Patient Access Jeopardy

Registration Basics

100

How do you expire an insurance card?

• Go to "Documents" tab
• Click the arrows for the “Dates” section
• Add the termination date in the "Expires On" field
• Click "Accept"

200

How do we confirm which co-pay amount is correct, with and without an ID card, if RTE brought back a different co-pay amount?

Contact the insurance to confirm the co-pay amount.

300

What are the 3 steps you take when the RTE response returns coverage with mismatched patient demographics?

• Check the RTE response to see if it matches the patient’s information
• Confirm with the patient that the coverage is theirs
• If not, inform the patient to contact their insurance to remove it and do not load the coverage

400

What are the 3 steps you take when the patient’s designated PCP in the RTE response does not match?

• Check the patient’s member ID card to confirm the PCP matches the RTE response
• Verify PCP details through payer portals or by calling the insurance company
• If the PCP is incorrect, the patient must contact their insurance to update it

Insurance 101

100

Can a patient with out-of-network coverage be self pay? 

YES, if the patient is being seen for a non-covered benefit.

200

How do you confirm Carelink coverage if RTE is down?

• You can verify eligibility through OnBase or by contacting Carelink directly.
• After confirming patient’s effective dates, update the coverage status to “verified manually” if appropriate.

300

What are the 4 steps to identify an IPA?

• By checking patient’s insurance card.
• Verifying RTE to see if the IPA returned in the coverage response.
• Verifying via payer portal.
• Contacting the insurance directly.

400

How can you determine if a plan is a DSNP (Dual-Eligible Special Needs Plan) when RTE does not indicate it and the patient does not provide an insurance card?

You can utilize:

• Provider portals to check eligibility
• Medicare Plan Finder
• Or simply call the insurance carrier for confirmation

Compliance

100

What is the law that protects patient information?

HIPAA

200

What should be collected at time of service?

Copay

300

Patient must sign this before treatment

Consent for Treatment

400

What is the most important reason accurate registration and identity verification matter?

Patient Safety

Bonus

100

Where can you locate insurance cards?

• Documents tab.
• Media tab in the patient’s chart.
• Certain payer portals, if available.

200

Are RAS able to give patients refunds?

Yes, ONLY if it is a same day service and a manager is onsite.

300

If a patient presents with an Out-of-State Medicaid coverage, how do we load this in Epic?

Out-of-state Medicaid coverage is only loaded for patients seen in the Emergency Center, not in outpatient settings.

400

What are the seven steps to load coverage when no plan exists in Epic?

• Get the insurance card
• Identify the payer
• Confirm the member ID
• Check the portal or call to verify if UHS is in network
• Load as Commercial Generic
• Confirm the claims address
• Enter coverage effective dates