Week 2 Flashcards
If a new patient calls to schedule, what should you do?
take the time to outline policies (payment, scheduling and cancellations)
if possible, verify the insurance benefits before the aptient arrives for their first appointment
request for treatment
usually patient initiates by phone
ask them to arrive 15-20 minutes before the appointment
when the patient requests treatment, what are some things you should go over with them?
payment scheduling cancellations have patient come early online forms welcome packet
welcome packet guidelines
welcome letter patient financial respsonsibility letter patient information form medical and health history forms informed consent form HIPPA privacy policy and acknoledgements financial hardship policy and application
written and printed policies available for patient guidelines
medical and health history forms (necessary)
informed consent
HIPPA privacy policy form and acknowledgements
what do you need to do to establish patient financial responsibility?
insurance information obtained (copy card front and back)
insurance verification (phone or internet)
financial policy explained
if insurance hasn’t been verified, what needs to happen?
DC may have to give patient an estimate of medical fees
medicare has the ABN form
ABN form
advanced benefitiary notice or waiver of liability
what should you require from patients during the inital visit?
copy of insurance card (front and back)
verification
referrals or pre-authorization (if necessary)
have patient sign forms (request for records/release, assignment of benefits)
you already verified the person’s insurance, do you still need a copy of their insurance card?
yes
what else do you need to do when you get their insurance card?
ask for a valid form of ID
what questions should you ask of patients who are established?
has any info changed since our last visit?
has insurance changed since last visit?
have you had any changes in your health history?
why do you need to ask all the questions to the established patients?
to verify if information has changed
see if their condition has changed
treatment plan requirements
diagnosis named what the treatment plan will be how many visits how long the plan is expected outcome and how you will measure it
date of onset is when for medicare?
the first date you saw the patient
documentation needed after appointment
document what happened
complete a fee slip (superbill)
collect any money owed from the patient
remin patient of next appointment (write down on card or have them write it down)
EOB/remittance
a form sent to the patient (proider) stating what has been paid by insurance and what patient owes
how do you get a reimbursement?
service must be
covered under payer’s health benefit plan
medically necessary according to apyer
appropriately documented in patient’s medical record
define medically necessary services
have been established as safe and effective
are consistent with symptoms or diagnosis
are necessary and consistent with generally accepted medical practices
are furnished at the most appropriate, safe and effective level
paradigm shift
cost sharing
patient needs to understand that most insurances will not pay 100% of the bill
patient needs to understand they need to accept responsibility for their portion of the bill
5 most common features of cost sharing
deductible co-pay co-insurance elimination/waiting periods out of pocket max
flow chart for payment
submit a claim is claim paid (follow up in 30 days if not, if yes, match EOB) is payment correct? (have policy in place if no) follow up send to collections rejected or denied? file and appeal appeal again (if you can) write off disallowed amount
if there is overpayment, what do you do? underpayment?
overpay- pay back ASAP
underpay- appeal
how often do you follow up on payments?
at least every 30 days
run reports in 30, 60. 90 day intervals
try to work out regular payments with patient before you send to collections
send to collections
should be outlined in payment policy and not an emotional decision
pay for a company to collect money for you (50% of what is collected)
disallowed amount
insurance adjusted amount or network savings
then balance bill to patient
essential benefits list
ambulatory patient services
emergency services
hospitalizations
maternity and newborn care
mental health and addiction treatment
prescription drugs
rehabilitative and habilitative services and devices
lab services
preventative and wellness services and chronic disease management
pediatric services, including oral and vision care
