FS Intake Trivia

What payor is loaded when you have exhausted your options in obtaining information from the clinic and/or patient?

Pending Payor Load/Verification

Self Pay Pending Insurance

Private Pay

COMM Self Pay

What are the top two main reasons our services are denied by a payor?

Services are denied for lack of information, that usually means we need to change the code being requested.

True

False

Patient services are being rendered in the patient's home, which verbiage should be used when requesting eligibility and benefits as well authorization?

Does plan cover compound medications administered through DME (implanted pain pump)?

Does plan cover home infusion therapy services, nursing services are involved?

Patient services are being rendered in the physician's office, which verbiage should be used when requesting eligibility and benefits as well authorization?

Does plan cover compound medications administered through DME (implanted pain pump)

Does plan cover home infusion therapy services, nursing services are involved.

If the prior verifier worked the account incorrectly, usually we just notate it already worked and close out the task.

True

False

The patient's plan termed, and a new insurance has been loaded. This is also an existing patient, which step should be performed before task is closed?

Flag the account

Create and a pending auth shell

Create credit rebill assignment

If a payor pushes back and states drugs are covered through the pharmacy, what would be your next steps?

Ask for name and reference #

Ask which dept process auth for drugs through the medical benefit that are not listed on the payor's auth list

Say thank you and end the call. Notate account and close task.

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