the PCP/Office have to respond once a message is sent?
What is..
24-48 hours
What call flow would you choose if a patient wants to cancel an appt within 3 hours of the appt time..
What is late cancellation
Give at least 2 examples of when you would add a guarantor note in Epic..
What is:
-pt gives you insurance but you are unable to verify that insurance or get it to go through
-pt did not have insurance card when calling
-Any RTE Error you are unable to correct
What information are we allowed to give a 3rd party about a patient if they are not on the HIPAA form?
What is..
Only able to answer YES or NO questions, anything specific, we would WT to practice.
If you have an urgent call (Not red flag), and are unable to reach the office during business hours, what steps should you take?
What is..Try to reach practice for at least 20 minutes and if you do not reach someone, contact supervisor and I will reach out to POC
What is the best way to ensure you are able to get the 5 W's needed in your message?
You can use a sticky note, notepad, email, etc.
True or False:
If a patient has not seen a Mercy provider in 3 years, but has been seen in the ED, this counts as seeing a provider in 3 years, so we should schedule as established patient.
What is FALSE! They need to be established with BSMH provider for it to count, otherwise they are "New patient".
What would the insurance filing order be for the following scenario:
Patient is 55 years old, and currently working. She has Anthem Commercial, UHC Medicaid, and also has Medical Mutual through her spouse who is currently working.
What is..
Primary: Anthem Commercial
Secondary: Medical Mutual
Tertiary: UHC Medicaid
(her insurance is first, spouse, then Medicaid)
TRUE or FALSE
*Trick Question, PAY ATTENTION!*
If a caller (who is not a patient) is listed on an outdated HIPAA form, but they are on a current POA form, it is ok to verify appt. information with the caller?
What is TRUE
The POA form is a legal document giving one person the power to act legally on behalf of another person. This document is acceptable in place of a HIPAA form.
True or False:
If you are having a difficult time reaching the office during open business hours, you should transfer to A/H
What is, False!
If you need to send a message to the office about an upcoming appt. you should change the default party from clinical to this..
What is.. change the default from CLINICAL to FRONT OFFICE to ensure the message is directed towards the right staff.
What happens if you don't click the blue "Finish" button or properly cancel a call flow?
What is.. It creates an "open case" that will need to be closed.
What are the steps to merge a patient chart in Epic
What is..
Epic dropdown>Tools>Mark Patient for Merge>fill out information in pop-up for both charts.
What is:
-Check to see if pt. is available to give verbal consent. (Check 3 verifiers with pt.)
-Check to see if caller is a POA