1. Chapter 5 Attaching Payers to a Patient

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. 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