Alta Partners News & Tips.  Information to Improve your Practice
September 2006
Volume 1- Edition 2

Table of Contents:

       Customer Service’s List of “Top 5 Preventable CS Calls”
       Alta Partners In Our Community
       Oh My Goodness – WHAT HAPPENED TO MY CASH IN SEPTEMBER!
       Let Us Hear From YOU!

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Customer Service’s List of “Top 5 Preventable CS Calls”… and how you can help us avoid them

We’ve all had to call the customer service department of a business to get an issue straightened out, and all of us have probably dreaded the process.  Most of the time, the call is necessary because of something that should have been addressed up front, at the time the service was provided, but wasn’t. 

We interviewed Shirley Kelley, Alta Partners customer service team leader, about calls she and her team take daily that could (and should) be avoided.  It didn’t take long to make out Shirley’s “Top 5 Customer Service Preventable Call List”.  Take a look below and ask your staff if they are addressing these matters at the time of the patient visit.  Here they are, in reverse order: 

#5 – “… but I was told the charge was only going to be $50?” 

Many times when new patients call to schedule their appointment they will want to know how much the fee is going to be prior to the visit and will ask the employee on the phone.  This is understandable; we all want to know what we are getting ourselves into financially.  However, I think we can all appreciate how difficult it is to answer that question with any office visit.  How do you know what level exam will ultimately be performed?  Will there be additional testing done?  Will there be any lab work or even maybe a procedure included?  

Then aside from the physical services performed, there’s the whole world of insurance.  Is the doctor in-network or out-of-network?  What is the patient’s deductible?  Has it been met?

With so much up in the air, it really is unfair to quote to any patient a fee for services in advance!  Yet it happens all the time and when the patient gets the bill for services, our customer service team gets a nasty phone call.  Please help us by instructing your staff NOT to quote fees over the phone.

#4 – “Here he is…. Tom Jones”

Well, while we all know of at least one Tom Jones, I’ll bet that all of you can think of someone else with that same name.  And guess what?  - in our Misys system, there are currently 19 Tom Jones’.  If your staff didn’t’ take the time to ensure that they picked the correct “Tom Jones”, then we have our #4 reason for a preventable customer service call, (and a messy situation on our hands to clean up.)  

Please stress to your staff that they should only choose a patient to schedule based on their Social Security number, not by just their name.  What we see often occurring is that the patient name is typed into the system and the staff employee picks the first name that comes up- (poor Tom Jones #1)!  That individual gets charges submitted for a visit he wasn’t even at and the whole process gets goofed up along the way with reversals, possible insurance refunds and new charges that need to be entered.

#3 – Mom, do I have to pay this doctor bill out of my allowance?

It’s unfortunate, but “Meghan” or “Jacob” could be getting bills sent directly to them if the patient account for the child is not set up correctly, with Mom or Dad calling customer service later wondering what is going on?. 

When setting up an account for a minor (under the age of 18), it is very important that the minor’s account is tied to an adult responsible party. In Misys, this occurs when the responsible party is entered as a “Responsible 3” in three different locations:

¨      The minor’s account must be entered “Responsible 3”

¨      The system will then prompt the user to select a responsible party. The responsible party must be selected from the system or added if necessary and should also be a “Responsible 3”

¨      Finally the insurance and the charge must be a tagged, “Responsible 3”

All these categories must be a responsible 3 for the charge to be submitted to the insurance and the correct responsible party billed if there is a balance. 

#2 – “But I have Insurance! Why do I have to pay for this visit?”

Another common customer service call occurs when the patient gets a personal bill for the preventive office visit.  Patients just do not understand this coding, especially if their insurance does not cover this type of visit, and who could blame them.  They booked an appointment with their primary care doctor, saw the doctor, and have insurance – why is this any different than any other office visit?

We do our best to help them understand the coverage terms of preventive visits, but really need you to explain, at the time of the visit, that a preventive visit may not be covered with their insurance.  While ABN’s are required for Medicare claims that are not covered, it might be a good idea to use the same ABN's for your commercial claims as well.   This way you would have documentation that the patient understood their potential financial responsibility in the event that insurance did not cover specific services.  (This is the exception to tip #5 above as the patient will need to be aware of the potential cost for the uncovered services.)

When a patient persists with customer service and insists that the charge used wasn’t correct, we may need to get the practice involved and will ask you (in writing) if the proper code was used – preventive vs. sick visit.  We appreciate a written response to these inquiries so we may confirm to the patient that the charge was coded correctly.

And the #1 preventable customer service call…   – “Why did you bill my old insurance?”

Of all the scenarios that are preventable this one is the biggest challenge for our Customer Service team.  Patients call after receiving a statement for the full amount of the visit, or because charges were billed to the wrong insurance.  

In most instances, the correct insurance has been entered into the system, but it was not tied to the charge correctly at time of charge entry.  This occurs because the new insurance and the charges are entered at different times.  Take a look at the two scenarios below and you will see how things can get fouled up: 

Example 1: The patient was registered at the time the appointment was made; however, no insurance information was entered at that time. Instead, the insurance was loaded when the patient arrived for the appointment. However, when the charge is entered, it is being linked to the information on the appointment scheduler, (which was entered with no insurance), so the charge is not submitted to the insurance, but to the patient directly.

Example 2: The patient’s old insurance is in the system at the time the appointment is made. The patient arrives with new insurance information, which is entered into the system and the old insurance is inactivated. When the charge is entered, it is linked to the appointment scheduler, which has the old insurance- the insurance that was active when the appointment was scheduled.  Even though the old insurance has been inactivated, charges are submitted to the old insurance because the new insurance was not linked.

Stress to your staff the importance of correctly loading insurance every time a change is made between the time an appointment is made and the time that charges are entered, and help us improve the service (and satisfaction) of your patients…all because they DIDN’T have to call customer service!

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Alta Partners In Our Community

The employees of Alta Partners supported several health awareness events in our community over the summer.

On Saturday, June 24, about a dozen Alta employees, family and friends participated in the American Lung Associations’, “Asthma Walk” held at Crocker Park Mall in Westlake.  The weather was perfect, ant there were plenty of sights (and shops) to see during our 3 mile walk.  Thanks go out to Linda Judge for serving as our team captain for this year’s walk where Alta Partners raised awareness and money for the cause of hopefully curing Asthma one day. 

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Continuing with our Lung Association theme, Alta Partners also hosted a rest stop on Thursday, August 4 for a group who were bicycling across the country as part of the American Lung Association’s 2006 Big Ride Across America!  40 cyclists from all over the USA enjoyed lunch put on by the many fine cooks in our office.  The bikers traveled from Sandusky and enjoyed the break before continuing on to their day’s end, in Burton, Ohio.
 

Oh My Goodness – WHAT HAPPENED TO MY CASH IN SEPTEMBER!

I don’t know how to say this other than our government; THE UNITED STATES OF AMERICA GOVERNMENT is now managing their cash short falls just like any other household does when they fall behind in debt, they don’t pay their bills until they get next month’s “pay check”.   See the below message which is on PalmettoGBA’s website and you’ll understand:

Hold on Medicare Payments

This message is a reminder for all providers and physicians who bill Medicare contractors for their services. 

A brief hold will be placed on Medicare payments for all claims during the last 9 days of the Federal fiscal year (September 22 through September 30, 2006).  The payment delays are mandated by section 5203 of the Deficit Reduction Act of 2005.  No interest will be accrued and no late penalties will be paid to an entity or individual by reason of this one-time hold on payments.  All claims held during this time will be paid on October 2, 2006.

Please note that payments will not be staggered and no advance payments will be allowed during this 9-day hold.

For more information, please view the MLN Matters Article at: http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5047.pdf

Now if only we could tell OUR creditors that we will not be paying them when their invoices are due and not incur any penalties!  - Suffice it to say that you need to be aware of this, and expect lower cash collected in the month of September, to return back to normal in October.

Let Us Hear From YOU!

We’d love to hear back from you and work to make this communication as interactive as possible.  Have an idea for an article or topic that you think would be good to put into our newsletter?  Send us an email with your topic. Be as specific as possible. If we use it in an upcoming E-Newsletter, we’ll give you a $50 gift certificate for your contribution.

Email your ideas to Stan Kasmarcak sjk@altapartnersllc.com.

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