Attaching Payers to a Patient

1. Attaching Payers to a Patient Chapter 5

2. Objectives • Gain a brief understanding of the different types of payers • Add a payer to a patient • Add a guarantor • Prioritize the payer order • Add insurance subscriber and policy information

3. Key Concepts • Patient responsibility • Financial classes • Financial viability • Mix of patients • Self pay • Guarantor • Payer • Subscriber • Primary payer • Secondary payer • Tertiary payer • Quaternary payer

4. Attaching Payers To Patients • Patient or patient’s guarantor(person responsible for bill) health insurance company will be paying for the patient’s medical services • MedTrak allows four simultaneous payers for each patient • Health care organizations track their financial information by individual payers and financial class of the payer • Important to the financial viability of the organization • Health organizations need a mix of patients in their facilities • Some classes pay for their medical services at higher rates than others

5. Categories for Financial Classes • Self pay • Guarantor • Commercial insurance • Medicare • Medicaid • Tricare

6. Medicare and Medicaid • The lowest rates typically are Medicare and Medicaid. • These are government payers • These rates based on national payer tables • These tables vary geographically • Commercial insurance carriers vary across companies but usually higher than government payers • Highest rates for medical care are Self Pay and Guarantor patients • Guaranteed patient is under age of 18 or incapable of payer for his/her own medical care. • Guarantor is responsible for the Guaranteed

7. Locating The Patient • MedTrak Main Menu • Click Patient Registration Button • Patients screen appears • Type patient last name • In Search Box • Click Search • Page refreshes • Your patient is at the top • Cursor in Command Field • Click Payers Button

8. Entity/Payers Select Screen • If your patient already had payers attached • Patient/Payers Screen would appear • If they do not, or they are a new patient • Entity/Payers Screen will appear

9. Selecting the Payer • Entity/Payers Screen displays all authorized payers for the entity that owns the health care facility • To attach insurance: • Place cursor in command field next to patients payer • Click SELECT PAYER button-for other than Self Pay or • Guarantor • Next Screen

10. Patient/Payer Screen

11. Patient/Payer Screen • Fields to complete: • Effective Date-date that coverage began • Termination date-date that coverage ends • ID number-subscriber’s contract number on front of insurance card • Group name-name of subscriber’s insurance group • Group number-number assigned by insurance company to subscriber’s group • Plan type-type of insurance purchased by group • Coinsurance %-percentage of the charges that subscriber must pay for the services-typically applies to MD portion • Copayment-amount subscriber pays for each office visit • Note-any special notes about copayment amount

12. Do This! Pg. 41

13. Attaching a Secondary Payer • Do This! Pg. 44

14. Attaching A Tertiary Payer • MedTrak returns to Entity Payers: Select screen with the message “Payer attached to patient…” at the top. • Do This! Pg. 45

15. Guarantors • For patients under the age of 18, there must be a guarantor attached to the patient, even if there is a group health plan. • The guarantor is responsible for paying the balance of any charges not covered by the insurance company. • Do This! Pg. 46