FACULTY PRACTICE PLAN LIFE OF A CHARGE PROCESS
Function: Patient Check In
Task(s): Greet the Patient
Perform re-scheduling functions when necessary
Demographic Verification
Insurance Verification
Record HIPAA Privacy Standard (COA) information
Collection of Co-payment
Collection of Previous Patient Balance(s) as needed
Posting Time of Service Payments on Account
Receipt Processing
Obtain signatures as needed
Measurement/Report: Electronic and Paper Claim Edit Report detailing failed insurance claims due to patient demographic information (PBI/REPORTS DASHBOARD/LAMONT-CLAIM EDIT REPORT)
Insurance Denial Report from PM system detailing insurance denials due to incorrect patient demographic information (PBI/REPORTS DASHBOARD/LAMONT-REJECTION DETAIL)
Bad Address FSC Report from PM system detailing return address mail (PBI/TES DAILY REPORTS DASHBOARD/PRE-COLLECTIONS REPORTS SUB DASHBOARD/PRE COLLECTIONS REPORT {looking at BAD Address FSC})
Standard: =/<2% Electronic and Paper Claim Edits
=/<2% Insurance Denials due to missing/incorrect demographic information
=/>95% Collection of Co-payments
=/>95% Collection of Previous Balances as identified from CBO and noted on accounts prior to the visit
=/<2% Returned patient statements
Policy and Procedure
Purpose: To obtain personal and financial information from patients in an efficient and courteous manner. Ensure timely payment from third parties by complying with all registration standards and billing requirements imposed by the third parties and regulatory agencies. Minimize bad debt through the timely identification, communication and proactive management of patients with inadequate insurance coverage. Safeguard the handling of cash.
Policy: To adhere to an “optimal patient service” mission whereby the patient is greeted respectfully and expediently. To ensure that all Patient/Responsible Party demographic information on file is accurate. To safeguard the acceptance and collection of co-payments and patient balances (if necessary) due prior to exam.
Procedure:
1. The front desk staff member will be positioned so he/she is always facing the reception area.
2. The front desk staff member will call the patient to the check in area to begin the patient check in process.
3. The front desk staff member will indicate the patient as ARRIVED on the PM system and the RowanMedicine Time Reception list. During this “Check In” process, the eligibility will be reviewed and the Appointment Data Form (ADF) will be reviewed for all required billing information related to this specific appointment, billing provider, primary FSC, referral, if required.
4. The front desk staff member will confirm the patient appointment by accessing the daily schedule on the PM system. The front desk person will greet the patient and verify the appointment time.
NEW PATIENT
1. If the practice submits a New Patient Packet to the patient prior to the exam, the front desk staff member will review the patient chart to ensure that the HIPAA Privacy Practices for Protected Health Information documents, the Health History Form (if applicable) have been received via mail or via the patient portal in the EMR. If the patient elected not to complete the forms and brings to the practice or if the practice does not utilize the New Patient Packet, the front desk staff person will present the patient with the forms and instruct the patient to complete the documents.
2. The front desk staff member will review the PATIENT INFORMATION FORM, the HIPAA Privacy Practices for Protected Health Information documents, the Health History Form (if applicable) for completeness. Any missing or illegible information will be obtained from the patient immediately.
3. The front desk staff member will give the patient the face sheet for review, and ask them to provide any additional information or changes to current information, and to sign it verifying said information changes. NOTE: The patient email is crucial for all current initiatives. Additionally, the patient will sign on the face sheet that they have reviewed the HIPAA Privacy Practices for Protected Health Information handout, for permission for Patient Reminders Call Preference; Health Information Call Preference, NJ Vaccination Registry, National Medication Coordination,, Research/Clinical Trials, Rowan Marketing Coordination and Foundation. (Facesheet must be signed for every visit.)
Definitions:
· Patient Reminder Call – This is for appointment and health reminders, with the option of Cell Phone, Home Phone, Text or Email.
· Health Information Call – This is for things like lab results and the phone preference
· NJ Vaccination Registry – State for all immunizations, if the patient qualifies for Vaccines for Children program they CANNOT opt out.
· National Medication Coordination – This is permission to reconcile the patient’s medications with the national database.
· Research Clinical Trials – This is permission to be contacted if the patient meets a specific criteria to participate in research or a clinical trial.
· Rowan Marketing Coordination – permission to receive communications from the marketing department for things like workshops or fairs.
· Foundation – permission to be contacted for fundraising.
Reminder: If a patient Opts-Out of the Immunization Registry, send a flag from the patient’s chart to the IST Triage folder with the details.
4. The front desk person will ask the patient for his/her insurance cards and state driver’s license for photo identification. The insurance cards and driver’s license will be scanned into the EMR. If the patient presents more than one insurance card, the front desk staff member will ask the patient which insurance is primary. A scanned image of the insurance card(s) (front & back) will be placed in the patient EMR chart along with the other documents in accordance to the Scanning and Indexing Documents Policy.
5. After verifying the patient’s insurance cards with the PM system, the patient’s eligibility should be verified/reviewed. This can be accomplished from the Appointment Manager during Check In.
STEPS:
Complete Registrations - update and/or review.
Next screen is the Eligibility List
Verify Primary FSC is Status is Active
Verify Outcome is Auto Eligible or Eligible
If Outcome is Patient MisMatch, select the Results button to compare the data returned from the insurance company to the registration in CB. Use check boxes to accept any changes.
If not eligible, update the insurance information.
ADF:
Make sure Billing Provider is Correct
If Billing FSC different than registration, validate correct
If Referral or Prior Auth, make sure attached
6. The medical chart will be reviewed for previous records. If the patient medical records have not been received, the patient will be asked whether he/she arranged to have the records sent prior to the visit. If the patient indicates that he/she did not arrange to have the records sent, then the front desk staff person will have the patient complete a release of medical records for the previous/referring physician and obtain the records for any follow up visits. If the patient indicates that he/she did arrange to have the records sent and they have not been received the front desk staff person will contact the patient’s referring provider’s office to obtain records. Once received, the records should be scanned into the patient’s chart in accordance to the Scanning and Indexing Documents Policy. If the records are received electronically, please open a ticket with IRT by emailing .
7. If the visit is with the patient’s Primary Care Physician, the front desk staff member will verify whether or not the appropriate Primary Care Physician or Primary Care Physician Group name appears on the front of the card and within the Eligibility module within the PM System. If the PCP or PCP group name is not indicated or is not the physician or physician group with whom the patient has the appointment, the staff will assist the patient with updating their PCP. Patient will be notified that he/she will be responsible for services and will be self-pay, with the exception of all Medicaid and Managed Medicaid patients. Medicaid patients may not be seen without the proper PCP identified. This communication should be documented in the appointments billing comments.
8. If the visit is with a Specialty Care Physician, the front desk staff member will ensure that a referral has been received and documented by the authorization staff. If no referral form exists, the front desk staff person will ask the patient if he/she has the hard copy referral. If the patient indicates they do not have the hard copy referral form, the patient will be asked to call the primary care physician and request that the referral be faxed immediately. The referral and authorization information must be documented on the Appointment Data Form. If the referral is not obtained, the patient’s appointment will be rescheduled.
9. The front desk staff member will collect the co-payment for the visit, if appropriate, and provide the patient with a receipt. The amount collected and payment type will be indicated on the payment journal (see attached). Please write the patient MR# on all checks received. If the patient refuses to pay, it will be indicated on the face sheet. If the patient wished to pay on a current balance, then follow the process indicated in the RowanMedine Processing Payments Received at Clinical Locations Policy.
10. The front desk staff member will enter the following information in the appropriate format into the PM system:
a. Patient, Responsible Party and Subscriber Social Security Number - If the Social Security Number is not known or refused, the following SS#’s will be entered as an identifier:
· 000-00-0000 – newborn or child without a SS#
· 333-33-3333 – patient does not know
· 999-99-9999 – patient refused
b. Patient, Responsible Party and Subscriber last name, first name and middle initial
c. Patient, Responsible Party and Subscriber street, city, state and zip code
d. Patient E-mail address – if the patient refuses to provide an email or does not have an email address the following should be entered:
· Refused – patient refuses to provide an email address
· None – patient does not have an email address
e. Patient, Responsible Party and Subscriber home and work telephone number – if the home telephone number is not known or refused, the following telephone numbers will be entered as an identifier:
· 000-000-0000 – no telephone
· 333-333-3333 – patient does not know
· 444-444-4444 – phone disconnected
· 999-999-9999 – patient refused
f. Patient, Responsible Party and Subscriber date of birth – if the date of birth is not known or refused, the following date of birth will be entered as an identifier:
· 01/01/1880 – patient received emergent or hospital care, data not collected at visit, patient unable to give, or patient does not know
· 01/01/1882 – patient refused
g. Patient, Responsible Party and Subscriber sex
h. Patient, Responsible Party and Subscriber Employer
i. Patient Primary Care Physician Name and Telephone Number
j. Patient Primary Insurance information: Insurance Company Name, Address, Telephone Number, Identification Number and Group Number
k. Patient Primary Insurance effective date
· If the insurance does not exist in the system, select insurance named Commercial FSC to finish check in process and complete the necessary follow up FSC questions or commercial insurance.
l. Patient Secondary Insurance information: Insurance Company Name, Address, Telephone Number, Identification Number and Group Number
m. Patient Secondary Insurance effective date
n. Patient Tertiary Insurance information: Insurance Company Name, Address, Telephone Number, Identification Number and Group Number
o. Patient Tertiary Insurance effective date
p. Patient Signature on File Information
q. Patient Emergency Contact, Relationship to Patient and Telephone Number
r. Patient Email Address
s. Patient Insurance Co-payment information
t. HIPAA Privacy Standard Information (COA)– the information will be recorded as follows in the designated area in the PM system:
· Line #1: “XX/XX/XXXX”-Enter date the patient was given the HIPAA Privacy Information Packet
· Line #2: “XX/XX/XXXX”-Enter date the patient signed the face sheet acknowledging the Patient Privacy documents
11. The front desk staff member will post the co-payment (on account) to the PM system and generate a receipt for the patient and a receipt to attach to the Payment Journal.
12. The front desk staff member will instruct the patient to be seated in the reception area.
13. All registration documents will be filed appropriately.
14. The front desk staff member will place the face sheet in the designated area to alert the clinical staff that the patient has been checked in and is ready to be treated. The patient information will be placed in appointment order to comply with patient satisfaction standards.
ESTABLISHED PATIENT
1. If the patient is established, the front desk staff person will instruct the patient to verify the demographic and insurance information on the PATIENT FACE SHEET. The front desk staff person will further request that the patient manually indicate any changes in the information. Lastly, the front desk staff person will ask the patient to sign and date the face sheet to indicate he/she has reviewed the information, indicated any updates, acknowledges the HIPAA Certification and to indicate permission for Medicine Reconciliation and registry submissions. (Facesheet must be signed for every visit.)
2. The front desk person will ask the patient for his/her current insurance cards. If the patient presents more than one insurance card, the front desk staff member will ask the patient which insurance is primary.
3. If the visit is with the patient’s Primary Care Physician, the front desk staff member will verify whether or not the appropriate Primary Care Physician or Primary Care Physician Group name appears on the front of the card and within the Eligibility module within the PM System. If the PCP or PCP group name is not indicated or is not the physician or physician group with whom the patient has the appointment, the staff will assist the patient with updating their PCP. If the patient refuses, the patient will be notified that he/she will be responsible for services and will be self-pay, with the exception of all Medicaid and Managed Medicaid patients. This communication should be documented in the appointments billing comments.
4. If the visit is with a Specialty Care Physician, the front desk staff member will ensure that a referral has been received and documented in the PM System. If no referral form exists, or if it has expired, or has no further visits available, the front desk staff person will ask the patient if he/she has the hard copy referral. If the patient indicates they do not have the hard copy referral form, the front desk staff member will check the eligibility verification system, or the patient will be asked to call the primary care physician and request that the referral be faxed immediately prior to completing the registration and inform the provider of potential delay. If the referral is not obtained, the patient’s appointment will be rescheduled.