Front Desk (PSR/MPA) Training Study Questions with complete top solutions

Front Desk (PSR/MPA) Training Study Questions with complete top solutions Registration is the basis for what? Collecting and maintaining patient information, including general, financial, and insurance details. Registration information must be verified when? Each time the patient visits. When registering patients, verification ensures what 3 things? 1. Patient demographics remain current. 2. Patient coverage or other financial information is updated. 3. Data entry errors are quickly identified and corrected. How would you access Epic Policies/Procedures for scheduling, pre-visit, check-in, check-out, financial counseling, off-site, and miscellaneous topics? Dbl. click Internet explorer icon on main computer; click the Policy & Reference tab on the MIV; click EPIC Policies & Guidelines on right hand side of screen. What are the three "levels" Registration Information is organized and stored in the system? 1. Patient - contains demographic and clinical info. 2. Account - contains guarantor and billing info. 3. Coverage - Contains ins. benefits and claim information. Guarantor is who? The person financially responsible for the medical bills. Subscriber is who? The primary policyholder of the insurance. Who is usually the guarantor of a minor child? Parent A husband carries the ins. through his employer for himself and his spouse. Who is the subscriber? Husband A husband carries the ins. through his employer for himself and his spouse. Wife is the patient. Who is the guarantor? Wife b/c she is over 18 and legally bears financial responsibility for her medical services. If both parents carry family coverage for a child what rule applies? Birthday Rule - Which ever parent b-day comes first is considered the primary ins and the other is secondary. If both parents carry family coverage for a child what rule applies when they both parents have the same birthday? Whichever parent had their insurance first. How many emergency contacts must you enter? 2 A stop sign indicates what? A "hard stop" you must enter info in order to proceed. A yield sign indicates what? A field where info is recommended, but you will be able to proceed. Consent Forms are good for how long? 1 year If the emergency contact lives with the patient, you can use what to fill in the address field and home phone areas? Pull Info button is the shortcut (with the "This Patient" radio button clicked). You can select whether you want to pull Address Only for Guarantor, Subscriber or Emergency Contacts. Once you have entered the First Section (Demographics, PCP, Employer, Patients Contacts) what do you do? Click Verify Patient or go to Checklist to Verify Patient. Where do you go to change the order of which insurance is listed as primary or secondary? Coverage Folder (to the left in folders). Where do you add insurance coverage? From the interactive facesheet hyperlink. Where do you go to find / lookup patients before you enter them as a new patient? Appts (Either located in main toolbar at top or in EPIC drop down menu under scheduling). What 5 steps of finding a patient do you use before clicking the NEW button? 1. MRN (Medical Record Number if pt. knows it, if not go to step 2) 2. Name (3 comma 3 rule) add B-Day if name is common 3. If patient cannot be found using name search remove name. 4. Sex and DOB (Review any patient with your patients first name or with Boy or Girl as the first name. 5. Search by SSN. * Ask the patient if they've ever gone by another name (Maiden, Adoptive, Divorced, Alias) For children ask if any other name has been used for the child. If the parent indicates the child was born at Metro look under the mothers maiden name with Boy or Girl as the first name. Also try the last name with Boy or Girl as the first name. To shorten the list of possible patients, be sure the have the SEX field completed. *If a patient on the listing is your patient, highlight the patient and click Accept. *If not click the New button, you are creating a new medical record. What must be entered before clicking the New button to create a new medical record? Name, Sex, Birthdate (SSN should already be there if not add it) *Names should be entered as last name comma first name with NO spaces before or after the comma. Smith,John. *Titles should be added after the last name before the comma Smith Jr,John (Sr., Jr., II, III, IV, V are the only allowable titles. Reg and Make Appt buttons allow you to? They are found where? Register a patient Make an appointment Appt Desk The Patient Summary button will take you back to where anywhere in Registration? Face Sheet What is the Interactive Face Sheet? A summary of the patient's current Registration information. Hyperlinks do what? Links to the form Once a child turns 18 what must you do to the existing P/F (Personal / Family) account? Inactivate it and create a new P/F acct. The 18 year old is now considered the Guarantor of the new P/F acct. Account Status: Returned Mail indicates what? Returned mail and need updated address. How should you verify a patient's address? By asking them to tell you their address, not stating the address. How long is a HIPPA verification good for? Indefinitely In the Coverages Folder how do you know if an ins. is active? A dot appears in the second column of the Coverages for Patient screen. What 3 things must you fill in when you click Make Appt? Visit Type Provider Start search on What are the 4 types of pmts. accepted? Cash Check Cr. Card Payrol Deduct What button is used for collecting a co-pay? Enterprise Pmt button Always check the Orders tab. If there are Schedulable Orders why would you want to check past appointments? To determine if the patient has already seen a provider in that particular specialty area. This determines if they will be an established or new patient. Walk-In Appointments have what 2 features/functions? Make an Appt and Check In If a patient calls for an appointment and has no coverage, or their Community Discount coverage will soon expire, the patient will need to see a Financial Counselor. To schedule an appt. what Visit Type and Specialty would you use? Use Visit Type (17) Financial Counselor and Specialty (62) Financial Counseling What are Joint Appointments? Joint appointments are two appts. for one visit type but require two providers or resources. ***Make sure you click on Joint Times on the Make Appt Screen and have BOTH providers...listed What is a Recurring Appointment? These are multiple appointments that can be made during one process such as weekly appts. that recur for 6 weeks (PT/OT, Chemo, INR...). *Check the Recur box on the Make Appointment Screen then fill out the Reur Appointments Screen. What is the DAR? Department Appointment Report - will give you a listing of all patients scheduled into the department for a date range specified. What is a Staff Daily Report? Provides a complete listing of appointments for a particular provider or resource for a specified date range. What Materials (Proof) does the patient need to bring to the Financial Counseling appointment for FAP (Financial Assistance Program) or HCAP (Health Care Assurance Program). *Located Main, InPt, ED, Satellites *Interviews by appt only *Standard time 20 mins *Discounts based on residency, family size, and income 1. Residency: Legal Mail, Lease/Rental Agreement, Letter, Self declaration. 2. Family Size: Marriage, Divorce, Death Certificate(s), Biological Birth Certificate or Adoption Papers (minors). 3. Income: Paystubs, Report of gross income and dates of employment from temporary agencies, SSI Benefits, Unemployment, BWC. FAP (Financial Assistance Programs) based on income levels of uninsured. What is SP/Uninsured CUY and SP/ Uninsured OOC percentage discounts? SP/Uninsured CUY (65% discount in county residents) SP/ Uninsured OOC (50% discount out of county residents) What is Tapestry? The billing side. Not Us! What is prior authorization? A formal process requiring a provider to obtain approval to provide a particular service(s) or procedure(s) BEFORE THEY ARE DONE. What is a referral? The process of sending a patient from one practitioner to another for health care services. In HMOs and other managed care organizations, a referral is usually necessary to see a specialist other than the PCP in order for the services to be covered. Health Plans may require documentation and/or authorization of referrals for coverage of specialty services. Why are referrals/prior authorization needed? Compliance and Reimbursement *Always verify eligibility and benefits for the service being requested. When scheduling an appointment, you may be prompted to link the appointment to a referral. CHOOSE THE CORRECT REFERRAL! Pre-Service Ctr can be contacted for questions/concerns. THE PARENT IS ALWAYS THE SUBSCRIBER - EXCEPT THESE 3! MEDICARE, MEDICAID, HEALTH SPAN THE KID IS THE SUBSCRIBER! ONLY EXCPTION. Minors may request that they be the guarantor for the following services: Contraception Tx of substance abuse Tx of venereal disease Prenatal, delivery, and postpartum care Medical Tx for gathering evidence of a sex offense HIV testing. In cases where the individual presenting the minor for services (NON-INVASIVE ONLY) is not the legal guardian (babysitter, r) who is listed as the guarantor? The legal guardian Invasive procedures on a minor require the legal guardian to do what? Authorize and Sign the Consent Form (the babysitter... can not authorize/sign). Who is the guarantor if the parents are divorced or separated? Generally the parent with custody is the guarantor. Unless the divorce decree is presented and declares the non=custodial parent financially responsible for healthcare costs then they are the guarantor. Info must be collected and stored in EPIC under Emergency Contacts. Does the name on the insurance card determine the guarantor? No; The guarantor is the person legally responsible for pmt of health care bills. True or false the subscriber may be the patient, parent, or spouse? True For patients covered under Medicaid or a Medicaid HMO, the patient and subscriber are the same. Is this true for minor, as well as adult patients? Yes In the case of employer group health insurance who is the subscriber? The employee (make sure you have the relationship code correct!). There are generally 3 types of insurance coverages in EPIC, what are they? 1. Private Insurance (Medical Mutual, Aetna, United Health...) 2. Government Insurance (Medicare, Medicaid) 3. Self Insured There are 2 types of private health insurance, what are they? 1. Employer group coverage (provided to employee by employer) 2. Individual group coverage (purchased by an individual/family directly with an ins company through an insurance agent) Recipient may have Medicaid FFS or a Medicaid HMO but: Never both! Medicare not only covers those who are 65 or older but who else? Younger than 65 who meet certain disability requirements or ERSD. Medicare Part A covers what type of services? Inpatient Medicare Part B covers what type of services? Outpatient What is important to capture, for ins., when a prisoner is a patient? The name of the correctional facility or jurisdiction responsible for the prisoner. If the patient has any other commercial insurance coverage the prison coverage will be SECONDARY! Prison coverage is primary over Medicaid/Medicare! Anthem Blue Cross covers what for the patient? Hospital coverage Anthem Blue Shield covers what for the patient? Physician coverage Medical Mutual and Local 880, which covers what? MM - Hospital coverage; Local 880 - Physician coverage (United Food and Worker's Coverage) Medicaid IS NEVER the PRIMARY insurance UNLESS what? It is the ONLY insurance! IT IS THE PAYOR OF LAST RESORT Medicare is the PRIMARY payor unless what? A Medicare Secondary payor condition applies (MSPQ). *65+ working w/coverage under a lg group employer *65+ covered by working spouse's lg group employer plan - spouse can be any age * Under 65 and has Medicare as result of disability but has coverage (for self or by spouse) under lg group employer plan *Covered for ESRD, carries gp ins through employment or spouse employment AND the COB (coordination of benefit) period HAS NOT BEEN COMPLETED! COB PERIOD IS THE FIRST 30 MONTHS AFTER A PATIENT STARTS DIALYSIS. *Personal Injury Claim (Auto Accident/Property Ins) *BWC claims *Covered under BLACK LUNG PROGRAM * Involved in a RESEARCH STUDY * Chooses coverage through the VA (Veteran's Administration) The MSPQ (Medicare Secondary Payor Questionnaire) must be completed for each Medicare patient who presents for treatment, what is the exception? NO EXCEPTIONS! Claims cannot be sent to them w/o it! Hospital can loose its Medicare provider status! Hospital can be fined! Can be charged w/inappropriate billing (auditing/$loss) May cause Hospital to manually bill claims with a hard copy MSPQ attached! Part III of MSPQ indicates why and individual is entitled to Medicare. It is Either _____ or _____ and/or ESRD. age or disability NOT BOTH! (age and ESRD is okay / disability and ESRD okay) Never age and disability. Eligibility must be due to one of these reasons! Champus/Champva (military insurance) is secondary to any large group health plan, excluding what? Disability insurance For children w/parents who are separated/divorced, what rules govern which insurance plan is filed first. Give in order! 1. Specific terms of any court order. 2. Insurance plan of parent with custody. 3. Ins plan of the SPOUSE of the parent with custody (Stepmother/Stepfather) 4. Ins plan of the parent without custody 5. Ins plan of the spouse of the parent without custody The patient has Aetna single coverage. The patient's spouse carries family coverage with Cigna Comprehensive Plan. What filing order should they be in? (Outpatient) 1. Aetna (Primary) 2. Cigna (Secondary) The patient carries Anthem Blue Cross and Blue Shield. The spouse has Medicare Part A and Part B. (Outpatient) 1. Blue Cross Blue Shield (only applies because the spouses Medicare does not apply) The patient is over the age of 65, single, and carries Medicaid and Medicare Part A only. (Outpatient) 1. Medicaid (only applies because part A is for inpatient only) The patient is a 5 y/o boy. Dad has single coverage with Healthstar, his DOB is 05/02/73. Mom caries family coverage with Medical Mutual, her DOB is 05/12/73. (Outpatient) 1. Medical Mutual (only applies here, single coverage is only for dad not family) The patient is insured w/Anthem Blue Cross for inpatient and Local 310 for outpatient. (Outpatient) 1. Local 310 (only applies to outpatient setting) The patient has Medicare Part A and Medical Mutual coverage through the spouses employer. The spouse is deceased. (Outpatient) 1. Medical Mutual (only applies part A is inpatient) The patient is a 3 mo. old boy. He lives with Mom and Dad. Mom has family coverage with Bankers Life; her DOB is 06/06/69. Dad has family coverage w/ Medical Mutual; his DOB is 06/04/69. (Outpatient) 1. Medical Mutual (Primary) 2. Bankers Life (Secondary) (B-day rule) The patient has Medicare Part A and Part B and is under the age of 65. The spouse is employed at Ford Motor Co. and has the patient covered under Emerald Health. (Outpatient) 1. Emerald Health (Primary) 2. Medicare Part B (Secondary) The patient has a Caresource Medicaid HMO card and also has an old Medicaid fee for service card. (Outpatient) 1. Caresource (Only applies b/c Medicaid card is too old, they are sent out monthly and can only be used for the current month) The patient has Medicare Part A only and also has Provident medical insurance. (Outpatient) 1. Provident (Only applies) The patient is retired and has Medicare Part A and Part B. The patient also has AARP supplemental and Medicaid supplemental coverage. (Outpatient) 1. Medicare Part B (Primary) 2. AARP (Secondary - this is a supplemental ins for Medicare) 3. Medicaid (Third - Always last if other coverage) The patient's DOB is 08/12/59 and has medical insurance w/ Commerce Benefits. The spouse's DOB is 04/06/62 and has family medical coverage w/Aetna. (Outpatient) 1. Commerce Benefits (Primary) 2. Aetna (Secondary) (B-Day rule doesn't apply here) The patient is a 7 y/o child and both parents have medical coverage. The parents are divorced. There is no court order or decree determining financial responsibility for medical bills. The patient lives w/dad and his stepmom. Dad has single coverage w/Aetna. The stepmother has the child covered under her family medical coverage w/ United Health care. The natural mother has the child covered under her family coverage w/Travelers. (Outpatient) 1. United Health Care (Primary) 2. Travelers (Secondary) (Because child lives w/stepmom. Dad has no coverage for kid. Biological mom secondary b/c she is non custodial parent. The patient is under the age of 65, has Medicare Part A and Part B, and has medical coverage w/ Aetna through Metrohelath. He started dialysis for ESRD 02/15/14. (Outpatient) (Date now is 12/2015) 1. Aetna (Only applies b/c Medicare Part B requirement of 30 months has not been met) The patient is 67 y/o and has ESRD. Dialysis began 10/15/11. The patient has Medicare Part A and Part B and is covered by her spouse's ins. w/ Cigna. The spouse is employed by CVS Pharmacy. (Outpatient) 1. Medicare Part B 2. Cigna (Patient meets 30-month requirement; Part A id n/a) Who would you contact with billing questions? PFS-Patient Financial Services If the patient has Medicaid in the state of Kentucky what must the Patient do? Verify coverage! Done by patient not PSR OR MPA. If a patient comes in and are out of state with BC/BS where can you verify coverage? Through Anthem Which radiology appointments can a PSR or MPA not schedule? IR- Interventional Radiology MR- MRI NM- Nuclear Medicine Any radiology procedures requiring sedation / anesthesia Any Biopsy Procedure for any imaging area Any Specialized Study with an EPIC type RADQUExx All STAT / ASAP orders