Cosmetic Procedures: Scheduling, Registering, Checking In, Collecting Documents, and Collecting Payment

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Date Last Revised: 1/7/2021 3:05:00 PM 1

Cosmetic Procedures: Scheduling, Registering,

Checking In, Collecting Documents, and

Collecting Payment

3. If payment in full is not received 7 days prior to the scheduled procedure date, Lenise Mulvihill will coordinate with the office to cancel the case. RMG RHFC Ruebhausen staff will call OR scheduling to cancel or reschedule and will send an email notice via the PFS COSMETIC CHARGE CAPTURE email group.

• Fees are collected based upon the current Cosmetic Procedure Price List.

• The first fee collected is the Initial Consultation fee of $100, which will be collected at the time of scheduling. This is to discourage no shows. If the patient calls to reschedule prior to the appointment, we must use the Cancel/Reschedule activity to reschedule, which will move the $100 payment with the new appointment. If they do not show up for their appointment, we will post a new charge, PRC COSMETIC CONSULT NO SHOW, and apply the payment to the no show charge. There will be no refunds for cosmetic no shows.

• If the patient opts for a procedure after the initial consultation, the consultation fee is applied toward the procedure price.

• If the patient does NOT opt for a procedure after the initial consultation, the consultation fee covers the consultation and is non-refundable.

• Consultations are good for 6 months. After this time, a new consultation will need to be scheduled and a separate consultation fee collected.

• Payments are NOT collected via the typical prepayment workflow. There is a specific workflow outlined in the Check In, Collect Documents, and Collect Payment section of this tip sheet.

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• If multiple procedures are performed at the same time, we will discount the RMG Professional Fee and the Facility Fee (including both Riverside Medical Center and Riverside Ambulatory Surgery Center aka RASC) 50% of the lowest priced procedure. A multiple procedure calculator has been added to the Cosmetic Price List to help with this.

• At no time would we discount implants, overnight recovery, or retail products.

• No prompt pay, self pay, or uninsured discounts are offered for any cosmetic procedures.

ENT Patient Workflow Differences

• Patients will probably NOT schedule a cosmetic consultation at ENT. They are brought in for a medically

necessary consultation (billed to health insurance), and it is then determined that a procedure will be scheduled. Whether the procedure is cosmetic or not will be discovered either during or post office visit.

• The $100 consult fee will NOT be collected for the medically necessary condition consultation.

• Insurance companies have medical policies that dictate medical necessity and may impact authorization of certain procedures as covered benefits. This must be considered during the authorization process.

• As ENT patients may not return to the office for a visit:

o The signed contract may be handled electronically between the office and the patient. o RMG and/or hospital payment may be obtained over the phone.

o NAPA payment - checks are currently the only accepted method of payment. We are waiting to hear if they will accept credit card payments for this scenario.

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RMG Clinic Cosmetic Workflows

Scheduling

In-office cosmetic procedures are scheduled in the RMG RHFC Ruebhausen department with Dr. Ruebhausen. In the Make Appointment activity:

• Enter an appropriate Appointment Note.

• Choose Visit Type = Cosmetic Procedure.

• Dr. Ruebhausen’s name autofills.

• These cosmetic procedures are scheduled into the existing Procedure block, which is currently on Wednesday afternoon and Fridays. Select the desired appointment date and schedule the

appointment.

• Every time any cosmetic procedure is scheduled, send an email to the email group for review.

Registering

1. Review and update as necessary all patient information. 2. On the Visit Info form:

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Date Last Revised: 1/7/2021 3:05:00 PM 5 A. Select the patient’s personal family (P/F) guarantor account.

B. Collect/verify the patient’s personal health insurance information – scan in card(s) accordingly. (See scripting section below for WHY we are collecting this information.)

C. Answer all 5 required questions.

Check-In, Collect Documents, and Collect Payment 1. On the DAR, select the patient and click Check In.

2. Collect an Ambulatory Consent for Treatment (if not already on file for RMG).

3. For Botox procedures, collect the Botox Informed Consent and scan into the document table.

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Date Last Revised: 1/7/2021 3:05:00 PM 6 Before any cosmetic procedure can be performed, RMG RHFC Ruebhausen staff must also collect and scan in a paper Cosmetic Contract that includes the estimate. There are two contracts:

▪ In-office procedures: form #751267 ▪ Facility procedures: form #751309

a. For procedures performed in a Riverside facility or at RASC, this will include the estimate for Dr. Ruebhausen, Riverside Medical Center, and NAPA (anesthesia group). Estimates for the patient are created based upon the current Cosmetic Procedure Price List.

b. Obtain the patient’s signature and witness.

c. Scan the completed document into Epic under document type COSMETIC CONTRACT. This contract will not be available until after the consultation is complete and the contract has been developed by the provider with the office staff’s assistance. As such it will be collected after the consultation or at check-out, whenever is most convenient for all involved.

It will be critical for RMG RHFC Ruebhausen staff to scan in the contract: The facility procedures contract will be used by OR Registration staff to populate the pre-payment field and by

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Date Last Revised: 1/7/2021 3:05:00 PM 7 5. If multiple procedures are performed at the same time, we will discount the RMG Professional Fee and

the Facility Fee (including both Riverside Medical Center and Riverside Ambulatory Surgery Center aka RASC) 50% of the lowest priced procedure. Here is an example:

Let’s use the example of a patient that wants a bilateral breast augmentation and a tummy tuck. Here is our current cosmetic price list:

➢ The NAPA estimate will not change as it is based on minutes. So the estimate for NAPA is $1,850 ($550 for the augmentation and $1300 for the tummy tuck). If it is performed in fewer minutes than

estimated, NAPA will refund any overpayments directly to the patient.

➢ Let’s assume this is being performed at the hospital. The total RMG pro fee + RMC facility estimate is $9,065 ($3,940 + $5,125)

o The total for the RMG Pro Fee for Dr. Ruebhausen’ s service is $5,375 ($2,000 + $3,375) o The total for the RMC Facility fee is $3,690 ($1,500 + $440 + $1,750)

➢ Because we are scheduling multiple procedures, the Riverside estimate will now be $7,315

Dr. Ruebhausen RMG Pro Fee is $4,375. We will discount the augmentation from $2,000 to $1,000, as it is the lowest priced procedure in this example ($1,000 + $3,375)

Hospital Facility Fee is now $2,940. We will discount the augmentation from $1,500 to $750. ($750 + $440 + $1,750) – Note: Implant remains at $440, no discount

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6. For procedures performed in a Riverside facility or at RASC, send an email to NAPA to the following email addresses to inform them of any patients you have provided quoted estimates to and the amount of that quote:

CosmeticsMelvilleOffice@napaanesthesia.com vbarbosa@napaanesthesia.com

Questions regarding this may be directed to: Michelle Tsang

Director, Revenue Cycle Management North American Partners in Anesthesia 6800 Old Collamer Road, Suite 1 East Syracuse, New York, 13057

Phone: 315-413-5229 Fax 315-413-5229

MTsang@napaanesthesia.com

7. Scripting to use when delivering the contract & estimate to the patient

A. Utilize this scripting when the patient is scheduled for a fully cosmetic procedure:

“You are scheduled for a fully cosmetic procedure. This procedure will not be submitted to your insurance. As a patient, you are 100% financially responsible for all cosmetic procedures. Riverside

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Date Last Revised: 1/7/2021 3:05:00 PM 9 Medical Center will not bill your personal health insurance for cosmetic procedures UNLESS there are complications; this is why we collected your personal health insurance information. Details about the need to bill your personal health insurance should complications arise are included in the contract being provided to you. I have a contract for you to review and sign. Within this contract the estimated cost for the procedures is listed. Please note all payments are due 7 days prior to your procedure. If any complications arise, these services are not included in the listed estimate and additional payment will be due. Do you have any questions?”

B. Utilize this scripting when a patient is scheduled for a partially cosmetic procedure:

“Your scheduled procedure includes a service that is considered cosmetic. This procedure will not be submitted to your insurance. As a patient, you are financially responsible for 100% of all cosmetic procedures. Riverside Medical Center will not bill your personal health insurance for cosmetic procedures UNLESS there are complications; this is why we collected your personal health insurance information. Details about the need to bill your personal health insurance should

complications arise are included in the contract being provided to you. I have a contract for you to review and sign. Within this contract the estimated cost for the cosmetic portion of the procedure is listed. Please note all payments are due 7 days prior to your procedure. If any complications arise from the cosmetic procedure, these services are not included in the listed estimate and additional payment will be due. The OR Registrar will contact you with a separate estimate for the medically necessary portion of your procedure. Do you have any questions?”

8. Click ContinueCheck In.

9. Collect Payment in Full Prior to Procedure

RMG RHFC RUEBHAUSEN staff will collect ALL payments, both for procedures performed in-office and at a Riverside facility.

A minimum of 7 days prior to the cosmetic procedure, RMG RHFC RUEBHAUSEN staff will collect payment in full. For procedures performed in a Riverside facility (outside of the office), you will collect two or three separate payments:

A. Dr. Ruebhausen’s (provider) fees B. The facility fees (Riverside or RASC) C. NAPA (anesthesia)

If procedure performed at Riverside, collect two payments: one payment for provider (PB) and Riverside (HB) charges (posted in one Enterprise Payment) and a separate check or money order for NAPA.

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Date Last Revised: 1/7/2021 3:05:00 PM 10 If procedure performed at RASC, collect three separate payments: one for provider (PB) fees, a check or money order for RASC, and a check or money order for NAPA.

We can accept any of our normal payment options for Dr. Ruebhausen and Riverside’s surgical department and these are entered via Enterprise Payment Posting (see Step #9).

For NAPA and RASC, we will ONLY ACCEPT A CHECK OR MONEY ORDER.

a. Collect a separate check or money order, made out to NAPA, and mail that check to: North American Partners in Anesthesia IL, LLC

PO Box 69

Glen Head, NY 11545

b. Collect a separate check or money order, made out to RASC, and mail that check to: Riverside Ambulatory Surgery Center

300 Riverside Drive, Suite 1100 Bourbonnais IL 60914.

Contacts: Carrie Stauffenberg or Robin Diepeveen. They both may be found in Riverside’s Outlook address book.

10. Click Enterprise Payment.

NOTE: Payments collected for hospital charges can be posted together with the provider (PB) charges. (Hospital charges will be transferred by billing staff to the appropriate HAR after it is created).

11. You may also click Collect Payment on the patient’s Interactive Face Sheet (Registration) to enter this workflow.

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Date Last Revised: 1/7/2021 3:05:00 PM 11 12. Click Add Prepay.

13. Click on the magnifying glass by Pre-Payment and select Office Cosmetic (PB).

• Manually enter the amount being collected for the cosmetic procedure (e.g. $100 for consultation). The $100 consultation fee MUST be collected at the time of scheduling (exception is ENT patients – see “ENT Patient Workflow Differences” section of tip sheet). This is to discourage no shows. If the patient calls to reschedule prior to the appointment, we must use the Cancel/Reschedule activity to reschedule, which will move the $100 payment with the new appointment. If they do not show up for

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Date Last Revised: 1/7/2021 3:05:00 PM 12 their appointment, we will post a new charge, PRC COSMETIC CONSULT NO SHOW, and apply the payment to the no show charge. There will be no refunds for cosmetic no shows.

14. Be sure to tab off the entry so that the total amount being collected displays correctly. Click Collect Payment and collect the payment.

If the patient does not prepay at the time of scheduling, add the amount to be collected per above, click “Not Collecting”, and provide a reason why you are not collecting.

15. If the patient opts to have a cosmetic procedure done on the same day as the consultation, you will need to enter Payment Posting again and add and collect another Cosmetic prepayment to the associated appointment. You may add multiple pre-payments to an appointment (e.g. clinic charges and facility charges). Just remember to choose the Cosmetic prepayment option.

NOTE: When you enter additional prepayments, the previous ones will no longer display as “Cosmetic” – they will revert to “Pre-payment”. This is ok. The build team verified it is working; it’s just a display issue when a second pre-payment is collected.

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16. When the provider adds additional changes during the in-office encounter, they will show up during

check out. The front desk will see these under Orders in the check out activity, which will help the front desk determine/verify price from the cosmetic contract:

17. If payment is collected outside of the appointment encounter (e.g patient calls or stops in ahead of appointment to make a prepayment), when you enter Payment Posting you will use the previous balance section/workflow: Click Edit, change the post type to Cosmetic and leave the payment as undistributed. Automation in the credit workqueue will take care of payment distribution.

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Cosmetic Procedures Performed in a Facility

Hospital Scheduling

Cosmetic procedures are scheduled in the facility with Dr. Ruebhausen and ENT providers through the case request workflow.

There are two new cosmetic billing type questions that have been added to the case request order. Cosmetic OR Scheduling Process

• Schedulers see 2 Cosmetic Billing Type questions in their Sched Info form in Case Entry.

• Procedures to be scheduled as OPS SDS Type only, NOT Inpatient or IP Surg Admit.

• Procedures are NOT to be scheduled earlier than 7 days out, in order for payments to post.

• If patient’s have not paid 7 days prior to the scheduled case, the office will be called to either cancel or reschedule into future to give patient time to make payment.

• No cpt codes are required for a Fully Cosmetic procedure, only Partially cosmetic.

• If patient is Medicare and is a Fully Cosmetic procedure, you will not run the ABN. Patient is a self pay.

• If patient is Medicare and is a partially cosmetic procedure, authorization for the specific Cpt Codes is required.

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Date Last Revised: 1/7/2021 3:05:00 PM 15 A scheduling warning will appear if the patient is not scheduled as an OPS SDS Type:

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Hospital Registration

1. All cosmetic procedures will fall into workqueue RMC Cosmetic Procedure [8678] for registration. 2. Do a full hospital registration.

3. Review and update as necessary all patient information. 4. On the Encounter Info form:

a. Select the patient’s personal family (P/F) guarantor account. b. Answer all 5 required questions.

5. Add the appropriate Hospital Account Activity (billing indicator). a. Go to the green Hospital Account folder

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Date Last Revised: 1/7/2021 3:05:00 PM 17 c. Type in “COS’ in the search field and select the appropriate account activity.

765 = Cosmetic Full 766 = Cosmetic Partial

d. Click Accept.

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Date Last Revised: 1/7/2021 3:05:00 PM 18 a. For fully cosmetic procedures, remove any attached coverages, then click Do not bill insurance

box.

b. For partially cosmetic procedures:

i. Leave the insurance on the registration, as it will be billed for the non-cosmetic portion of the procedure.

ii. Run an estimate on the non-cosmetic portion of the procedure and provide the estimate to the patient. Collect payment as usual for this portion.

7. Once the HAR is created, go to Media Manager and locate the cosmetic contract. Populate the pre-payment due for the cosmetic procedure from the contract using the steps below.

a. Go to the hospital encounter for the procedure (if you are not there already). b. Click on Estimates.

c. Verify that the information which populates for the estimate is correct and click Accept. Coverage information should NOT populate for cosmetic procedures, only for non-cosmetic procedures.

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Date Last Revised: 1/7/2021 3:05:00 PM 19 d. Click on the Patient Pays field and enter the amount due for the hospital portion of the

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Date Last Revised: 1/7/2021 3:05:00 PM 20 e. Click Save.

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Date Last Revised: 1/7/2021 3:05:00 PM 21 g. Next to the Pending Estimate, click on Prepay field, select “Facility Cosmetic (HB)” and enter

the amount due from the contract. Make sure the amount collecting field is $0.00. Click “X” to close when done.

8. If the patient wishes to make a payment toward their full or partial cosmetic procedure, view the Cosmetic Contract in the media manager and post the payment in Enterprise Payment. NOTE: You will not be able to see any previous prepayments made, so ask the patient what, if any, previous payment she has made toward the procedure. See payment posting process in the “RMG Clinic Cosmetic Workflows” section of this tip sheet.

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Date Last Revised: 1/7/2021 3:05:00 PM 22 9. Schedule your PAT as you normally would.

When Complications Arise During Cosmetic Procedures

When complications arise during cosmetic procedures conducted in a facility, Access staff must do the following:

1. Call the patient’s insurance for authorization/benefits and find out whether or not complications from cosmetic procedures are covered.

2. If complications are NOT covered, send notice to the PFS_FinancialCounselor email group. A Financial Counselor/customer service representative will contact the patient immediately to notify the patient of the non covered services. The Financial Counselor/customer service representative will make payment arrangements with the patient prior to them leaving the facility.

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Workqueues

1. RMC Cosmetic Procedure Pre-Pay Review [8680] – Monitored by Customer Service:

This workqueue will captureaccounts for a patient with cosmetic procedures to be performed. a. Payment is to be collected prior to services performed.

b. Patients will populate that are scheduled within 8 weeks with no payment collected.

2. RMC Cosmetic Procedure [8678] - Monitored by OR schedulers.

Cosmetic Procedures: Scheduling, Registering, Checking In, Collecting Documents, and Collecting Payment