The Outstanding Receptionist Program

March 17th, 2008

This half-day program coming to your area seems to spotlight a few key areas that every good receptionist should be proficient in.

  • Perfect telephone skills
  • Project an image that commands respect
  • Improve your customer service
  • Become more than “just a receptionist”

Follow this link to the online brochure at CareerTrack. If you go, leave a comment on how the seminar was.

Basic Insurance Primer

March 13th, 2008

• Billing Address: PO Box 981109, El Paso, Tx
• HMO = 8 alphanumeric (mostly letters). Primary cardholder ends in A.
• PPO/POS = W + 9 numbers
• Never uses the letter O, always uses the number 0 (zero)

Blue Cross – Federal
• Policy = R + 9 numbers

Blue Cross – Other
• Policy = 3 letter prefix + numbers and letters
• Call 1-800-676-2583 opt 4 with your 3 letter prefix to find out what state it goes to

Champ VA
• Patient is subscriber
• Policy = Pt’s SSN

• Policy = U + 8 numbers + 2 number suffix
• Group = 7 numbers

Harvard Pilgrim
• Policy/contract number will begin with HP
• Group number is HPHC
• Note: Policy beginning with HH = Health Plans NOT Harvard Pilgrim

Health Plans Inc
• Billing Address: PO Box 5199, Westborough MA 01581
• Policy/contract number will begin with HH

TriCare (North)
*** Subscriber’s address needs to be the physical street address; PO Boxes are not accepted by TriCare
• Billing Address: PO Box 870140, Surfside, SC
• Specify Military Status and Branch of Military

TriCare for Life
• ***Patient must also have Medicare (Medicare is typically primary payer)
• *** subscriber’s address needs to be the physical street address; PO Boxes are not accepted by TriCare
• Specify Military Status and Branch of Military

United Healthcare
• Policy = 9 numbers
• Group = 6 numbers

Please comment with your basic, major insurance tips!

Contact Lens Tips

March 12th, 2008

I have found a couple of helpful tips that work really well for me.

1 – Wet your eyes with something, rewetting drops, saline solution, something, immediately before putting the contacts into your eye.

2 – Try a few different rewetting drops until you find the one that works best for you. I used to use Bausch and Lomb (B&L) Rewetting Drops, but I had to use them almost hourly to keep my eyes from feeling too dry. I tried Visine For Contacts because Visine is a big name in the eye business. The difference is amazing. I now compare the two to oil and water. The B&L just feels like dropping water into your eye. Visine feels like dropping lubricating oil into your eye. It has worked so much better for me.

The pre-wetting plus Visine tips have helped me go from wetting my eyes almost hourly to wetting just a couple times a day. It has been great.

While I’m on the Visine topic, I want to plug their redness reliever drops, Visine L.R. The drops I used to use (and I can’t remember the product name) were extremely painful to drop into my eye. It burned for many seconds afterward, and I think my eyes became redder before they cleared a bit. Visine’s redness reliever drops don’t feel like that at all, and they make my eyes more white than they have been in years.

Do you have contact lens or eye drops stories to share?

Harvard Pilgrim or Health Plans, Inc?

March 11th, 2008

It’s often confusing when trying to identify if a patient is covered through Harvard Pilgrim or Health Plans, Inc. by looking at their card. Both insurance cards show the Harvard Pilgrim name and logo, usually in the upper left corner. At a quick glance, one might be tempted to merely list Harvard Pilgrim in the system and call it good. However, Health Plans, Inc. cards also have their name on the upper right. When claims are sent to the wrong insurance company ,they are denied and returned to the healthcare facility for correct billing.

Besides looking for the Health Plans, Inc. brand on the upper right corner of the card, here is the easiest way to distinguish one plan from the other:

If the insurance ID begins with HP, it’s Harvard Pilgrim.

If the insurance ID begins with HH, it’s Health Plans, Inc.

It’s as simple as that. Get this one distinction in your memory and never have your Harvard Pilgrim/Health Plans, Inc claims bounced back again.

Humor Me Monday

March 10th, 2008

Mondays can be so serious and are already full of work. Let’s take the time out to laugh today.

A sales rep, an administration clerk, and the manager are walking to lunch when they find an antique oil lamp. They rub it and a genie comes out. The genie says, ‘I’ll give each of you just one wish.’

‘Me first! Me first!’ says the Admin clerk. ‘I want to be in the Bahamas, driving a speedboat, without a care in the world.’ Puff! She’s gone.

‘Me next! Me next!’ says the sales rep. ‘I want to be in Hawaii, relaxing on the beach with my personal masseuse, an endless supply of cold drinks, and the love of my life.’ Puff! He’s gone.

‘OK, you’re up,’ the genie says to the manager.

The manager says, ‘I want those two back in the office after lunch.’

Moral of the story: Always let your boss have the first say.

Up Front Collections: Every Little Bit Adds Up

March 5th, 2008

Collecting co-pays from patients can make you feel proud, like you are doing worthwhile work for your organization.  Sitting down with your supervisor and saying “I collected $300 today in co-pays” shows that you are an asset to the company.  Any time the cash is in hand instead of owed is a win for the company.  Sometimes, though, collecting small co-pays seems like it’s not worth your time.  “I’m going to go for the big ones and not waste my time with the small ones,” you may think.  “Ten dollar co-pays aren’t worth my effort.”

Here’s why small co-pays are worth your effort.

A co-pay is something that the patient owes for their visit.  It is an established dollar amount and doesn’t change from visit to visit depending on severity of service.  The patient owes a flat fee and the insurance company is going to hold the patient responsible for their part.

If a patient does not pay the co-pay at time of service, there is a cost involved on our end to send that patient a billing statement.  Sending a statement does cost time to pay the employees involved.  There are costs involved for material for the statement, return envelope, outgoing envelope, and postage.  Currently in my organization, it costs approximately $5 to send a billing statement.

Often, we have to send more than one statement for a patient’s co-pay.  At $5 per billing statement, you can see how quickly it adds up.  For a $5 co-pay, you’re not making any money if you have to bill for it.  For a $10 co-pay, you’re not making any money if you have to send more than one statement.  For higher co-pays, you’re still losing $5 every time you send out a bill for the co-pay.

While collecting higher co-pays will help you to stand out like a star, it is important to focus on collecting lower co-pays.  1) The patient is more likely to have the lower amount of money on them, if they’re not just paying by check or credit/debit.  2) Getting in the habit of collecting lower co-pays will make it smoother for you when you need to ask for higher co-pays.  3)  The little co-pays will add up throughout the day and the week, and higher co-pays are sure to join it since you’re asking, allowing you to remain, as before, the collecting star.

Mitigating Medicare Mishaps

March 4th, 2008

Medicare numbers, also called Health Insurance Claim (HIC) numbers, are almost always 9 digits with a letter suffix, such as 000-00-0000A. The HIC is the wage earner’s Social Security Number (SSN), which could be either the patient’s, a spouse’s or a parent’s SSN. Because of this, you can’t assume that the patient’s Medicare number is always their SSN+A. It is important that you have them read the number to you from their card if updating the patient on the phone, or that you see the card if you have the patient in front of you.

In some instances, HIC numbers can change, though usually it is only the ending letter. For example, a patient receiving spousal benefits (spouse’s SSN + B) will have their Medicare number change to a survivor’s benefit (spouse’s SSN + D) when the spouse expires. For this reason, you should always update a patient’s Medicare number as you would any other insurance when registering. This is also a good time to make sure the patient does not have a Medicare Replacement/Advantage Plan.

In some computer systems, when entering a HIC number it is important make sure there are no leading spaces. If there is a number following the suffix, such as B2, a leading space will keep the number 2 from transferring to billing software. This may delays claim processing and create more work for billers. For this reason, it is also a good practice not to have leading spaces in any insurance ID.

More Medicare Trivia (or Muddling Through the Medicare Miasma)

Railroad Retiree Medicare numbers have a letter prefix, such as MA000-00-0000.

Typical Medicare HIC Suffixes include the following:
A —patient’s SSN (wage earner)
B —spouse of wage (also B1 through B9!)
C —child (could be followed by a number or letter)
D —widow (could be followed by a number or letter)
E —mother/widow (could be followed by a number or letter)
F– F1 Father, F2 Mother, F3 Stepfather, F4 Stepmother, F5 Adopting father, F6 Adopting mother, F7 Second alleged father, F8 Second alleged mother
K —receiving wife’s special age 72 benefits through her husband (could be followed by a number or letter)
J1 —receiving special age 72 benefits (also J2, J3, and J4)
M —has enrolled in Part B ONLY, but receives no monthly Social Security benefits (also M1)
T —has enrolled in Part A and possibly Part B, but receives no monthly Social Security benefits (could be followed by a number or letter)
W —disabled widow/widower (could be followed by a number or letter)

Correctly Identify Insurance

March 3rd, 2008

At the hospital/office, we’re only as up to date and informed as the information given to us. If we’re not given any information, however, then it stands to reason that we’re not informed or up to date. If we’re not given any information because we can’t squeeze blood from a rock, that’s one thing. If we’re not given any information because we aren’t asking for it, then shame on us.

It is vitally important that we are viewing insurance cards when we do account updates. It’s important that we ask the patient to get their insurance card and read us the numbers when updating an account over the phone. My favorite errors are where the account comments read “no insurance changes per pt” or “per mom”. And then guess what? The patient’s Medicare ID isn’t their SSN with an A after it. They now have a Medicare Advantage Plan instead of classic Medicare. Or, their business changed from Aetna PPO to Aetna HMO, but we only asked if they still had Aetna.

It’s concerning when the account information states that the patient was just completely updated, yet the Anthem website says we have the wrong insurance prefix or the wrong review group, address, subscriber, etc.

If we are sure to stress that we need to see the card instead of asking “have there been any changes,” then we are less likely to have incorrect billing information. When you have correct billing information, you are saving your business money. When you have correct billing information, you are performing very good service to your patients because they don’t receive bills for services that should have been paid for by their insurance. When you collect correct billing information, we all win.

Access Week

March 2nd, 2008

National Healthcare Access Personnel Week is coming up March 30 – April 5, 2008. This is a week for hospitals and management to show appreciation to their Access personnel. These associates include:

Insurance Verification/Precertification

Looking for some ideas on how to celebrate? Activities could include:

Sweets baskets
Congratulatory balloons
Surprise gifts
Fruit/Meat/Cheese/Cracker platters
Random Drawings
Crossword Puzzles
Word Searches
Who’s Who? – Match the childhood photo to the current Access associate
Who Lives Here? – Match the home photo to the Access associate
Super Secret – Match the little-known trivia to the Access associate
Access Pets – Match the pet to the correct Access associate
Cater a lunch
The list goes on!

To learn more about Access Week and what you can do for your employees, see NAHAM’s Access Week page. Start preparing now and delight your staff when Access Week arrives.