ECI - Kp.org Payment Screen Updates: We streamlined the ECI Payment screens to be more visible to our patients and to make options clearer, including the
... [Show More] opt-out options. The instructions are more straightforward and include the wording_____________________________.
"skip the line"
Real Time Eligibility allows staff to verify what coverages?
1. Major commercial coverage
2. Medicaid
3. Medicare
4. Visiting Member coverage
Brainpower
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When is RTE is automatically ran for all scheduled appointments when no primary KP insurance is present?
1. 72 hours before
2. 72 hours after appointment
What should be ran when a patient has additional unverified non-kp insurance?
Manual Real Time Eligibilty
This coverage is not added through Real Time Eligibility
Kaiser Coverage
All KP Georgia plans are transferred into HealthConnect via
IRCS/Common Membership
What forms should be obtained from the patient while running Real Time Eligibility?
1. AOB
2.COB
What are the AOB/COB forms used for?
Authorizes KP to bill patient's non-kp insurance provider
While using Real-Time Eligibility coverage is
auto-created for the patient
These accounts are generally auto-created by Membership administration during the back end onboarding process
Guarantor accounts
This is required to complete patient check-in process
active guarantor account
Staff can now create this type of account in real-time
P/F (Personal Family) guarantor account
Registration staff should only create this type of account
P/F (Personal Family) guarantor account
These accounts are prohibited by PRA staff and should be escalated to the Financial Counselor for creation
1. WorkerComp
2. Employee Health Accounts
3. Other
After selecting Personal/Family under type of guarantor account, select ______ or___________.
1. Self
2. who the financially responsible party will be.
If a patient does not have any guarantor listed, select this option
Create new account
If a patient's insurance is under a spouse, father, or mother select____to pull-up guarantor to add to the patient's account. Enter family members HRN to pull up info and click____. Patient will populate under Guarantor select box. Click ______to add guarantor. Under Coverage selction, click _______
1. Find existing account
2. Select a patient
3.Select
4. Finish
You can activate and deactivate a guarantor account by entering yes or no. After deactivating a guarantor account the guarantor account will be_____________.
greyed out
This provides a condensed overview of the guarantor's professional billing record/account
Guarantor Snapshot
While accessing Guarantor Snapshot, selecting items in _____ will____.
1. Blue
2. Redirect staff to specific areas of the billing record.
Guarantor snapshot provides a quick review of the last____ items of four different categories which are?
1. five
2. Visits
3. Statements
4. Payments
5. Refunds
Guarantor Overview (Guarantor Snapshot)
Provides demographic information, payment plan details, and basic notes on statements, kp.org, and work queues the guarantor account may be in
Balances (Guarantor Snapshot)
shows the distribution of funds in various buckets including insurance, self-pay, undistributed, and bad debt
Workqueues (Guarantor Snapshot)
displays work queues the guarantor account or transactions may be in
Patients (Guarantor Snapshot)
lista all patients and their coverages the guarantor is responsible for
Visit (Guarantor Snapshot)
displays the last five visits
Statements (Guarantor Snapshot)
displays last five statements
Payments (Guarantor Snapshot)
displays last five payments received
Refunds (Guarantor Snapshot)
displays the last five refunds issued
Contact History (Guarantor Snapshot)
Shows users who has accessed the guarantor account and all notes or activities that have been documented for the guarantor account. Letters including MFA letters and Payment plan letters are listed here
Enter a New Activity (Guarantor Snapshot)
where a user can document a new note or activity, create a Tickler/Reminder, set up payment plan etc.
MFA and Payment Plan letters are listed under_____.
Contact History (Guarantor Snapshot)
When setting up a payment plan, the letter automatically pulls in the_________.
total self-pay balance due
Payment plans must be established for the _________.
entire self-pay account balance.
Payment plans are established for self-pay balances _______or greater.
$100
Minimum monthly payment amount for a payment plan must be ____ or more.
$25
All payment plan request that exceed financial hardship range, should be escalated to the ________ for review.
financial counselor
The first payment for a payment plan is due___________.
when payment plan is established.
Payment plans are not established on_______.
bad debt account balances.
The patient must contact __________ to discuss account settlement options. (Payment Plan)
bad debt collection agency
When creating a payment plan, verify that the _________ and __________ are the ________.
1. Current Self- Pay Balance
2. Total Plan Amount
3. Same
When providing OSB details at check-in, staff should only provide______ level information and not______.
1. CPT Code
2. Diagnostic codes
Transaction Details provides visit level PHI, that can be shared with patients at check-in, when attempting to collect outstanding balances. What are the five approved PHI?
1. CPT/Procedure Code
2. Appointment Department
3. Appointment Date
4. Provider
5. Copay amount
Transaction Details provides visit level PHI, that can be shared with patients at check-in, when attempting to collect outstanding balances. What is the one prohibited PHI?
Diagnostic Code
Professional billing statements are mailed every_______days to the account guarantor, based on the last statement date.
30
Professional billing statements are only generated/mailed when the account balance is_______
$5 or greater
When patients advise that they have not received a professional billing statement
1. Verify ______located in Guarantor Snapshot and update according to current workflow.
2. Remove all _________.
1. Address
2. Return Mail flag
Account notes are added to document adjustments and account maintenance actions made to any Guarantor Account such as
1.
2
3
1. Payment Plans
2. Adding, activating, deactivating accounts
3. Reprinting Letters
Account notes should be clear, precise and accurate, as nots are legal documentations and can be______________.
subpoenaed by the court of law.
Patient Summary
provides patient level demographics and associated guarantor accounts for each patient listed on existing guarantor account
Medicare Secondary Payer Questionnaire (MSPQ)
Survey required to help determine if Medicare is a primary or secondary payer for the patient.
Failure to maintain a system of identifying other payers is viewed as a________ of the provider agreement with Medicare.
violation
Commercial is ______ and Medicare should always be __________ (MSPQ)
1. Primary
2. Secondary
If you have a member on Medicare and Medicaid, Medicare is _______ and Medicaid is always _______. (MSPQ)
1. Primary
2. Last
If a member has commercial, Medicare and Medicaid, the filing order is___? (MSPQ)
1.
2.
3.
1. Commercial
2. Medicare
3. Medicaid [Show Less]