Attaching Payers to a Patient

Chapter 5Attaching Payers to a PatientObjectivesGain a brief understanding of the different types of payersAdd a payer to a patientAdd a guarantorPrioritize the payer orderAdd insurance subscriber and policy informationKey ConceptsPatient responsibilityFinancial classesFinancial viabilityMix of patientsSelf payGuarantorPayer SubscriberPrimary payerSecondary payerTertiary payerQuaternary payerAttaching Payers To PatientsPatient or patients guarantor(person responsible for bill) health insurance company will be paying for the patients medical servicesMedTrak allows four simultaneous payers for each patientHealth care organizations track their financial information by individual payers and financial class of the payerImportant to the financial viability of the organizationHealth organizations need a mix of patients in their facilitiesSome classes pay for their medical services at higher rates than othersCategories for Financial ClassesSelf payGuarantorCommercial insuranceMedicareMedicaidTricare

Medicare and MedicaidThe lowest rates typically are Medicare and Medicaid.These are government payersThese rates based on national payer tablesThese tables vary geographicallyCommercial insurance carriers vary across companies but usually higher than government payersHighest rates for medical care are Self Pay and Guarantor patientsGuaranteed patient is under age of 18 or incapable of payer for his/her own medical care.Guarantor is responsible for the Guaranteed

Locating The PatientMedTrak Main MenuClick Patient Registration ButtonPatients screen appearsType patient last nameIn Search Box Click SearchPage refreshesYour patient is at the topCursor in Command FieldClick Payers Button

Entity/Payers Select ScreenIf your patient already had payers attachedPatient/Payers Screen would appearIf they do not, or they are a new patient Entity/Payers Screen will appear

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

Patient/Payer ScreenFields to complete:Effective Date-date that coverage beganTermination date-date that coverage endsID number-subscribers contract number on front of insurance cardGroup name-name of subscribers insurance groupGroup number-number assigned by insurance company to subscribers groupPlan type-type of insurance purchased by groupCoinsurance %-percentage of the charges that subscriber must pay for the services-typically applies to MD portionCopayment-amount subscriber pays for each office visitNote-any special notes about copayment amount

Do This! Pg. 41

Attaching a Secondary PayerDo This! Pg. 44

Attaching A Tertiary PayerMedTrak returns to Entity Payers: Select screen with the message Payer attached to patient at the top.Do This! Pg. 45

GuarantorsFor 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