Reggie
What items does the patient need to verify to be able to speak to them?
DOB, last 4 of SSN, policy #, address (NOT UNDER EMERGENCY CONTACT)
Name 3 things you can find in VIA.
what clinic they visited, coinsurance, modality, pt demographics, notes that were left, billed amount, estimated allowable
What is PFE?
Patient Financial Evaluation
This many queues are in CISCO Finesse...
What are 5 queues?
Who processes adjustments/MCBD?
Angelica & Barbara
Where can you find the clinical TM's in RNG?
Clicking on the blue hyperlink of the facility # under facility TM's
What do we send to the lockbox address?
We send patient/payor payments and claim denials
What is COB?
Coordination of Benefits
What are some words we cannot tell the patient?
Disregard the bill, bad debt, it will be adjusted
What makes a claim bad debt?
If it has been more than 121 days of billing and 5 statements have been sent out
Who are the clinical TM's we reach out to?
FA, SW, IC, Charge Nurse, AA, PCT
What can you find in the electronic remittance advice?
Patient Responsibility, How much ins paid, who we billed, claim received, DOS, CPT Codes, why claim denied
What is VIA?
View Invoice Account
Where do we process a CC payment?
What is Forte?
What makes a claim untimely?
If we transferred down to the patient 11 months after the latest remit
Where can we find the CMS 2728 form?
What is RNG under documents and under Patient Consents and Medicare Forms
What does a voided claim mean? (RED)
Voided claim is when it was reprocessed and corrected
What is EGHP?
Employer Group Health Plan
What do we use if we cannot find the check in SPARC of the patient?
We use payment finder to locate the check.
When should we request a transfer up?
When insurance paid at 100% leaving no pt responsibility (reference ERA)
Where do you set coverage for a PFE?
Go in RNG under Coverage History and then click Edit
What is the difference between research cash and unallocated?
Unallocated is insurance and patient payments. Research cash is from voided claims.
What is PAFR?
Patient Authorization & Financial Responsibility
What is the waiting period for COB?
30 months with a 3 month waiting period for in-center, no 3 month waiting period for PD within the first 90 days
What is the difference between the MCBD/Adjustment Log?
When Medicare is primary it goes to MCBD (Barbara, Debbie to approve) and other primary go on the Adjustment log (Angelica, Norman to approve)