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Brooks Rehabilitation Outpatient
Welcome
Welcome
Welcome to the outpatient Business Office. We look forward to working with you. Let me tell you a little bit about outpatient.
Future Growth
About Us
We currently have 42 outpatient locations throughout Florida and we are not slowing down anytime soon. We are continuously looking for more growth opportunities. So expect new clinics in the near future!
Patients
Patients
We see on average about 30,000 new patients and have just over 300,000 visits per year in Outpatient alone!
Patients
TIME
LOCATIONS
LOCATIONS
We have offices starting in north Florida all the way down to the Orlando and Tampa areas.
The Team...
The Team
...consists of several roles that are vital to the success of the whole team. We are committed to working together daily to provide optimal outcomes for our patients.
Manager
Oversee's all aspects of the Outpatient Business office
Manager
Collector Supervisor
Oversee's all aspects of the collector role
Collector Supervisor
Director
Oversee's all aspects of the OPBO
Collector's
Collects outstanding balances from Insurance companies and Patients
Collector
Active Patient Balance Specialist
Active Patient Balance
Research and communicate accurate patient balances to the FDC's to be collected at check in.
Refund Specialist
Ensures refunds are sent to the appropriate receiver accurately and timely.
Refund Specialist
Adjustor
Posts adjustments requested by collector's accurately and timely.
Adjustor
Biller
Releases claims from our clearing house that are clean and accurate.
Biller
Support Float
Assists with all support role's and provides backup as needed as well as posts all BMG payments.
Support Float
Clerical Representative
Clerical Rep
Preforms charge corrections timely and accuratley, scans insurance correspondence into our EMR and prints necessary attachments to be sent with paper claims.
Customer Service Rep
Answers the office phone calls and assists with patient balance collections.
Customer Service
Payment Poster
Posts all payments received for the outpatient non hospital based clinics timely and accurately
Payment Poster
Team Work
Surrounding Teams
The Business Office could not function with out the help of the teams around us.
Central Intake Unit (CIU)
The CIU team verifies benefits, loads insurance and patient Responsibility information and retrieves authorizations before the patient arrives.They also update insurance and benefits information for active patients when needed
Front Desk coordinators (FDC)
The FDC's check in patients and explains and collects financial responsibility
Medical Records/Health Information Management (HIM)
The Medical records/HIM team houses our authorizations that give us the ability to speak to people other than patients. They also code the patients accounts.
Before the Business office...
Before our work begins
There are quit a few things that happen before an account is ready to be worked by the business office
First
Referral
A patient is refereed to our organization typically by their primary care provider. They may also be refereed to Outpatient by another area of our system of care such as Inpatient.
Then
Schedule
Once Refereed, the patient will be contacted to schedule an appointment. During this time, we will collect the insurance information and that information will be sent off to the Verifiers in CIU to verify benefits.
Visit Time
Finally
The patient will come to their appointment and that is when their account will be registered, after their appointment the therapist will create their documentation and the charges will be posted. The system will create a claim , the claim will go to the payer and then our work begins.
Here is a list of terms you will hear and use.
Commonly used terms
Co-pay
Co-Pay
- A set amount determined by the patient’s policy that is paid each visit. The copay can vary from a doctor’s office, specialty or emergency room visit.
Co-insurance
- A set percentage the patient will owe toward each visit. The % depends on the policy if we are in or out of network and what the allowable charges are for the plan if we are contracted
- When you are collecting toward co-insurance it is important to remind the patient this is an estimated rate to help them reduce their end balance, They will most likely receive a bill
Deductible
- The set amount the patient must pay out of pocket before the insurance will pay any amount of money toward the patient’s bill
- The deductible usually starts at the beginning of the policy year. Most are in January but it can be any month the policy became effective.
- The patient can state they met their deductible from their insurance but if they didn’t pay the company it was applied to it is still outstanding.
Example: We see a patient from January to June and they have a $250 deductible all of the deductible has been applied to the January invoices. We call to collect in June and the patient states per my insurance I have met my deductible, Yes they have but it was applied to Brooks Americare invoices. Which the patient needs to pay.
Out of Pocket Maximums: (oopmax)
Out of Pocket Maximums (OOPMAX)
- The maximum the patient pays toward their patient responsibility before the insurance covers their charges (if covered in their plan’s guidelines) at 100%.
- Some plans have coverage exclusions so the patient still has financial responsibility even though their out of pocket max is met.
Maximum Benefits
Max Benefits
- The maximum an insurance will pay out towards a service or all services
- Once the cap is met then the patient will not have insurance coverage for the service provided
- The cap can be viewed as a visit limitation or monetarily. Such as $1500 or 30 visits.
Example:
The patient has 20 PT visits per year.Even if we are authorized 30 the plan will only cover 20 visits. The policy limitations always override the authorization.