FACULTY PRACTICE PLAN LIFE OF A CHARGE PROCESS
Function:
Patient Check In
Task(s):
Greet the Patient
Perform re-scheduling functions when necessary
Demographic Verification
Insurance Verification
Record HIPAA Privacy Standard (COA) information
Collection of Co-payment
Collection of Previous Patient Balance(s) as needed
Posting Time of Service Payments on Account
Receipt Processing
Obtain signatures as needed
Measurement/Report: Electronic and Paper Claim Edit Report detailing failed
insurance claims due to patient demographic information
Insurance Denial Report from PM system detailing
insurance denials due to incorrect patient demographic
information
Bad Address FSC Report from PM system detailing return
address mail
Standard:
=/<2% Electronic and Paper Claim Edits
=/<2% Insurance Denials due to missing/incorrect
demographic information
=/>95% Collection of Co-payments
=/>95% Collection of Previous Balances as identified from
CBO and noted on accounts prior to the visit
=/<2% Returned patient statements
Policy and Procedure
Purpose:
To obtain personal and financial information from patients in an efficient
and courteous manner. Ensure timely payment from third parties by
complying with all registration standards and billing requirements imposed
by the third parties and regulatory agencies. Minimize bad debt through
the timely identification, communication and proactive management of
patients with inadequate insurance coverage. Safeguard the handling of
cash.
EFFECTIVE DATE: ________________ AUTHORIZED: ________________
REVISION DATE: __03/19/14 _______ AUTHORIZED: Dir, Prac Mgmt
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To adhere to an “optimal patient service” mission whereby the patient is
greeted respectfully and expediently. To ensure that all
Patient/Responsible Party demographic information on file is accurate. To
safeguard the acceptance and collection of co-payments and patient
balances (if necessary) due prior to exam.
Policy:
Procedure:
1. The front desk staff member will be positioned so he/she is always facing the
reception area.
2. The front desk staff member will call the patient to the check in area to begin the
patient check in process.
3. The front desk staff member will indicate the patient as ARRIVED on the PM system
and the RowanSOM Time Reception list.
4. The front desk staff member will confirm the patient appointment by accessing the
daily schedule on the PM system. The front desk person will greet the patient and
verify the appointment time.
NEW PATIENT
1. If the practice submits a New Patient Packet to the patient prior to the exam, the
front desk staff member will review the patient chart to ensure that the the HIPAA
Privacy Practices for Protected Health Information documents, the Health History
Form (if applicable) have been received via mail or via the patient portal in the EMR.
If the patient elected not to complete the forms and brings to the practice or if the
practice does not utilize the New Patient Packet, the front desk staff person will
present the patient with the forms and instruct the patient to complete the
documents.
2. The front desk staff member will review the PATIENT INFORMATION FORM, the
HIPAA Privacy Practices for Protected Health Information documents, the Health
History Form (if applicable) for completeness. Any missing or illegible information
will be obtained from the patient immediately.
3. The front desk staff member will give the patient the face sheet for review, and ask
them to provide any additional information or changes to current information, and to
sign it verifying said information changes. Additionally, the patient will sign on the
face sheet that they have reviewed the HIPAA Privacy Practices for Protected
EFFECTIVE DATE: ________________ AUTHORIZED: ________________
REVISION DATE: __03/19/14 _______ AUTHORIZED: Dir, Prac Mgmt
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Health Information handout, for permission for Medicine Reconciliation and registry
submissions. (Facesheet must be signed for every visit.)
4. The front desk person will ask the patient for his/her insurance cards and state
driver’s license for photo identification. The insurance cards and driver’s license will
be scanned into the EMR (or copied if not available). If the patient presents more
than one insurance card, the front desk staff member will ask the patient which
insurance is primary. A scanned image of the insurance card(s) (front & back) will
be placed in the patient EMR chart along with the other documents.
5. The medical chart will be reviewed for previous records. If the patient medical
records have not been received, the patient will be asked whether he/she arranged
to have the records sent prior to the visit. If the patient indicates that he/she did not
arrange to have the records sent, then the front desk staff person will have the
patient complete a release of medical records for the previous/referring physician
and obtain the records for any follow up visits. If the patient indicates that he/she did
arrange to have the records sent and they have not been received the front desk
staff person will contact the patient’s referring provider’s office to obtain records.
6. If the visit is with the patient’s Primary Care Physician, the front desk staff member
will verify whether or not the appropriate Primary Care Physician or Primary Care
Physician Group name appears on the front of the card. If the PCP or PCP group
name is not indicated or is not the physician or physician group with whom the
patient has the appointment, the patient will be notified and informed that he/she will
be responsible for services and will be self-pay. This communication should be
documented in the appointments billing comments.
7. If the visit is with a Specialty Care Physician, the front desk staff member will ensure
that a referral has been received and documented by the authorization staff. If no
referral form exists, the front desk staff person will ask the patient if he/she has the
hard copy referral. If the patient indicates they do not have the hard copy referral
form, the patient will be asked to call the primary care physician and request that the
referral be faxed immediately.
8. The front desk staff member will collect the co-payment for the visit, if appropriate
and provide the patient with a receipt. If manual paper (as opposed to machinegenerated) receipts are used, such receipts should be sequentially numbered receipts
for all deposits and forms of payment, and the serial numbers should be controlled, that
is, the serial number for the next receipt on the pad should be indicated on the payment
journal for the previous service day and today. The amount collected and payment type
will be indicated on the patient encounter form and the payment journal (see attached).
Please write the patient MR# on all checks received. If the patient refuses to pay, it
will be indicated on the encounter form. Additionally, the staff member will document
why payment was not received in the practice management system under the
EFFECTIVE DATE: ________________ AUTHORIZED: ________________
REVISION DATE: __03/19/14 _______ AUTHORIZED: Dir, Prac Mgmt
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appointment billing comments (see user manual). If the patient wished to pay on a
current balance, or if the notes from the billing office indicate the same, then follow the
process indicated in the RowanSOM Depositing Payments Policy. This payment WILL
NOT be entered into the system but will be included in the payment journal.
9. The front desk staff member will enter the following information in the appropriate
format into the PM system:
a. Patient, Responsible Party and Subscriber Social Security Number - If the
Social Security Number is not known or refused, the following SS#’s will be
entered as an identifier:



000-00-0000 – newborn or child without a SS#
333-33-3333 – patient does not know
999-99-9999 – patient refused
b. Patient, Responsible Party and Subscriber last name, first name and middle
initial
c. Patient, Responsible Party and Subscriber street, city, state and zip code
d. Patient E-mail address
e. Patient, Responsible Party and Subscriber home and work telephone number
– if the home telephone number is not known or refused, the following
telephone numbers will be entered as an identifier:




000-000-0000 – no telephone
333-333-3333 – patient does not know
444-444-4444 – phone disconnected
999-999-9999 – patient refused
f. Patient, Responsible Party and Subscriber date of birth – if the date of birth is
not known or refused, the following date of birth will be entered as an
identifier:


01/01/1880 – patient received emergent or hospital care,
data not collected at visit, patient unable to give, or
patient does not know
01/01/1882 – patient refused
g. Patient, Responsible Party and Subscriber sex
h. Patient, Responsible Party and Subscriber Employer
EFFECTIVE DATE: ________________ AUTHORIZED: ________________
REVISION DATE: __03/19/14 _______ AUTHORIZED: Dir, Prac Mgmt
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i.
j.
Patient Primary Care Physician Name and Telephone Number
Patient Primary Insurance information: Insurance Company Name, Address,
Telephone Number, Identification Number and Group Number
k. Patient Primary Insurance effective date

l.
m.
n.
o.
p.
q.
r.
s.
If the insurance does not exist in the system, select insurance
named Commercial FSC to finish check in process and
complete the necessary follow up FSC questions or
commercial insurance.
Patient Secondary Insurance information: Insurance Company Name,
Address, Telephone Number, Identification Number and Group Number
Patient Secondary Insurance effective date
Patient Tertiary Insurance information: Insurance Company Name, Address,
Telephone Number, Identification Number and Group Number
Patient Tertiary Insurance effective date
Patient Signature on File Information
Patient Emergency Contact, Relationship to Patient and Telephone Number
Patient Insurance Co-payment information
HIPAA Privacy Standard Information (COA)– the information will be recorded
as follows in the designated area in the PM system:


Line #1: “XX/XX/XXXX”-Enter date the patient was given the
HIPAA Privacy Information Packet
Line #2: “XX/XX/XXXX”-Enter date the patient signed the face
sheet acknowledging the Patient Privacy documents
10. The front desk staff member will post the co-payment (on account) to the PM system
and generate a receipt for the patient payment.
If time does not permit to complete registration changes into the PM system, the
front desk staff person will manually write the information on the face sheet and will
enter changes into system (on same date of service) and prior to scanning into the
EMR as time permits.
11. The front desk staff member will instruct the patient to be seated in the reception
area.
12. All registration documents will be filed appropriately.
13. The front desk staff member will place the patient medical chart or face
sheet/encounter form in the designated area to alert the clinical staff that the patient
EFFECTIVE DATE: ________________ AUTHORIZED: ________________
REVISION DATE: __03/19/14 _______ AUTHORIZED: Dir, Prac Mgmt
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has been checked in and is ready to be treated. The patient information will be
placed in appointment order to comply with patient satisfaction standards.
14. If this patient is an add-on (not already scheduled prior to the beginning of the day)
the check in staff must communicate this information to the check out staff at the
time of registration so they can ensure that they reconcile the encounter form when
the patient departs the practice.
ESTABLISHED PATIENT
1. If the patient is established, the front desk staff person will instruct the patient to
verify the demographic and insurance information on the PATIENT FACE SHEET.
The front desk staff person will further request that the patient manually indicate any
changes in the information. Lastly, the front desk staff person will ask the patient to
sign and date the face sheet to indicate he/she has reviewed the information,
indicated any updates, acknowledges the HIPAA Certification and to indicate
permission for Medicine Reconciliation and registry submissions. (Facesheet must
be signed for every visit.) .
3. The front desk person will ask the patient for his/her insurance cards. If the patient
presents more than one insurance card, the front desk staff member will ask the
patient which insurance is primary.
4. If the visit is with the patient’s Primary Care Physician, the front desk staff member
will verify whether or not the appropriate Primary Care Physician or Primary Care
Physician Group name appears on the front of the card. If the PCP or PCP group
name is not indicated or is not the physician or physician group with whom the
patient has the appointment, the patient will be notified and informed that he/she will
be responsible for services and will be self-pay. This communication should be
documented in the appointments billing comments.
5. If the visit is with a Specialty Care Physician, the front desk staff member will ensure
that a referral has been received and documented in the PM System. If no referral
form exists, or if it has expired, or has no further visits available, the front desk staff
person will ask the patient if he/she has the hard copy referral. If the patient
indicates they do not have the hard copy referral form, the front desk staff member
will check the eligibility verification system, or the patient will be asked to call the
primary care physician and request that the referral be faxed immediately prior to
completing the registration and inform the provider of potential delay.
EFFECTIVE DATE: ________________ AUTHORIZED: ________________
REVISION DATE: __03/19/14 _______ AUTHORIZED: Dir, Prac Mgmt
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6. The front desk staff member will collect the co-payment for the visit. If the patient
refuses to pay, it will be indicated on the encounter form, the payment journal and
the appointment billing comments.
7. The front desk staff member will record the payment amount and type on the
encounter form and the payment journal.
8. The front desk staff member will post the co-payment (on account) to the PM
system and generate a receipt for the patient payment.
9. The front desk staff member will refer to “billing comments” on the Appointment
Detailed Form, or the scheduling comments on the Time Reception List. If an
amount appears and the CBO has documented that the patient agrees to pay a
balance, the front desk staff person will inquire about payment. Otherwise, the CBO
will be in charge of collecting past due balance.
10. If time does not permit to complete registration changes into the PM system, the
front desk staff person will manually write the information on the encounter form and
will enter changes into system (on same date of service) as time permits.
11. The front desk staff member will instruct the patient to be seated in the reception
area.
12. All registration documents will be filed appropriately in the designated area.
13. The front desk staff member will place the patient medical chart, face sheet or
encounter form in the designated area in the clinical area to alert the clinical staff
that the patient has been checked in and is ready to be treated. The patient charts
will be placed in appointment order to comply with patient satisfaction standards.
14. If this patient is an add-on (not already scheduled prior to the beginning of the day)
the check in staff must communicate this information to the check out staff at the
time of registration so they can ensure that they reconcile the encounter form when
the patient departs the practice.
EFFECTIVE DATE: ________________ AUTHORIZED: ________________
REVISION DATE: __03/19/14 _______ AUTHORIZED: Dir, Prac Mgmt
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