front office collections...

www.hillcountrypain.comPhone: 210-582-6600 • Toll Free: 866-384-5470 • Fax: 210-582-6601

• Warmly greet each patient with a smile.

• Use the patient’s name- it shows respect. (ex. Mr. Jones or Ms. Jones)

• If a patient is not on the Daily Collection List contact Business Dept. to confirm if they owe a copay or balance. Do not assume they do not owe anything if they are not on the list.

• Avoid asking “Would you like to pay?” Instead, state: “How would you like to take care of your copay/balance today?”

• Use a gentle but firm tone when asking for payment.

• If a patient owes a balance, look around to see if the conversation might be overheard; if so, write the amount on a slip of paper and hand it to the patient.

• Look the patient in the eye when you are asking for payment.

• Avoid inappropriate facial expressions such as laughter or frowning when discussing balances or other financial matters with patients.

• If the patient questions the balance, print a copy of the statement. (In EMD’s go to Reports, Trial Balance and search for patient name, date range from and to, check the including zero balance and print)

• Provide the patient with a printout of his or her coverage and eligibility verification information if needed. (In EMD’s chart go to verification/precert log note)

• Give the patient the contact information for his/her health plan if the patient has questions about coverage or benefits or direct to precert so they can explain the benefit coverage; indicate that the human resources office of the patient’s employer may also be helpful to the patient.

• Collect all monies due at the time of service, not just the copayment - If a patient comes in with no money to pay inform the physician and they will make a decision on whether they wish to see patient.

• Post-dated checks are not accepted for New Patients. If an established patient brings a post- dated check we will accept for as long as it’s post-dated within 5 days and Business Dept has verified the patient is in good standing with previous payments. If a post-dated check is written for more than 5 days, physician approval will be required.

• If a patient can only pay half of monies due, we will accept half as long as patient agrees to payment plan for the remaining amount. Take the patients credit card information so we can run on the date that is agreed on, fill out payment plan form and attach to Daily Collections List and return to the main office.

• Always provide a receipt. If your printer is down at the satellite office you are at, contact the main office and we can fax or mail a receipt to the patient.

• The only credit cards we accept are Discover, Visa, Mastercard. We do not accept Care Credit.

• Always thank the patients for paying.

Front Office Collections Checklist


Morning Calls- Good Morning, Hill Country Pain, Raquel speaking, how may I help you?

Afternoon Calls- Good Afternoon, Hill Country Pain, Raquel speaking, how may I help you?

**Reminder- If you are unable to get a hold of anyone at the time of the phone call, take a message and obtain two good call back phone numbers and send a task to the appropriate department.

Prescription/Radiology/Physical Therapy/Disability Form Requests

Transfer calls to clinical team extension 3294.

Clinical Department compliments/complaints- Direct to Laurie Boultinghouse extension 3204.

New Patient and Medical Record Requests

Direct call to Parker Mackeil extension 3207.

Scheduling

Bill Murphy M.D. & Nancy Burgher P.A. – Direct calls to extension 3220.

Justin J. Vigil M.D. – Direct calls to extension 3230.

Scheduling and New Patient Department concerns - Direct call to Emily Rincon extension 3202.

Durable Medical Equipment (DME)

Transfer to Emily extension 3202.

Referrals/Precertification/Authorizations/Insurance Questions

Transfer to Isabel Medina extension 3240 or Anna extension 3209.

Precertification Department compliments/complaints- Direct call to Raquel Terriquez extension 3208.

Patient Billing/Payment Plan Inquiries

Direct call to Raquel extension 3208 or Venessa Zamora extension 3229.

Billing Department compliments/complaints- Direct to Laura Paredez extension 3227.

Internal Coding questions- Direct to Peggy extension 3228.

Human Resources/Accounts Payable/Employee Verification Calls

Direct to Meliegh Phipps extension 3206.

Marketing

Contact Alana Redepenning if you receive calls from physician offices that needreferral pads, compliments/complaints. Advertising, sales and marketing calls.Cell: 210-269-8480 or Email: [email protected]

Phone Call Directory


Application for Disability License Plates - $10.00

Disability Forms - $25.00

Family Medical Leave Act Application (FMLA) - $25.00

Narrative Disability Form - $50.00

Form Fees


• ACCOUNTABLE HEALTH PLANS TX (MCO)• ADMAR CORPORATION• AETNA EPO• AETNA HMO• AETNA POS• AETNA PPO• AFFILIATED HEALTHCARE PPO• APWU (American Postal Workers Union)• BAPTIST HEALTHCARE SYSTEM-EMPLOYER• BCBS-BLUECHOICE PPO• BCBS-PAR PLAN• BEECH STREET (MCO)/CAPP CARE (MCO) • BOON-CHAPMAN• CARE IMPROVEMENT PLUS• CCN MANAGED CARE PPO• CCN MANAGED CARE TX WORKERS COMP• CENTRAL TEXAS PROVIDER NETWORK• CIGNA HMO• CIGNA POS• CIGNA PPO• COASTAL COMP HEALTH NETWORK• COMMUNITY FIRST COMMERICAL HMO• DIRECT CARE• ELDER HEALTH• FIRST HEALTH PPO• FIRST HEALTH TX WORKERS COMP• GALAXY HEALTH NETWORK• GREAT WEST PPO• HARRINGTON PPO• HEALTH PAYORS ORGANIZATION (MCO)• HEALTHSMART• HEALTHSPRINGS• HUMANA-ALL PLANS• INTEGRATED MEDICAL SYSTEMS• MANAGED HEALTHCARE INC. (MCO)• MEDCORP SOUTHWEST• MAIL HANDLERS

• MEDICAL CONTROL INC. (MCO)• (PPO NEXT, PHN, HEALTHSTAR, HHPO)• MEDICARE-TRADITIONAL (preferred)• MEDICARE-ADVANTAGE PLANS (most)• MULTIPLAN INC., CHOICEONE, PREFERED PLAN (MCO)• NATIONAL CHOICE CARE WORKERS COMP• NATIONAL HEALTHCARE ALLIANCE• OCCUPATIONAL HEALTH SOURCE• ONE HEALTH PLAN HMO AND OPEN ACCESS• ONE HEALTH PLAN PPO• PHCS• PROAMERICA MANAGED CARE• PRONET (MCO)• PROVIDER ALLIANCE OF CENTRAL TEXAS• PROSPECT MEDICAL• SECURE HORIZONS-PACIFICARE OF TEXAS• SAN ANTONIO EMPLOYERS HEALTH (SAEHA)• SCOTT & WHITE • SUPERIOR MEDICARE• TEXAS HEALTHCARE FOUNDATION WORKERS COMP• TEXAS INTEGRATED HEALTH NETWORK• TEXAS MUNICIPLE LEAGUE (MCO)• TEXAS TRANSPLANT INSTITUTE• TEXAS TRUE CHOICE• TRICARE FOR LIFE• TRICARE STANDARD• TRICARE PRIME• UNITED HEALTHCARE EPO• UNITED HEALTHCARE HMO• UNITED HEALTHCARE POS• UNITED HEALTHCARE PPO• UNITED PAYORS & UNITED PROVIDERS• UNITED STATES DEPT OF LABOR• USA MANAGED CARE ORGANIZATION• USC HEALTH SERVICES (MCO)• WORKERS COMPENSATION-TEXAS• WELLCARE

Accepted Insurances List

Maps, New Patient Forms, and Pain Management Information atwww.hillcountrypain.com


Dear Patient,

Welcome to Hill Country Pain where our mission is relieving pain and restoring hope. We appreciate the opportunity to participate in your care. We encourage you to visit our website www.hillcountrypain.com for the latest news and information regarding pain diagnosis and treatment. Our website provides a variety of patient centered tools and resources to enhance your experience at Hill Country Pain.

This letter is to confirm your appointment scheduled on _________________at_____________ a.m./p.m. (Arrival time)with: o Dr. C. William Murphy o Dr. Justin Vigil

for a consult at the following location:

o San Antonio Main Office 14800 San Pedro Ste 115 • San Antonio, TX 78232

o New Braunfels Office 861 Landa • New Braunfels, TX 78130

o San Marcos Office 2003 A Medical Parkway • San Marcos, TX 78666

o Fredericksburg Office 1011 Hwy 16 S, Ste 5 • Fredericksburg, TX 78624

To better serve you, please complete the information provided and utilize the checklist below to ensure you have everything ready for your appointment. Please hand-carry the following to your appointment.

o Attached new patient packet (completed) o Insurance card and identification cardo Any applicable payment for visito You are scheduled for a procedure. Please see procedure instruction sheet on back. Please notify our office if you are taking Any Blood Thinners so we can arrange your lab work to be done prior to your procedure.

Thank you for choosing Hill Country Pain. We look forward to seeing you at your appointment if you have any questions or require further assistance, please contact our office.

o Please call to schedule your appointment if you have not already done so.

Regards,Scheduling Dept. 210-582-6600 Opt. 2

Appointment Confirmation


Injection Letter

Procedure Instructions:

1. Please report to your appointment at your scheduled arrival time.

2. You must have someone with you to drive you home.

3. Please do not have anything to eat or drink at least 6 hours prior to your procedure.

4. Bring a list of your current medications. Please take blood pressure medication, and other essential medications, with a sip of water before coming to procedure.

5. If you are taking any blood thinning products see table below, In addition a laboratory test must be performed the day prior to the procedure or the day of the procedure.

ANTICOAGULATION PROTOCOL

6. If you are diabetic, please let you pain care physician or nurse know to receive information about diet and insulin.

7. Wear comfortable clothing and low-heeled shoes.

8. Please leave all jewelry and any valuables at home.

9. If you are late, your appointment may be delayed or rescheduled according to the doctor’s schedule.

MEDICATION WHEN TO DISCONTINUE LAB. DRAWN PRIOR TO PROCEDURE

Warfarin/Coumadin 5 days PT/INR

Clopidogrel/Plavix 7 days Bleeding time/ PFA

ASA/Aspirin* 7 days Bleeding time/ PFA

Eliquis 3 days

Enoxaparin/Lovenox 10 days

Ticlopidine/Ticlid 7 days Bleeding time/ PFA

Tirofiban/ Aggrostat 7 days Bleeding time/ PFA

Dipyridamole/Aggrenox 7 days Bleeding time/ PFA

Pletal/Cliostazol 7 days Bleeding time/ PFA

Pradaxa / Xarelto 2 days

Vitamin E, Garlic, Ginseng, Fish Oil, Omega 3, Ginko, Ginger, Feverview

7 days

Injection Letter Cont’d

During your procedure:

1. Your procedure will be performed in one of our procedure rooms.

2. If you desire IV Conscious Sedation, you will have an intravenous infusion started. Your blood pressure, pulse, and respirations will be monitored.

3. Your doctor will determine in what position he will perform your procedure.

4. The doctor will order your sedation to help reduce any kind of discomfort and anxiety you may have. You will not be having general anesthetic.

5. The doctor will give you local anesthetic at the injection site.

6. Your procedure can last anywhere from 15 minutes to 60 minutes, depending upon the procedure.

7. Your family may wait for you in the waiting room.

After your procedure:

1. Pain relief is variable. If may occur immediately, but may also take several days for the procedure to be effective. In addition, there may be soreness from the procedure for a few days. You must understand that some medications take several days to affect the pain.

2. You will remain in the Recovery Room approximately 30-60 minutes after your procedure, depending upon whether you have sedation.

3. You will still be monitored to include blood pressure, pulse, and respiration while in the Recovery Room.

4. You will be offered liquids at that time.

5. You will note some drainage from the site, but this is normal.

6. You may experience increased pain and soreness at the injection site for 48 hours after the procedure.

7. Some side effects may occur, but the nursing staff will go over these with you prior to your discharge.

8. The doctor will tell you, at the time of your discharge, when to follow-up.

*It is okay to stay on Baby Aspirin if you are having a Lumber Procedure.


SAN MARCOS SURGERY CENTER1891 Medical Prkwy. • San Marcos, TX 78666

EXIT #202 - WIMBERLY

SAN MARCOS OFFICE2003 A Medical Prkwy. • San Marcos, TX 78666

EXIT #202 - WIMBERLY

SAN ANTONIO MAIN OFFICE14800 San Pedro, Ste 115 • San Antonio, TX 78232

NEW BRAUNFELS OFFICE861 Landa St. • New Braunfels, TX 78130

FREDERICKSBURG OFFICE1011 Hwy 16 S, Ste 5 • Fredericksburg, TX 78624

PAIN TREATMENT LOCATIONS


Patient Name: Phone #:

Diagnosis:

Reason for referral (check all that apply): o Consult o Ongoing o Management o Procedure o Other:

Does patient have MRI: o Yes o On CT: o Yes o No XRays: o Yes o No

Physician name: Phone #:

Please check out our website - www.hillcountrypain.com - for all your management needs.Here are a few things you will find.

• MAPS AND DIRECTIONS to our locations

• NEW PATIENT FORMS to bring with you to your appointment

• Accepted INSURANCE products

• EDUCATION/INFORMATION about pain management problems and treatments

• Information about our DOCTORS AND STAFF

PLEASE FAX TO 866.384.5471 AND GIVE COPY TO PATIENT

C. WILLIAM MURPHY, M.D. JUSTIN J. VIGIL, M.D. NANCY BURGHER, PA-C

R E F E R R A L

RELIEVING PAIN. RESTORING HOPE.

Patient Name _______________________________________ DOB: _________________ Date _________________

Preferred Pharmacy Name & Phone # ________________________________________________________________

Visit: New Patient Follow Up Procedure Consult Pump Refill

Location of Pain:_________________________________________________________________________________

Pain Score Now: 0 1 2 3 4 5 6 7 8 9 10 Usual pain score: with Medication _______ without Medication _______ (Use scale below)

VAS PAIN SCORE SCALE 0 ------------------------------------------- 10

Is your pain: Mild or Severe? Constant or Intermittent? Better, Worse, or No Change?

Percentage of Change? Better __________ Worse ___________

Pain Description? Sharp Shooting Dull Stabbing Tingling Burning Numbness Other ________________

What makes your pain better? Rest Lying Down Walking Medications Massage Chiropractic Heat/Cold Nothing

TENS Other ___________________________________________________________________

What makes your pain worse? Activity Driving Standing Walking Lying down Other_______________________

Pain is worse: Morning Afternoon Night Interfere with sleep? Yes / No

Last Physical Therapy: ___________________________________________________________________________

New Diagnosis, Treatments or Medications since last visit ________________________________________________PINK=PAIN BLUE=NUMBNESS

Circle ALL of the following that apply:1. Chills, fever, fatigue, weight gain ________lbs, weight loss ________ lbs.2. Blurred vision, eye pain, sensitivity to light, glasses, contacts3. Hearing problems, ear pain, congestion, runny nose, nose bleeds, dental problems4. Chest pain, rapid heart beat, heart flutter, ankle swelling, shortness of breath5. Cough, difficulty breathing, bloody sputum6. Abdominal pain, heartburn, constipation, diarrhea, stool changes7. Genital lesions, genital discharge, bloody urine, difficult urination, frequent urination, menstrual problems8. Back pain, muscle spasms, joint pain9. Dry skin, skin rashes, atypical moles, masses10. Dizziness, headaches, numbness, weakness, seizures11. Easy bruising, bleeding, enlarged lymph nodes, HIV /AIDS12. Anxiety, depression, feelings of stress, problems with sleep, suicidal thoughts

Patient Name ______________________________________ DOB: __________________ Date _________________

Preferred Pharmacy Name & Phone # ____________________________________________________________________


Location of Pain:______________________________________________________________________________________

Pain Score Now 0 1 2 3 4 5 6 7 8 9 10 Usual pain score: with Medication _________ without Medication _________ (Use scale below)




Pain Description? Sharp Shooting Dull Stabbing Tingling Burning Numbness Other ____________________


TENS Other _________________________________________________________________

What makes your pain worse? Activity Driving Standing Walking Lying down Other___________________


Last Physical Therapy: _____________________________________________________________________________

New Diagnosis, Treatments or Medications since last visit ________________________________________________

PINK=PAIN BLUE=NUMBNESS R L R L L R R L Circle ALL of the following that apply: 1. Chills, fever, fatigue, weight gain ______lbs, weight loss_____ lbs. 2. Blurred vision, eye pain, sensitivity to light, glasses, contacts 3. Hearing problems, ear pain, congestion, runny nose, nose bleeds, dental problems 4. Chest pain, rapid heart beat, heart flutter, ankle swelling, shortness of breath 5. Cough, difficulty breathing, bloody sputum 6. Abdominal pain, heartburn, constipation, diarrhea, stool changes 7. Genital lesions, genital discharge, bloody urine, difficult urination, frequent urination, menstrual problems 8. Back pain, muscle spasms, joint pain 9. Dry skin, skin rashes, atypical moles, masses 10. Dizziness, headaches, numbness, weakness, seizures 11. Easy bruising, bleeding, enlarged lymph nodes, HIV /AIDS 12. Anxiety, depression, feelings of stress, problems with sleep, suicidal thoughts

R L R L

Office Rm #

Previous Proc.: Prior Sed.:

Office Rm #

Previous Proc.:

Prior Sed.:




Location of Pain:______________________________________________________________________________________







TENS Other _________________________________________________________________






R L R L

Office Rm #





Location of Pain:______________________________________________________________________________________







TENS Other _________________________________________________________________






R L R L

Office Rm #


Patient Name _____________________________________ DOB: __________________ Date __________________

Allergies to Medicatios:____________________________________________________________________________

Current Medications: _____________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

Last OV:_____________ Type of OV:___________________________________________ Last VAS:_______

Vitals: BP:_______/________ P: ________ Ht:__________ Wt:__________ R:__________

Notes:

_________________________________________________________Physician Signature / Physician Assistant Signature

Current Procedure

Approach: _________________________________________

Levels: ___________________________________________

Sedation: _________________________________________

Mixture: __________________________________________

PlanFollow up: OV ______________ CWM, JJV, JKS, JCJ, NBB, FG, NBG

Dx: ______________________________________________

_________________________________________________

Scheduled Procedure:

Medication Quantity Direction Refill

_____________ _______ _________________ ______

_____________ _______ _________________ ______

_____________ _______ _________________ ______

_____________ _______ _________________ ______

_____________ _______ _________________ ______

____ Morphine Sulfate ____ Opana ____ Flexeril

____ Oxycontin ____ Percocet ____ Soma

____ Oxycodone ____ MS Contin ____ Zanaflex

____ Duragesic ____ Nucynta ____ Skelaxin

____ Norco/Hydrocodone ____ Zohydro ____ Robaxin

____ Elavil ____ Ibuprofen ____ Neurontin

____ Celexa ____ Daypro ____ Lyrica

____ Lexapro ____ Celebrex ____ Topamax

____ Nortriptyline ____ Mobic ____ Effexor

____ Cymbalta ____ Compound Cream _______________

Drug Screen / Genotype Pharmacogenetic Test

____ Urine Drug Screen ____ Oral Swab____ Blood ____ PGX

DME____ Back Brace ____ Knee Brace____ 4 Points/LSO ____ Wrist Brace____ Tens Unit ____ Other

1. TENS therapy to address myofascial pain2. Patient has previously tried and failed (other modalities).A 4 lead TENS is necessary as a 2 lead TENS unit would not adequately cover area of pain.

Physical Therapy____ Eval & Treat ____ Back/Neck Program____ Home Exercise Program ____ Home stretching Program____ Decrease back pain ____ Manual Therapy____ Therapeutic Exercise ____ Traction____ Range of Motion ____ Electrical Stimulation____ Gait Eval/Training ____ Increase Core Strength____ Heat/Massage ____ Other____ Modalities (Heat/Cold/Tens/Ultrasound, E-Stim)

Radiology____ L-MRI No Contrast ____ C-MRI No Contrast____ L-CT ____ C- CT____ L-X-Rays ____ C-X-Rays____ MRI Knee Rt. / Left ____ X-Rays _________________ Pelvis ____ LE Joint Hip / Ankle____ Other ________________________________________

Chiropractic____ Eval & Treat ____ Other

Other Referral____ ORS ____ NS____ Psych BHE ____ Psych – Eval/Treat____ Sleep Specialist/Sleep Study ____ Other

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