Customer Support. Department Training. Customer Support Department.

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Customer Support Department

Customer Support

Department Training

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Order Intake – Setting Groundwork for Order Processing

▰ Begin the process with the best possible verification!

▰ Slow down and think about each piece and how it shapes the entire order

▰ Share the information you see by using verification notes for the next person to see as well – this builds trust within the team

▰ The goal is to stop the need to double check each person’s work!

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Teamwork – Work Smarter, Not Harder

▰ Verifying the intake documents = Setting the basis for how the order is booked.

▰ Tell the sales agent the most you can to help the booking of the order in the most accurate and efficient way.

▰ The patient’s first experience is most often with the sales agent, so we want the experience to be as smooth as possible. First impressions matter!

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Why do the details matter?

▰ Booking orders correctly helps our Operations Team process orders easily.

▻ Time is not wasted by chasing Rxs for the wrong HCPCS; Requesting UAB notes for a patient who has been off of a machine for 3 years;

Booking reships because we didn’t ship the mask that the patient was fitted with during the titration.

▻These are team building improvements….encouraging us to trust each other by showing we are paying attention to what we are doing.

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Key Parts to Creating a Patient – Double Check for Accuracy

▰Demographics

▻Phone number(s) – Include all listed and any special contact notes (i.e. language, best time to reach patient, family member to contact)

▻Email address – It’s much easier for you to type it than an elderly patient spell it to the booking agent.

▰ Patient Came From

▻Selecting the wrong company can set the entire order for failure due to company settings.

▻Forgetting to add any company to the account basically makes the patient fall into a black hole.

▻AutoFax rules are set at Company level, not just doctor level.

▰ Insurance

▻Add both primary and secondary (when provided), then Everify

* SNAP Tip: When Adding the Patient Came From, you can type the name of the company once you click on the dropdown box – it won’t show what you’re typing, but it will scroll down to the company you type.

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Came From – Market Patients

▰ These are patients we are gaining through organic growth by our Territory Sales Managers – these are Verus reps going to doctor offices and asking for orders.

▰ Unless the patient came form the Total Respiratory, Persante, or Lifecare acquisitions – AND ARE ALREADY IN SNAP – any new patient from TX, and CA, that is not under another referral – should be added under their corresponding market, either Texas or California Marketplace.

▰ Also, any patient in those states who have not ordered in the last 12

months should also be tagged as Marketplace – this is tracking our efforts

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Don’t Miss the Forest for the Trees

▰

Begin with the Fax Cover – Although it is the first page of communication from the doctor’s office, the Fax Cover is often overlooked and underutilized.

▰

Read the Fax Cover – It may specify exactly what is needed or may respond to a request from us – then note it.

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Contact information is normally on the Fax Cover. It’s always a good idea to confirm the contact information that is listed on the Fax Cover matches the information in SNAP.

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Fax Cover

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Fax Cover ^…Cont’d

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Be Sure to Add the Doctor from the Fax Cover

Sometimes the chart notes / prescription / sleep study are all from different

physicians – make sure you check the Fax Cover to confirm you’re adding the correct physician to the patient’s file.

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3 Very Important Document Types

1. Sleep Study 2. Doctor Eval 3. Prescription

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Let’s Take Time to Understand Sleep Studies

▰ What is a Sleep Study?

▻Non-invasive overnight study of your brain and body during your sleep cycles by measuring things like oxygen levels, body movements, heart and breathing rates, to document any sleep disorders like apnea events or upper airway obstruction.

▰ What are the different types of sleep studies?

1.Diagnostic – 120 + minutes of recorded sleep without any treatment.

a.Facility/Lab test (Type 1) b.Home Sleep Study

2.Titration – 120 + minutes of recorded sleep with treatment (Mask and Machine) 3.Split night – Sleep without treatment, then with treatment during the same night.

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Understanding Sleep Studies

▰

Why does it matter if we pay attention to the type of sleep study?

▻Medicare requires proof the patient was instructed on how to perform the home sleep study o Proof of instruction can be found:

o Mentioned in the Doc Eval

o Signed by the patient on a delivery ticket / disclosure form o Pamphlet included with the home sleep test results

o Attestation form signed by the patient sent by Verus (used for older HSTs)

▻Medicare requires a facility/lab test for patients requalifying due to failing the compliance period.

▻Split night studies and titrations often state exactly what type of machine and mask the patient needs, telling us exactly what we should order for the patient.

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Examples of HST Instructions

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Examples of HST Instructions…Cont’d

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Verifying Sleep Studies

▰ Document Date – The date the sleep study was performed; if multi-night study, any of the study dates will work

▻May differ from the date signed or the date that the sleep study was ordered by the physician

▰ Interpreted by Doctor – The physician who interprets the test results

▻May differ from the doctor who ordered it

▻ If the doctor has multiple entries in SNAP, make sure to select the Sleep board Certified doctor, if possible.

▻ Use ABIM.com, ABSM.org, Healthgrades to confirm if the doctor does not show as Sleep Board Certified.

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Signature Versus Study Date

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Verifying Sleep Studies

▰ When to check the Interpreting Doctor Signed Document Box

▻Is it electronically or hand signed by the interpreting physician? Not the technician or RT oDictated but not read / signature on file / signed before reading does not mean signed

▻If yes, next question: Is it a home sleep study (type 2, type 3, or type 4)?

oNo – signed facility test: check the box

oYes, next question: Do we have proof of instruction?

•Yes – Signed, home sleep test with proof of instruction: check the box

oSigned, home sleep test, missing instructions: do NOT check the box. In the optional notes, write “HST without instructions”

▻Once the instructions are received, re-verify the Sleep Study and check the box.

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Verifying a Home Sleep Test without Instructions

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Verifying a Home Sleep Test with Instructions

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Verifying Sleep Studies

▰

AHI / RDI – Include both if listed

▻Apnea Hypopnea Index per hour – often found in

the summary section. We are looking for the average overall number per hour – this combines ALL sleep positions and cycles supine / lateral / prone / rem / nrem data.

▻Respiratory Disturbance Index – apneas,

hypopneas, and respiratory effort related arousals divided by total sleep time.

▻Make sure to use the overall number for the

diagnostic portion, not just the results from part of the test (i.e. not the supine AHI).

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Examples of Locating the AHI/RDI

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Examples of Locating the AHI/RDI ^…Cont’d

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Examples of Locating the AHI/RDI ^…Cont’d

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Analyze the AHI and RDI

▰As long as either the AHI or RDI is 15 or greater, no secondary diagnosis is required.

▰If both AHI and RDI, or the only one we have available, is between 5 and 14.9, a secondary diagnosis is required.

▰Go ahead and add a qualifying secondary diagnosis.

▰Look through the SS at the beginning section (history or indications) or at the end (results or impression). Check the chart notes if none are listed in the sleep study.

▻Frequent Secondary Dx: Hypertension, ischemic heart disease, history of stroke, excessive daytime sleepiness, impaired cognition, insomnia, or mood disorders

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* SNAP TIP: Limit the Diagnosis

Codes to PAP Secondary Codes if you are having trouble knowing what will qualify.

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Analyze the AHI and RDI ^…Cont’d

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Summarize Your Findings to Help Your Team

▰ In the Optional Notes:

▻ No OSA; unable to complete test

o Could this be a RAD patient? Or does the patient need a new study?

▻ (1) Pressure Settings with (2) Mask Brand and (3) Size o Tell us the test results to help insure that we book the

correct order (i.e. CPAP at 8 cm; BIPAP at 10/14; ASV 15- 20)

▻ Tried and Failed CPAP/ASV/BIPAP

o Again, help make sure we book the right order

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What about the titrations?

▰If we already have a diagnostic sleep study on file, verify the titration as “Other”.

Include both the date of the titration and results in the optional notes.

▻The date of the titration matters – new ones may indicate a machine switch, a new mask type, and/or a pressure change.

▰If we do not have a DxSS, but have a signed titration that references the AHI/RDI and date of the DxSS, verify it as a sleep study, using the DxSS date as the

verification date. Note in the optional notes “titration referencing DxSS” including the titration date and results.

▻This can only be used for replacement machines, not first machines.

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Titration Referencing Diagnostic Sleep Study

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What is Needed to Switch from CPAP to BIPAP?

1. Documentation that the patient is on CPAP

2. Documentation that the patient has a properly fitting mask

3. Documentation that pressure is not an issue

▰ These things can be shown in a titration and/or chart notes. Verus prefers to have a titration on file. However, Medicare does not require it.

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Switch Support Found in the Titration

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Switch Support Found in the Titration

^…Cont’d

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Switch Support Found in the Titration

^…Cont’d

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Don’t Overlook These Sleep Study Steps

▰ If we receive HST instructions we were needing, go back and updated the DxSS on file by checking the interpretation box and updating the note that instructions are on file.

▰ If a BIPAP titration is on file, but the order is booked for a CPAP, something is probably wrong.

▰ If a patient had a titration, they will almost always want to use the mask they were fitted with – don’t overlook this valuable information by going too fast. Be sure to note if the patient also used a chinstrap.

▰ Forgetting to add a secondary diagnosis for AHI/RDIs under 15 will delay an order and make someone else go back through the documents that you already read.

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Doctor Eval Details

▰ Determine the doctor’s intentions by reading it thoroughly and note your findings:

▻Orders Sleep Study / Discusses

▻CPAP UAB / BIPAP UAB / ASV UAB

▻CPAP using but not benefiting

▻Machine broken

▻Stop using, ordered new DxSS

▻Pressure change needed

▻Mark issues

▰ Be aware that sometimes doctors interchange CPAP and BIPAP, so read thoroughly to make the best interpretation; review other documents for better understanding; when in doubt – call the doctor!

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Why do these details matter?

▰ The Doctor Eval helps determine if we need to process the machine order as a first machine or a replacement machine.

▰ Booking the wrong order type is a definite way to delay orders, cause your team more work, and frustrate

doctors, patients and your team.

▰ Sometimes the eval mentions if a pressure change is needed or a new mask is needed.

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Doctor Eval Details

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Doctor Eval Signature

▰ Review the signature section – the doctor must sign it – not the nurse/tech

▰ Make sure it is the final version, not the draft version

▰ If the chart notes are handwritten, the doctor’s name must be either identified in addition to the signature – either typed or written

▰ If it is not signed, verify it as an Incomplete CN and note why.

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Using and Benefiting

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“Using and Benefiting” is not required verbatim – look for notes implying using (good compliance / can’t sleep without it) and benefiting (wakes up refreshed /doesn’t snore)

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What if the machine is broken or the patient stopped using the machine?

▻

If the patient stopped using the machine but still has a working machine, suggest that the patient start using it again, then go back to the doctor so that the doctor can note the patient is using the machine.

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Doctors can note the patient was using the machine prior to it breaking

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Examples of Using and Benefiting

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Prescriptions – Commercial Insurances

▰ Patient’s Name

▰ Items Prescribed – no details needed

▰ Doctor’s Signature

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Prescriptions - Medicare

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What makes a prescription Medicare valid – per the LCDs and per SNAP?

1.

Beneficiary’s name

2.

Prescribing physician’s name

3.

Treating physician’s NPI

4.

Treating physician’s signature

5.

Date the treating physician signed the order

6.

Date of the order (machine orders must have 2 dates on the Rx)

7.

Detailed description of the device being ordered

8.

Detailed list of all accessories/supplies with quantity to dispense, number of refills, and replacement frequency

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Prescriptions - Medicare

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Don’t overcomplicate, but don’t overlook!

▰ HCPCS are not required; details outweigh the HCPCS – so if ‘F10’ is written on a prescription, verify it for a full face mask. If you are not sure of the mask type, look it up online to confirm.

▰If the HCPCS is conflicting with the description, verify the described item.

▰ If the pressure(s) is listed, but the box beside the machine is not checked, verify it for the machine!

▰If the Rx says “dispense supplies” and lists items, verify all items listed.

▰ Look for manufacturer details and note the prescribed machine type and/or mask – this should ALWAYS be noted in Optional Notes!

▰ Type in the NPI when verifying the doctor rather than typing the doctor’s name – this helps confirm that you pick the correct doctor and that you are verifying the NPI is listed.

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Prescription Verification

▰

Even if the prescription is not Medicare valid, still verify it as a prescription – the patient’s insurance could update or the Rx may dispense the order.

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Unless it’s just a pressure change – verify it as Other and note the new pressures

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Do not verify it as a prescription without any HCPCS selected – SNAP reads that as an Rx with all items listed

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If the prescription is Medicare valid based off the 8 items listed in the LCDs, check the Medicare valid box. You may note “multiple tubing/masks”. SNAP’s insurance rules will know if the region of Medicare will accept the Rx. Once the order is booked, the workflow will ask for an Rx if one is needed.

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Seriously – Do Not Overlook….

▰

If you are verifying a prescription for a patient already in SNAP, you need to look at the patient’s account to see how the prescription affects the patient…

▻

Is there an order on file?

o

Yes > Does it support the items on the order?

•

Yes > Great!

•

No > Review the documents to see if the order needs to be changed (i.e.

machine type or mask type or first machine to REPAP)

o

Yes > Does it satisfy the missing part(s) of the order?

•

Yes > Great!

•

No > Create a follow-up task for fax back for the corrections needed

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Seriously – Never Verify A Document without seeing if action is needed

When you fail to do this, your work is wasted; often escalations arise and/or the order is lost entirely

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What if there is not an order on file?

▰ If there is not an order in process, you must use one of these prompt actions:

▻ Create a Follow-Up Task when verifying the document

▻ Request a Callback on the patient screen

▻ Request clinical follow-up

▰ Without doing one of these things, SNAP will not prompt a call for the patient until they are eligible for reorder.

▰ Check the patient’s active status: Should the inactive reason be removed?

▰ Do we need to reship something?

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Create a Follow-Up Task

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Requesting a Callback

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SNAP Assists First Machine – 6 Month Rule

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Doctor Orders Sleep Study: 5/5/2017

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Patient Has Sleep Study: 12/1/2017

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Patient Goes Back to Doctor: 12/31/2017

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Doctor Writes Rx for Machine: 3/13/2018

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As long as we have chart notes prior to the sleep study and a valid Rx within 6 months of the second chart notes following the sleep study, we are good to go.

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Verus does not allow sleep studies over one year.

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Beneficiary Entering Medicare

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This is a patient who is on PAP therapy prior to enrolling in Medicare.

▰

What do we need to process a replacement machine for these patients?

▻

Signed Diagnostic Sleep Study PRIOR to Medicare enrollment

▻

Signed Chart Notes AFTER Medicare enrollment

o

Showing the patient has OSA

o

Showing the patient is using the machine

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Medicare valid prescription

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Chart notes and prescription must be within 6 months of each other and within the last year.

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Random Information

▰ Verus cannot service patients in the hospital, hospice or a skilled nursing home.

▻ Why? Those services are covered by Medicare Part A. DME is Medicare Part B. Medicare is not going to pay a Part B item while Part A is in effect and paying.

▰ Verus can service patients in long-term nursing homes – stays over 100 days – as that is Medicare Part B coverage – At that point, the nursing home is their “home.”

▰ Verus Healthcare does not service patients without any insurance. We recommend EasyBreath.com or Shop.VerusHealthcare.com for cash pay patients.

▰ What does Beneficiary Entering Medicare mean? A patient who was on PAP therapy prior to enrolling in Medicare, so Medicare has paid supplies, but did not cover the original machine.

These should be processed as Replacement machines, and we need the DxSS prior to the patient enrolling in Medicare.

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When is a Release of Information (ROI) Required?

▰ If the patient transitioned from an acquisition, all we need is a verbal request from the

patient or anyone authorized to speak on the patient’s behalf.

▰ ROIs are required for brand new patients.

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How do I handle this Inbound Call?

▰ First, find the patient in SNAP.

* SNAP Tip: SNAP will provide search results for partial information entered. Meaning: You do not have to get the

patient’s full name. Get the date of birth and the first few letters of their first and last name.

* SNAP Tip: You can enter the date of birth in any format.

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So there’s an Order, but it has not shipped - What does the Current State mean?

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How can you help?

▰ Check the Patient Notes to see if another agent has been trying to get in couch with the patient – possibly for updated insurance information, a compliance report, or doctor

information.

▰ If the Current State is: Sent to Warehouse, check the

Documents tab to see if the packing slip is verified, but SNAP has not updated.

▰ What are the preship issues?

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How can you help?^...Cont’d

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How to View Patient Cost

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How to View Patient Overdue Balance

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How to Collect Payment from a Patient

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What if the patient requests to pay by check?

▰ Many of our patients are elderly and do not feel comfortable paying over the phone.

▰ If a patient says that he/she will mail a check, email your supervisor to go ahead and ship the order.

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Collecting Payment Information

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Patients may delay payment processing up to 10 days.

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Payments may be split over 3 months. However, this is not an option we voluntarily give. This is only given if the patient asks.

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If payments are split, SNAP will do the math for you once you enter the amount of Monthly Payments. Do not change the Payment Amount!

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Credit card information is not stored in SNAP except in this situation.

Never add a patient’s credit card number in any other screen. ^{This Photo}by Unknown Author is licensed under CC BY-SA

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Other Payment Options

▰ For patients with financial hardships, we do have a financial waiver option for those who qualify based off of monthly income.

▰ If a patient wants to apply, you may mail or email he/she an application. If approved, the cost will be waived for one year.

The patient will have to renew it annually.

▰ Orders shipped while the application is being reviewed will be billed to the patient. The patient should wait until we confirm if he/she is approved for the cost to be waived.

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Customer Support. Department Training. Customer Support Department.