Hearing life training

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  • The more information the better. Signing all forms is crucial.
  • Insurance contract numbers are always changing. Ask patients to see their cards & note any changes &/or additions, deletions in Pinnacle. By dating the page in chart that has copy of insurance cards, you will remember when you last confirmed contract numbers & insurance plans
  • All HearingLife forms are found in Sharepoint under the Sales tab – Professional Forms
  • If a question arises about a referral and/or medical clearance, this information will be very helpful if there is an issue with claim regarding these particular issues. It saves time asking PCC.
  • The more detail the better. All radio buttons chosen correctly & boxes at the Privacy section are chosen. Claims will not go through if HIPPA Waiver Signed box is not checked. Can not check it unless patient has signed the form which must be kept in the patients chart
  • Go to the Order ID that you will be creating claim for
  • In the actual order . . .All items must be marked fitted with the date patient rec’d them.
  • Once item(s) have been marked fitted, go to the claim blade & select “add a claim”
  • Make sure all fields are accurately filled out. Be mindful of the insured’s information if different from the patients.
  • Date of referral/medical clearance. GY modifier is used if Medicare is primary and item is a non-covered medicare service. Medicare will process and forward to secondary insurance.
  • Facility & Provider NPI is HearingLife’s – 1366628166. Physician Name & Physician NPI is either your Audiologist or Michelle Giddings if you bill under her. Save claim first and then submit to Clearinghouse. (they will be green). **NOTE: DISPENSERS SHOULD BE GETTING THEIR OWN NPI
  • Example of notes in order

Transcript

  • 1. Working Efficiently and Accurately HEARINGLIFE CLAIM TRAINING
  • 2. INTRODUCTION  In order to make sure that our insurance claims get paid in a timely manner, we will be doing a step-bystep instructional.  Following these guidelines is crucial.
  • 3. AGENDA Intake & update information  Inputting into Pinnacle is critical  Rules & regulations for submitting claims  When a claim is rejected  Sharepoint & EOB’s  Patient balances  Write offs & collections 
  • 4. INTAKE & UPDATE INFORMATION  It is important to get as much information on a patient. Name, Address, Phone, Date of Birth, Physician, Insurance & referral source.  All intake forms must be from HearingLife – Intake, Financial & HIPPA. The patient must sign all of them.  If existing patients haven’t signed HL forms they need to update their records. Get copies of insurance cards to make sure they are current.
  • 5.  For existing patients ask to see their insurance cards & if anything (address, etc) has changed since their last visit.  Make copies of all insurance cards & date them. Put this in the patients chart.  Use the insurance verification form (found in Sharepoint) for details on benefits. Note who you spoke with and obtain call ID # if possible.
  • 6. Current forms found in SharePoint under Sales Tab then to Professional Forms
  • 7. It is imperative the patient signs financial policy & checks the financial responsibility box on intake form
  • 8. INPUTTING INTO PINNACLE IS CRITICAL  If information isn’t entered into Pinnacle accurately a claim will get rejected.  No hyphens, hashtags, commas, periods, etc. are allowed except in phone number, date of birth & social security fields.  All boxes should be checked especially the gender & HIPPA waiver signed (make sure patient signed this).
  • 9.  Add patients primary care physician &/or ENT in details blade.  When entering insurance information be careful to chose the correct one in the insurance manager section.  Patients can not have Medicare and a Medicare Advantage policy. Any Medicare Advantage policy takes place of Medicare.  Patient information entered MUST match exactly as their insurance cards!
  • 10.  If the patients insurance is under their spouse or parent, then the insured’s name, date of birth & gender must be entered in the insurance manager, not the patients.  Make sure you are selecting the correct Insurance name & address in Pinnacle.
  • 11.  Please document when a referral &/or Medical Clearance is received, by who and the date in the Notes section under the details tab. (Important for those working in the insurance department).
  • 12. Information added wrong
  • 13. Information added correctly
  • 14. RULES & REGULATIONS FOR SUBMITTING CLAIMS  Use the insurance verification form to determine the patients insurance benefits. Make sure you document date/time & persons name you spoke with. If possible, get call ID #.  When creating an order that will be submitted to insurance you must chose “Yes” when Pinnacle asks if this order will be paid by insurance.
  • 15.  Audiologists must make sure there is a referral from a PCP (primary care physician) prior to doing a hearing test (self referrals not allowed).  Medical Clearances must be obtained prior to fitting patients with hearing aids. Verify if M.C. must be from a DO, MD or ENT. If patient received clearance at a different facility, try to get copy by using records release form. DO NOT PROCEED WITH DELIVERY IF M/C HAS NOT BEEN RECEIVED!
  • 16. CREATING A CLAIM
  • 17. #1 #2 #3 • Enter Claim Information • Submit to Clearinghouse or Create Outside System Claim if it is a 3rd Party Claim ie: TruHearing • Check back for notes from biller & correct mistakes if necessary. Let biller know once errors are corrected so they can resubmit • Biller will close claim after receiving EOB/Payment. • Invoice patient any remaining balance or refund if it is due.
  • 18. When a Claim is Rejected  You will know if a claim was rejected either from the biller or an EOB (Explanation of Benefits).  Check the notes section of an order as this is typically where the biller will note details about claim.
  • 19.  At no point are you to hit the “Process Claim” button. Only the biller is allowed to do this.  At no point can you submit a claim to the Clearinghouse for secondary insurances. Only the biller can do this.  At no point should you reject a claim & reprocess it. This creates a problem at the billing end.
  • 20. FINDING EOB’S IN SHAREPOINT
  • 21. GET EMAIL ALERTS FOR EOB’S
  • 22. PATIENT BALANCES  Once a claim is completed the biller will process it and mark it closed. If there is a patient balance- be it a coinsurance, copay, deductible or balance bill amount you then print out a receipt/statement & send to the patient.  Find a system that works for you to keep track of patient balances. Petoskey has a “tickler file” labeled Patient Invoices.
  • 23.  Find a system that works for you to keep track of patient balances. For instance, when printing out invoices you can print two. One to send to the patient and the other to keep in the invoices file.  Petoskey uses labels to put on invoices that say “Your insurance has indicated that the balance due is part of your deductible, copay or coinsurance. Please refer to your recent Explanation of Benefits that you received from your insurance company for details. Balance is due upon receipt – Thank you.”
  • 24.  You can send out statements from Pinnacle. Go to Administrator, then scroll to Accounts Receivables/Collections.
  • 25. CLAIM TERMS
  • 26. HEARINGLIFE PROTOCOL FOR PATIENT BALANCES 1. Once insurance has paid their portion and there is a patient balance, immediately send a statement. 2. You must note in Pinnacle on the patient order, in the Notes blade, the date that the statement(s) were sent. 3. After 30 days, phone patient and send 1st demand letter- available on SharePoint. You must note in Pinnacle on the patient account the date that the letter was sent. (Keep copy of letter(s) in patient chart) 4. After 60 days, phone patient and send 2nd demand letter- available on SharePoint. You must note in Pinnacle on the patient account the date that the letter was sent. 5. After 90 days, phone patient. Work with accounting to send a 3rd and Final Demand letter. You must note in Pinnacle on the patient account the date that the letter was sent. 6. Once the 3rd and Final Demand Letter is sent, consult with Michelle & Liz regarding the use of a collection agency. Only the Senior Accountant can send accounts to collections. 7. You can not tell accounting to write off a balance without your RVP’s written consent!