Question

You are the manager of patient registration at a community hospital. When registering patients, your staff is required to obtain insurance information. The largest employer in your town has recently changed its employee benefit plan from an indemnity plan to a managed care plan. As the manager of patient registration, you must educate your staff as to the differences in registering patients in a managed care plan versus an indemnity plan.

What will be your process for obtaining co-pays? How will your staff handle cash or checks? How will you ensure that cash or check co-pays are correctly credited to each patient’s account? What will you instruct your staff to do if a patient with managed care insurance comes to the hospital for admission but their physician is not a participant in the patient’s managed care plan?

Answer 1

The managed care plan is a type of health insurance who has contracts with health care providers and medical facilities to provide care for members at reduced cost.

The indemnity plan is where an individual can visit almost any doctor or hospital they are interested and the insurance company then pays a set portion of the total charges.

A copayment is a sum amount which is fixed, paid by a patient to the service provider before receiving any service.

The process of obtaining co pay is that when a individual pays a fixed amount for example $50 for a covered health service after paying the deductible. For instance If a patients insurance allowance cost for doctors office visit is $120. The patients co pay for the visit is $50. If the patient has paid the deductible he can just pay $50, usually at the time of visit. If the client had not met his deductible the client must pay $120 full allowance amount for the visit.

The process for obtaining copay is that : When the patient arrives, verify his/her demographic and insurance eligibility and benefits and upon receiving the response from the health insurer, inform the client of his coverage, details making sure to identify the copay, co insurance and remaining deductible amounts.

As the copay should not be billed and must be collected at the the time of service the staff can handle cash or cheque of the payment what the patient has done. If the client has paid the cash it has to be entered with all the required details in the system and mode as to be put as cash and if it's by cheque... Must be clear with all the details and should assure it has no problems with account of cheque bouncing so that she enters the details of patient account details with cheque number and even making sure that the insurance company has signed.

The status of money credited to each patients account can by ensured by checking the status and balance of each client and also the acknowledgement received.

Managed care insurance is a type of health insurance whereby they have contracts with the health care providers. If the patient with this insurance comes to hospital for admission but their physician is not a participant in patients managed care plan the staff can accept it proceed with other formalities as physician and patients have the contract with insurance company but not with each other.