Insurance Training 101
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1 Access Management Insurance Training 101 University of Mississippi Medical Center Access Management Patient Access Specialists I
2 In Access Management WE are the FIRST STAGE in the Revenue Cycle. If Patient Information is entered incorrectly by US, the hospital can t get paid for services it provides. When errors occur, valuable resources must be spent recovering money lost because of OUR mistake. Access Management is the foundation of the Revenue Cycle!
3 What to Expect This module will help you prepare to be an effective and efficient Patient Access Specialist. You will learn how to avoid the most commonly made PAS errors. A quiz at the end will measure what you learned.
4 Many Mistakes Occur Regarding: Patient Verification Treatment Authorization ID Insurance Company Contact Information Determining the Subscriber s Name Determining Patient Relation to Subscriber Verifying Demographic Information
5 Patient Verification Info Page
6 Patient Verification This screen will pop up with each registration. It s vital that you check this screen to verify you have the correct patient. You re looking to see if the PATIENT S NAME and BIRTHDAY match what s listed on this screen. Doing so prevents creating dual patient records which are costly and troublesome to correct.
7 Patient Verification Info Page
8 Treatment Authorization ID
9 Treatment Authorization ID This is a pre-authorization code necessary for insurance companies to reimburse certain medical procedures. This field MUST be populated with an Alpha/Numeric code or the code NPR to be billed properly. NPR means No Preauthorization Required. Check with your supervisor about which h procedures are NPR on your floor.
10 Treatment Authorization ID If Field is Left Blank The hospital doesn t get paid because the claim is rejected by the payer. The hospital must then waste time, money, and resources to investigate and correct the mistake. Additional Financial Penalties could result as well.
11 Treatment Authorization ID PERSONAL ACCOUNTABILITY: Because money is lost each time this simple field is left blank, Supervisors receive reports each day listing how many times their employees left this field blank. This allows managers to identify employees who continually struggle with this mistake and provide them with further training.
12 Treatment Authorization ID
13 Insurance Co/Contact: vs. Ins Plan Name:
14 Insurance Co/Contact vs. Ins Plan Name The two fields circled are often confused. The insurance company s name and contact information go in these two fields. What s confusing is the name and contact g information could be DIFFERENT. Let s look at the screen again.
15 Insurance Co/Contact vs. Ins Plan Name
16 Insurance Co/Contact vs. Ins Plan Name Did you notice that the Insurance Plan Name (Cigna Multiplan) was different than the Insurance Co/Contact (Tyson Health Plan)? This is caused by one insurance company underwriting a policy for another. This happens frequently, and Payers will reject claims if this information isn t correct. Therefore you must learn how to address this issue.
17 Insurance Co/Contact vs. Ins Plan Name Avoiding this mistake is simple. To prevent it, you MUST make sure the contact information listed on the back of the insurance card in the Mail claim to section goes in the Insurance Co/Contact field.
18 Insurance Co/Contact vs. Ins Plan Name
19 Subscriber Info
20 Subscriber The SUBSCRIBER is the person the insurance company considers the owner of the insurance policy. There are two common complications associated with this page. Which name to use when filing insurance How to determine the subscriber
21 Subscriber Name There are 3 different kinds of names you will encounter during registration. The Name on Driver s License: Vincent Coleman Smith The Nickname: Buddy Smith The Name on the Insurance card: Vincent C The Name on the Insurance card: Vincent C. Smith
22 Subscriber Name In this example, the patient s legal name (Vincent Coleman Smith) is listed on his driver s license. He entered his nickname (Buddy Smith) on his registration form, and the name on his Insurance card has only a middle initial (Vincent C. Smith). Which name do you enter?
23 Subscriber Name You enter the name EXACTLY AS IT APPEARS on the Insurance Card. In this case, Vincent C. Smith. If it is not an EXACT MATCH with the name on the card, the insurance company will reject the claim.
24 Another Example: Subscriber Name Driver s License: Vincent Coleman Smith Registration Form: Buddy Smith Insurance Card: Vincemt Buddy Smith What name do you enter?
25 Subscriber Name Always enter the name as it appears on the insurance card, EVEN IF MISSPELLED. In this case, Vincemt Buddy Smith. Be prepared to enter a name different than what is on their Driver s License or Birth Certificate. For the hospital to be reimbursed, Subscriber Info Page must match the name on Insurance card.
26 Subscriber Relation to Insured
27 Subscriber Relation to Insured Determining the Subscriber: The Subscriber is considered the owner of the policy. Relation to Insured refers to the patient s relationship to the Subscriber. Usually the patient and the Subscriber are the same, but the patient could also be the Subscriber s spouse, child, etc.
28 Subscriber Relation to Insured Therefore you must determine the relationship of patient to Subscriber and code accordingly. Possible choices are Self (if the patient and subscriber are the same), Spouse, Child, Employee, Step Child, etc. The next slide shows all allowable values.
29 Subscriber Relation to Insured
30 Subscriber Relation to Insured A common mistake occurs when the ELDEST SIBLING is considered the SUBSCRIBER. This confusion is best addressed by first distinguishing between the GUARANTOR and SUBSCRIBER.
31 Subscriber Relation to Insured A GUARANTOR is ultimately responsible for paying the bill while the Subscriber owns the Insurance Policy. In most cases, the GUARANTOR and Subscriber are one in the same. The GUARANTOR can t be a minor, except in rare circumstances. The GUARANTOR has to be present at registration and provide a signature.
32 Subscriber Relation to Insured As previously mentioned, the main confusion comes when the eldest sibling is the subscriber. EXAMPLE: Imagine a UMHC employee has insurance with the state t but has purchased a separate policy for her two children. If that s true, then BC/BS considers the eldest child the Subscriber.
33 Subscriber Relation to Insured In other words, a 17 year old girl who has never paid a monthly premium in her life (but her parents have) technically owns the policy. In this case, she (the 17 year old girl) is considered the Subscriber.
34 Subscriber Relation to Insured
35 Verifying Demographic Information
36 Verifying Demographic Information On this page, the Demographic information must be verified and double checked in order to ensure accuracy. If address is incorrect, insurance won t reimburse and the hospital has to waste resources correcting the mistake. Assuming this information is correct could be a costly error.
37 Verifying Demographic Info VERIFY all information on this page, especially the information in the WHITE FIELDS. Similar to other vital patient information, reports are sent to supervisors when information is entered incorrectly so they can take steps to minimize the frequency of the error.
38 Verifying Demographic Info If patient is incarcerated, then their address MUST BE the correctional facility where they are currently being held. In the past, when a residential address has gone overlooked, the letter has gone to a family or friend s house mentioning their medical appointment at the hospital. Friends and family have been known to use this information to try to visit them during the appointment, or in extreme situations, help them escape.
39 Verifying Demographic Info Therefore, always make sure all fields on the Demographic Information Page are verified by the patient, especially the information in the white fields. A d if th ti t i i t d k And if the patient is incarcerated, make sure the address is a correctional facility.
40 Verifying Demographic Information
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STEPS FOR APPLYING FOR FINANCIAL AID 1. Determine if you are a dependent student or an independent student. A student is only an independent student if he or she is: a. 24 or older at the beginning of