Applies to: Surgical Counselors, Front Office Lead, Clinic Leads, Billing Lead
 
On all elective cases, we need to get payment up front.  There are simply too many scenarios in which, when this does not happen, one of two things result:
 

1. We spend an inordinate amount of time pursuing the payment;
2. We do not get paid.

 
Therefore  do not make payment plans on the day of surgery because monies may not collected. It is a key responsibility of the each of the Counselors to explain that their (estimated) copayments, co-insurance, deductibles, and other amounts due for surgery (FEC and ASC) must be paid in advance of surgery.  The Counselors also need to explain that if the payments due in advance of surgery are not made, unfortunately, their procedure will be cancelled. This is especially important with regard to patients having DSEK and Transplants (PKs).
 
We should not be ordering corneal tissue – which costs ~ $4600 – until the Counselor confirms that any copayments, co-insurance, deductibles, and other amounts due for surgery (FEC and ASC) have been paid in advance of surgery.
 
All such scenarios – concerns/issues related to payment must be brought to the attention of the CEO, Billing Supervisor, ASC DON and Scheduling Supervisor.
 
Patients are not to pay for premium IOLs, LRIs, copayments, deductible, co-insurance and other patient financial responsibilities on the day of surgery,  these monies are to be collected in advance of the day of surgery.  Some people may not be prepared to make payment at the time of pretesting/Counseling, but they could do so at any time in advance of surgery.
 
Some patients who may not feel comfortable providing you with credit card information over the phone.  They can drop a check off in advance of surgery or pay by credit or debit card in person if this makes them more comfortable.  They can also pay via our patient portal.  (If you have questions regarding this, ask the Billing Supervisor).
 
This should be explained to patients at the time of pretesting to ensure that the payments we need to receive are, in fact received prior to surgery.

Applies to: Front Office Leads, Cllinic Leads
 
When our physicians are called in to do an emergency surgery before their clinic starts, it is very important that we notify patients that the doctor had an emergency surgery to perform.
 
The other point is that the front desk coordinator should occasionally call the OR, speak directly to the Director of Nursing, and obtain estimates – subject to change – as to the anticipated time of completion of the surgery – and to communicate this information to assist the clinical supervisors, the desk staff, CEO and others to manage patient expectations and to plan.

Applies to:  All Employees
 
In the event of a patient becoming injured while on TEI property, the most important thing is to make sure the patient is safe and further damage occurs.  While most of the falls are minor and need no further follow up, they can also be tragic and have poor or tragic results.  I want to make sure that everyone understands the correct process to follow if such an event should occur.  Please keep in mind this is not limited to falls, but to any time a patient becomes injured on our property.   It is important that all staff know what to do if this should happen.
 
STAY CALM.
Immediately see that the patient is stable.  
Quickly assess the situation to see if a doctor or other health care provider is needed. For the Melbourne location, remember that on Tuesdays, Wednesdays and Thursdays there is a likelihood that there are medical staff in the ASC who may be able to assist. 
If so, contact the doctor or other health care provider that is closest to the situation, advise them of the name, condition and location of the  patient. 
Depending on the condition of the patient, ask another employee to stay with the patient until you are able to seek additional help. 
If needed , contact 911 IMMEDIATELY, advising the 911 operator of the address, type of incident, current condition of patient, name of patient, and location of patient (i.e., 2nd floor, hallway X). 
DO NOT attempt to move a patient that is non-responsive or unable to move on their own as you could further injure the patient. 
It may be possible that bandages or compresses are needed.  Know where to locate them in each of your offices.
 
When the patient is stabilized, contact Human Resources for an incident report and let her know what has happened.  The incident report needs to be completed as accurately and quickly as possible after the incident so that key details are not  forgotten.  Please include any witnesses to the incident and secure their statement of what they witnessed or how they participated. 
 
Return the completed Incident Report to Human Resources.
 
If you have any questions, please do not hesitate contact Human Resources.

Effective immediately the process for securing money collected should be as follows:

• Melbourne office – Front desk person should balance and close their batch; all monies collected for the day in each drawer should be sealed in an envelope, with the staff member whose drawer it is having first counted the money, then signing and dating the envelope over the back seal of the envelope prior to taping over the signature to fully seal the envelope.With this done and the cash enclosed verified, the envelope should be placed in the lock box located in Michele Sacco’s office.
  
  
• Palm Bay and Rockledge offices – Front desk person should balance and close their batch;all monies collected for the day in each drawer should be sealed in an envelope, with the staff member whose drawer it is having first counted the money, then signing and dating the envelope over the back seal of the envelope prior to taping over the signature to fully seal the envelope.The envelope should not be sealed until the monies contained therein have also been counted by the staff member taking the charts to Melbourne.Once this has been done both the staff member whose drawer contents have been placed in the envelope, as well as the transporter should sign and date the envelope over the back seal of the envelope prior to taping over the signature to fully seal the envelope.Once the envelope has been transported to Melbourne the transporter is to place the envelope in the lock box located in Michele Sacco’s office.

Applies to:  Front Office Leads, Anterior Segment Assistants, Doctors, Clinic Leads
 
When filing out the Amniograft post cards please DO NOT USE the patient’s name.  You MUST use patient’s account # only.  Any use of their name is a HIPAA  violation since this information is on a post card which anyone handling the mail would have access to.

Applies to: Jason K. Darlington, M.D.; Anterior Segment Assistants; Billing, Marketing, Front Office Leads; Clinical Leads

In order that billing be correct, and in order for us to be in compliance, the following steps must be taken in all cases and without exception.
 
In order that YAG Cap procedures that are to be co-managed get filed appropriately from the start, three items need to be addressed:
 

1. The record needs to be appropriately documented under PLAN that the patient is to be co-managed.  Be specific in your note.  Example:   “Patient to see Dr. Lawrence Thomas for PO care and be co-managed at Optique Unique.”
2. The Superbill needs to be noted – “COMANAGED – 54 – Dr. L. Thomas.”
3. The usual co-management paperwork should be signed – both by the surgeon and the co-managing doctor, as well as the patient.   If the patient does not arrive with co-management paperwork from the referring/co-managing doctor,  this paperwork should be available in the exam rooms and signed by the surgeon and patient.  This should be placed in the outguide.  When it gets to billing, it should get to Louise to ensure that the document is countersigned by the co-managing doctor.  This paperwork must be kept on file.
4. If at checkout, the Superbill is noted that the patient is to be co-managed but there is no paperwork in the outguide, this must be brought back to the surgeon to be addressed by check out or the front desk supervisor.  (Front desk supervisors – review this carefully with all checkout staff.).
5. Clinical Supervisors – be certain that all assistants are fully clear as to their role and responsibilities relating to this matter.

Applies to: Front Office Receptionists, Schedulers, Phone Operators
 
If a patient’s appointment is changed just 10-15 minutes, this can cause the patient to be rescheduled due to the patient being too late to be seen relative to the new appointment time.  We cannot presume the patient has received a message of the appointment change.
 
All patients must be spoken to directly before appointments are moved.
 
If we need to leave a message for the patient we must note that we did so in the appointment description as follows:
LM for pt to change appt.  time to 10:15 6/27 AS.
 
It is imperative that we continue to follow up until the patient can be spoken to directly. 

Applies to: Doctors, Assistants, Clinic Supervisors, Billing, Front Office
 
Please see the information below.  It shows where the "Residence" listing is noted under the "Social History" Section in Medflow.  (This is where you would note if the patient resides in a private residence vs. a nursing home, an assisted living facility or a rehabilitation facility).
 
This is of great importance as due to the "consolidated billing" rules, if we do not determine if a patient resides in a nursing home, an assisted living facility or a rehabilitation facility, prior to initiating care and we do not contact that facility first to authorize payment we will not receive payment, even if the patient has a valid Medicare card.  (If payment is made, it will likely be recouped within three months).
 
All Assistants must double check this at all visits - we cannot assume that by looking at someone and seeing that they appear relatively healthy that residency in one of these types of facilities is not a possibility.  The consolidated billing issue becomes a factor even for very short/temporary stays.
 
If you find that a patient resides in such a facility, immediately contact the Billing Lead so that she may obtain authorization prior to initiating care.  If you have difficulty getting ahold of someone in billing me and I will facilitate this .

Sent: Thursday, April 4, 2013 4:58 PM
Subject: RE: Nursing Home/Rehab/Assisted Living Tab in Allscripts
 
Please see the updated attachment.  This shows where in Medflow this information will be entered and accessed. 
 
Unfortunately, we are unable to edit section headings in ROS, but I was able to add a “Residence” section in Social History (right next door to ROS and Family History J )

From: Front Office Lead
Sent: Monday, February 24, 2014 12:50 PM

Patients frequently receive new insurance cards at the beginning of each year.  Because of this, we should be scanning ALL insurance cards the first time we see patients each calendar year, at the time of check in. 
 
At this time we should be asking patients if they have received a new insurance card or cards recently (in some cases, patients may have multiple insurance cards, and it may not be clear to them which cards are the most current ones).   Whenever you are presented with multiple cards and it is not completely clear as to which is/are the most current, please call the Billing Department at 186 for further assistance in verifying the correct insurance.
 
We should be checking insurance at subsequent visits to ensure that no changes have been made, including new plans, loss of coverage or other circumstances that could impact payment, copays or deductible .
 
Scheduling/telephone staff – be certain that you are asking about insurance and any potential changes.