Insurance
If you are verifying coverage on RTE and the patient is not assigned to HealthPoint, what does the hard stop at check-in require you to do?
Get the PCP switch form signed and mark it as "received" in Epic.
What is a FA case?
Financial Assistance Case
What is standard work?
In lean manufacturing, standardized work is a system for documenting the most efficient and effective methods for performing tasks, ensuring consistency and minimizing waste. It involves defining the precise steps, sequence, and timing for each process, promoting safety, quality, and continuous improvement.
Who am I? I'm uninsured and fled from my home country to the US on my own for safety.
An Asylum Seeker
What is the correct filing order if someone has Medicare and a private commercial plan?
Commercial/private is primary and Medicare is Secondary, or it can depend on MSPQ response.
How can I delete a coverage if entered by mistake or in duplicate?
Add in the effective dates 01-01-1900 and coverage to be deleted to have it sent to the background.
Who can apply for sliding scale?
Everyone - Even if they have insurance!
What is a Good Faith Estimate - and who is required to get one?
A good faith estimate, or "Jiffy" is an estimate we must provide to patients due to the law "No Surprises Act"! Patients who are not insured are required by law to receive one.
I want to update my email so I can log into MyChart, what is required of me at the front desk?
Identification like an insurance card or photo ID. We cannot update patient information like this on a patient's chart without proving that they are actually the patient.
Trick question! I have active Medicare, but I also have a Medicare Advantage plan. What do I need to attach to encounter when checking in?
Only the Medicare Advantage plan! Do not also attach Medicare Part A & B.
What is the Insurance Matrix?
A tool to see what insurances we accept.
What does a patient need to bring in to apply for the Sliding Scale?
Any accepted form of proof of income, you can check the full list at any time by reviewing the back of the sliding scale application.
What is a STAT call? And what do I do if I answer a phone and it's a STAT call? What shouldn't I do?
You should always identify yourself and site location, get the MRN, and get your clinic's nurse or MAS as soon as possible. Never hang up on the patient, or do a blind transfer.
What is the purpose of using the Welcome tablets? Are there any advantages?
It's paperless and requires less data entry from the PSR's.
Let's say a patient is seeing our acupuncturist, but they have Molina Apple Health. Should we attach the insurance? What other important conversations should I have with the patient?
No, you should NOT attach the insurance - Molina doesn't cover acupuncture. A waiver is not required, and the patient should have a Sliding Scale discount active and on file to get a better price.
Do we need to upload insurance cards, patient photo ID? Why?
Yes - Because sometimes we need to refer to these items to bill the patient or their insurance. It also helps us avoid creating duplicate charts.
If a patient wants a one-day discount, what must we obtain in their chart? How often can we do this? Can we save it for later?
The registration form with their approx monthly income, household size and patient signature. Patient's can qualify for a one day discount once a year, unfortunately we cannot save it for a rainy day.
What is a 123 switch form?
123 switch form: a form that patients use to switch to a Medicaid plan we accept, such as Molina, Coordinated Care, or CHPW and get off a plan we’re not contracted with like United or Wellpoint.
If they are not willing to switch and have an Apple Health plan we’re not contracted with, they must find a new doctor.
Can we accept new adult patients in dental? What criteria do they have to meet?
Yes, if they are already established in Medical, have a Dental insurance we accept or be uninsured, and meet one of these criteria:
Refugees
Patients who are pregnant
Patients with a diagnosis of hypertension (high blood pressure)
Diabetic patients
Patients who are receiving SUD care (suboxone)
Patients with CHPW Medicare
When should you use the Payor Returned Section and why do we do this?
When the patient information on the portal or RTE is different than what we have on file for the patient. We do this so a claim can get processed and not stuck in a workqueue. BUT MAKE SURE this is the correct patient, if you have any doubts, please confirm coverage with the patient.
Can someone with Original Medicare only see a ND/Naturopath provider?
No, Original Medicare does not cover visits with Naturopathic Providers.
Can we leave cases and trackers pending or in progress? Yes or no, and why?
No, they will fall into a workqueue if not completed. Patients cannot receive their discounts or even be billed until completed.
What is a PCP switch form?
Patients use these forms to change the clinic and primary care provider (PCP) they are assigned to. For example: if a patient has Molina Apple Health but they are assigned to SeaMar, the patient must sign the PCP switch form. We MUST have this done to process referrals, prescribe medications and get paid for the visit.
How do you verify a patient is who they say they are - 5 Point Check - to avoid duplicate charts
Verify first name, last name, date of birth, address and phone number
If a patient has Medicare, what portal should I be using? What should I be collecting and scanning into chart?
Noridian! And you want to scan the patient's insurance card and photo ID