Follow-Up Process Call flow

• Opening Spiel: “Hi, this is ______ from MBHC. Am I speaking with ______? (Check previous notes to confirm if we are contacting the caregiver or the patient.) How are you? (Acknowledge response.)

 "I'm calling for our monthly routine follow-up. Is now a good time to talk? Great!" (acknowledge response)

• Verification of address and Primary Insurance spiel: “Let me verify some of the information we have on file.”

• Address Verification:

IF you’re talking to the PT: Are you still residing at this address? (read the address from BT)

IF you’re talking to the caregiver:  Is the patient still residing at this address? (read the address from BT)

• Insurance Verification:

IF you’re talking to the PT: Are you still with _____  for your insurance (read the PRIMARY insurance from BT)

IF you’re talking to the caregiver: Is the patient still _____ for his/her insurance? (read the PRIMARY insurance from BT)

• Proceed on the F/U questionnaires, don’t ask all the n/a questions. 

“Let us proceed with your follow up questions...”

Reminder:

ONLY ask all the applicable questions.

Do NOT ask again about the primary and secondary insurance or the address, as these are already included in the verification. 

These questions should be part of your prep-time.

• Make sure to add the current month to Subject line. 

• Once done with the questions, change the status to 'Closed' (for successful calls only) and save it.

• Add a new note for the next current month but leave it blank. 

PROCEED with the Re-supply

Resupply Call Script

• Informing patient or caregiver for the re-supply if only eligible:

1. For the resupply, we can take your order and send you the list of your supplies for this month via Klara. You can confirm it with me today. Do you still have some extra time? 

• If the patient is not eligible:

  1. “You will be eligible for resupply on this date or month (check the last date of DOS from the Orders tab). However, you can call us two weeks before this date to place your order."

Klara Messaging Script (Only if the patient disagreed with email template) 

• Resupply Process Format (Message Confirmation)

1. Hi, (Pt's name) Below is the list of supplies we will order for this month. Please review and let me know if you approve. Thank you!

Examples list of supplies.

2 Nasal Cannulas

1 Water Chamber

1 Nebulizer kit 

4 Suction Tubing

• The patient should reply "Yes I approve "

• Agent should proceed creating a new patient note for re-supply and make sure to assign it to yourself.

Closing:

• 1. “Thank you for your time today. I’ll ensure we update everything on our end. If you need anything else, please don’t hesitate to 

Patient: 

Patient Type: 

Contact person: 

Address:

Phone:

Insurance: 

Prio-Auth (Y/N): 

DWO/Prescription: 

Progress NOTES:  

Authorization: 

Resupply eligibility/DOS (Y/N and 30days after):

Resupply List: 

Preparation Steps

1. Key Tabs to Review:

   • Orders Tab: Identify active rental equipment and determine resupply eligibility.

   • Insurance Tab: Confirm insurance details, including coverage and billing cycles.

   • Notes Tab: Review previous interactions, follow-up notes, and unresolved issues.

   • Documents Tab: Ensure DWO (Detailed Written Order), progress notes, and authorizations are valid and up-to-date.

2. Recommended Windows to Keep Open:

   • Patient’s main account screen

   • Last completed follow-up note for reference

   • New follow-up note for documentation

   • Current DWO for cross-verification

3. VENT FOLLOW UP GUIDE
1.Are you still using your ventilator as prescribed by your doctor? *CHECK VSO*
Yes- Move on to next question
No- Why? When? MD ordered? Inform Management. Needs stop date?
Why? - Why did they stop using it? “Why did you stop using the ventilator?”
When? - When did they stop using it? “When was the last time you used the ventilator?”
MD Ordered? - Does the Doctor know they stopped using?  “Does your doctor know you stopped using the ventilator?” 

1. • 2.When was the last time you saw the doctor that helps you with your ventilator?
     Acceptable Answers = Yesterday, Last week, Last month, a few months ago, 6 months ago, exact date
     Unacceptable Answers = Can’t remember, Last year, 7+ months ago, over a year
     Response to unacceptable answers:
     You may be due for a follow-up, call your doctor to schedule an appointment.  We require annual progress notes to keep your account open. “I can’t see my doctor” – Ask PT for MD and Clinic name and let the patient know you will look into this to see how we could help them. Inform management.

   • 3.Has there been any changes made to your ventilator settings within the past 30 days?
     No- Move on to next question
     Yes- When were setting changes ordered? Where? Rx on file?
     When? - When were the setting changes ordered?
     Where? -  Where were the setting changes made? At the hospital or Outpatient/Doctor’s office? (If the answer is at the hospital, see question # 6)
     Rx on file? - Do we have the prescription on file? (If the answer is no, ask the patient to follow up with their doctor to send us over the prescription. Inform management.)

   • 4.Are you still using your oxygen as prescribed by your doctor? *CHECK DWO*
     Yes- Move on to next question
     No- Why? When? MD ordered? Inform Management. Needs stop date.
     Why? - Why did they stop using? “Why did you stop using Oxygen?”
     When? - When did they stop using? “When was the last time you used oxygen?
     MD Ordered? - Does the Doctor know they stopped using?  “Does your doctor know you stopped using Oxygen?” 

   • 5.Has there been any changes made to your oxygen flow setting within the past 30 days?  CHECK DWO
     No- Move on to next question.
     Yes- When? Where?
     When? - When were the changes made?
     Where? -  Where were the changes made? At the hospital or Outpatient/Doctor’s office? (If the answer is at the hospital, see question # 6)
     Rx on file? - Do we have the prescription on file? (If the answer is no, ask the patient to follow up with their doctor to send us over the prescription. Inform management.)
     
     6.Have you been readmitted to any hospital for any reason within the past 30 days? *NEEDS BT NOTE*
     No- Move on to next question
     Yes- When? Where? Why?
     When? - When were you admitted and when were you discharged? (If pt still admitted, Inform management. Needs stop date.)
                   Where? – Where were you admitted? What hospital? Get hospital name and city.
                   Why? – Why were you admitted? Was it respiratory related?
     
     7.Do you have home health nursing service? *CHECK DWO* *CHECK INSURANCE TAB*
     No- Move on to next question
     Yes- Who?
     Who? -  What is the name of the Nursing company? (If PT has Medicare and receives Tracheostomy Supplies, Inform Management.)

   • 8.Are you enrolled in hospice care?
     No- Move on to next question
     Yes- Who? When? Inform Management. Needs stop date.
     Who? What is the name of the Hospice company?
     When? When was the patient enrolled into Hospice? Get exact date if you can. 

   • 9.Do you have any changes with your health insurance within the past 30 days? *CHECK INS. TAB* *NEEDS BT NOTE*
     No- Move on to the next question
     Yes- When? Who? Inform Management. Needs stop date.
     When? When did your previous insurance expire? When does your new insurance start?
     Who? What is the new insurance information? Please let me know the name of your insurance and policy number please. We will check eligibility and call you back to review your benefits.

   • 10.Has your address changed within the past 30 days? *CHECK SUMMARY TAB*
     No- Move on to the next question.
     Yes- Where? When? Temporary? Inform Management.
     Where? – Where did you move? What is your new address?
     When? – When did you move?
     Temporary? Is your move temporary or permanent? *If permanent, let patient know we will reach back out to them to schedule a Home assessment.
     A Home Assessment is when a technician goes to the patients home to check if the environment is safe for our equipment and the patient. They check if outlets are working, smoke detectors, etc.  

   • 11. Do you or anyone in the home have flu-like symptoms?
     No- Move on to next question
     Yes- What symptoms are you experiencing? Inform management. 

   • Do you have any questions or concerns for me at this time?

   • For any questions or concerns you cannot address, please let the patient know that you will look into this for them and return the call. Inform Management. 

4.  NON VENT FOLLOW UP GUIDE
You will need to check DWO/Orders Tab to find out what rental equipment pt has other than Oxygen. Remember, not all rental patients have Oxygen at home. We will use Cough Assist as an example.

1.Are you still using your oxygen/*equipment* as prescribed by your doctor?
*CHECK DWO* *CHECK ORDERS TAB*
Yes- Move on to next question
No- Why? When? MD ordered? Inform Management. Needs stop date?
Why? - Why did they stop using? “Why did you stop using Oxygen/ the cough assist?”
When? - When did they stop using? “When was the last time you used oxygen/the cough assist.”
MD Ordered? - Does Doctor know they stopped using?  “Does your doctor know you stopped using oxygen/the cough assist?” 

2.When was the last time you saw the doctor that helps you with your oxygen OR When was the last time you saw the doctor that ordered your *equipment*?
*CHECK DWO* *CHECK ORDERS TAB*
Acceptable Answers = Yesterday, Last week, Last month, a few months ago, 6 months ago, exact date
Unacceptable Answers = Can’t remember, Last year, 7+ months ago, over a year
Response to unacceptable answers:
You might be due for a follow-up, call your doctor to schedule an appointment.  We require annual progress notes to keep your account open. “I can’t see my doctor” – Ask PT for MD and Clinic name and let the patient know you will look into this to see how we could help them. Inform management.

3. Has there been any changes made to your oxygen flow setting within the past 30 days?
*CHECK DWO* *CHECK ORDERS TAB*
It is OKAY to skip this question if the patient DOES NOT have Oxygen at home.
No- Move on to next question
Yes- When were setting changes ordered? Where? Rx on file?
When? - When were the setting changes ordered?
Where? -  Where were the setting changes made? At the hospital or Outpatient/Doctor’s office? (If the answer is at the hospital, see question # 4)
Rx on file? – Check to see if we have the prescription on file (If the answer is no, ask the patient to follow up with their doctor to send us over the prescription. Inform management.)

4.Have you been readmitted to any hospital for any reason within the past 30 days?
No- Move on to next question
Yes- When? Where? Why?

When? - When were you admitted and when were you discharged? (If pt still admitted, Inform management. Needs stop date.)
              Where? – Where were you admitted? What hospital? Get hospital name and city.
              Why? – Why were you admitted? Was it respiratory related?

5.Do you have home health nursing service?
No- Move on to next question
Yes- Who?
Who? -  What is the name of the Nursing company? (If PT has Medicare and receives Tracheostomy Supplies, Inform Management.)

6.Are you enrolled in hospice care?
No- Move on to next question
Yes- Who? When? Inform Management. Needs stop date.
Who? What is the name of the Hospice company?
When? When was the patient enrolled into Hospice? Get exact date if you can.

7.Do you have any changes with your health insurance within the past 30 days?
No- Move on to the next question
Yes- When? Who? Inform Management. Needs stop date.
When? When did your previous insurance expire? When does your new insurance start?
Who? What is the new insurance information? Please let me know the name of your insurance and policy number please. We will check eligibility and call you back to review your benefits.

8.Has your address changed within the past 30 days?
No- Move on to the next question.
Yes- Where? When? Temporary? Inform Management.
Where? – Where did you move? What is your new address?
When? – When did you move?
Temporary? Is your move temporary or permanent? *If permanent, let patient know we will reach back out to them to schedule a Home assessment.
A Home Assessment is when a technician goes to the patients home to check if the environment is safe for our equipment and the patient. They check if outlets are working, smoke detectors, etc.  

9. Do you or anyone in the home have flu-like symptoms?
No- Move on to next question
Yes- What symptoms are you experiencing? Inform management. 

10.Do you have any questions or concerns for me at this time?
For any questions or concerns you cannot address, please let the patient know that you will look into this for them and return the call. Inform Management.

Part 1:

Review resupply list and Verify Documentation

1. Read Pop Up notes (look for approvals)

2. Check for active hospital admissions (Check the notes tab) 

3. Check for completed monthly follow up. If needed, call the patient to complete the monthly follow-up.

4. Verify resupply Eligibility date (Orders tab) 

5. Verify insurance eligibility (From the notes tab) 

6. Review DWO (Detailed Written Order) 

7. Review for adequate medical notes

8. Review authorization

9. Seek clarity of items requested if needed

Review supplies requested

1.Read Pop-up/Acknowledgement notes (take note of any address changes, shipping address, signature required, new trach tube orders, approval notes etc.)

2.Go to insurance tab to verify which type of insurance pt has

3.Go to notes tab to review insurance verification for the month. HARD STOP if pt is ineligible or has a SOC/Spend Down.

4.In notes tab, confirm Monthly follow up has been completed for the month AND check for active hospital admissions. Also take note of any insurance or address changes.

5.Go to documents tab, verify we have adequate documentation (DWO, Notes, Auth). Some patients will have multiple authorizations on file. Please note that not all insurance requires authorization- agent can find this information in the Insurance Verification note.

6.Verify we have DWO and auth for items requested on the resupply request. Keep DWO and Auth pulled up for reference. The goal is to make sure we’re not ordering items that we DO NOT have DWO or Auth for- escalate to management if assistance is required. The agent will need to go line by line to ensure we have dwo and auth for each item AND quantity requested. (Auth quantities are determined by approved dates of service)

7.Create New Sales Order- Keep 3 windows open: 

• 1 for Resupply Note, 

• 1 for previous order found under Item History, 

• 1 for the sales order. 

• Have DWO and Auth open for reference.

Part 2:

Creating New Sales Order

1. Add items line by line based off resupply note

2. Select correct Procedure code and item quantity

3. Update order note- Resupply note/Item Frequency, Last Dispensed date/Approval note/Signature required/Address change/Trach tube change

4. Any item that exceeds insurance limitations requires an approval note (some notes need to be renewed)

5. Make sure the appropriate CMN’s/PAR’s are linked to the correct item (please note, some pts have multiple CMNs)

6. Review backordered/out of stock items

7. Go tab by tab to verify work

8. Only acceptable error messages are “You must enter the Date of Service”, “Must enter DOS To date.”, “You must select a valid Lot Number”

Sales Order Processing Steps

1. Order Tab

• Update Scheduled Date and Order Note.

Attached is a detailed breakdown of the resupply eligibility date. 

To simplify the scheduled date

The Scheduled Date on the Sales Order should always match the next DOS.
If a patient has SKIPPED months of supplies or is ordering supplies PAST their last DOS, the scheduled date would be one week from the processing date. This would be the patient’s new DOS.
Example: If pts last DOS was 2/27/2025 and the current date is 5/12/2025, that means the scheduled date on the order would be 5/19/2025. The next DOS would be 6/19/2025

• Verify Address (check for separate mailing address).

• Format Order Note as: M/D rn.
  Example: “5/1 rn. Neb kit Q6mos, last disp 11/1/24. Approval for 2 portable circuits.”

2. Clinical Tab

• Confirm Ordering Doctor and Diagnosis Codes match the latest DWO.
  HARD STOP if they don’t match.
  (Note: Some patients have multiple DWOs—use correct one for item type.)

3. Insurance Tab

• Under Primary, verify insurance matches what’s on file.

• Under Verification, select Coverage Verified.

• Remove any policy with 0% coverage.
  
  

4. Items Tab

• Add items from resupply note using Quick Add.

• Match item ID, quantity, and insurance-eligible brands.

• Use prior order history & Brightree Item List.

• Watch for changes in: suction filter/size, trach tie/size/brand, trach tube, suction tip, etc.

• Stay aware of backorder notices from Nhan.
  
  

5. Final Checks

• Confirm resupply note matches sales order (line by line).

• Clear all unacceptable errors (escalate if needed).

• Link all items to correct Active PAR and Active CMN (escalate if pending).

• Print > Preview to ensure all billable items show pricing.

• Set WIP state to 30

• Add mment to resupply note: SO (####) created., then close the note.

EXTRA STEPS FOR MEDICARE PATIENTS:

-Verify insurance eligibility. Because Medicare only covers 80% of the cost of services, all Medicare patients should have a Secondary insurance policy. Escalate to management if the insurance verification note mentions no eligibility for secondary insurance.

-Check for hospital stays from the previous month, this might effect the date of service/resupply date.

-Verify Hospice or Home Health status. Patients that have recently elected hospice might not be eligible for our services- escalate to management. Patients that have home health are not eligible for tracheostomy supplies.

-Utilize SUPPLY QUANTITY ALLOWABLE spreadsheet. Some items like the trach tube are dispensed 1/3 months for Medicare patients, agents must ensure that we are not ordering more than the insurance allowable.

EXTRA STEPS FOR MEDI-CAL MANAGED PATIENTS:

- Utilize SUPPLY QUANTITY ALLOWABLE spreadsheet. Request an APPROVAL NOTE for items that exceed the insurance allowable. Before requesting an approval note, agents must confirm DWO and Auth are on file for the requested quantity. See PROCEDURE FOR SUPPLY ORDERS THAT EXCEED INSURANCE ALLOWABLE handout for reference.

-Most common requested items that require an approval note are Trach tubes and HME’s.

EXTRA STEPS FOR PRIVATE PATIENTS:

- Utilize SUPPLY QUANTITY ALLOWABLE spreadsheet. Some items like the pulse ox probes are covered at 4/mo.

-Double check acknowledgment/pop-up notes if the patient owes any copays. The patient might not be eligible for supplies if there’s an outstanding balance on their account.

EXTRA STEPS FOR HOSPICE PATIENTS:

-LOA (Letter of Agreement) typically only covers rental items. If a patient is requesting suction supplies, the LOA must list each item requested. Escalate to management if assistance is needed.

Airway Management Equipment

• Definition: Devices designed to maintain a clear and open airway in patients who may experience airway obstructions or respiratory distress.

• Health Conditions:

  • 1. Severe allergies or anaphylaxis

    2. Trauma or airway injury

    3. Neurological conditions like ALS or muscular dystrophy

Oxygen Therapy Equipment

• Definition: Devices that deliver supplemental oxygen to patients with respiratory deficiencies.

• Health Conditions:

  • 1. COPD (Chronic Obstructive Pulmonary Disease)

    2. Pulmonary fibrosis

    3. Severe asthma or pneumonia

Respiratory Monitoring Devices

• Definition: Tools that track respiratory function, such as oxygen levels, respiratory rate, and lung capacity.

• Health Conditions:

  • 1. Sleep apnea

    2. Post-surgical recovery

    3. Chronic lung diseases

Portable Ventilators

• Definition: Compact devices that assist or fully control a patient’s breathing when they cannot do so independently.

• Health Conditions:

  • 1. ALS (Amyotrophic Lateral Sclerosis)

    2. Spinal cord injuries

    3. Respiratory failure

Respiratory Assist Devices

• Definition: Non-invasive machines that help patients breathe more effectively without intubation.

• Health Conditions:

  • 1. Obesity hypoventilation syndrome

    2. Central or complex sleep apnea

    3. Neuromuscular disorders

Sleep Therapy Equipment

• Definition: Devices such as CPAP or BiPAP machines used to treat sleep-related breathing disorders.

• Health Conditions:

  • 1. Obstructive sleep apnea

    2. Complex sleep apnea syndrome

    3. Snoring with underlying respiratory concerns

What is the GoTo Connect softphone?

The GoTo Connect softphone is a software-based phone interface integrated into the GoTo Connect app (desktop, web, and mobile). It essentially turns your computer or smartphone into a full-featured business phone, powered by VoIP—no physical handset required

Key Features

• Make & receive calls directly from the app without needing a desk phone

• Dockable interface: you can pop it out, dock it, resize, or pin it on top of other applications .

• Call controls: mute/unmute, hold, transfer, parking, three‑way conferencing, dialpad, caller ID switching

• Audio settings: choose mic, speaker, ringer—ideal for headsets or speakerphone setups .

• Contact integration: search your corporate directory or personal contacts right in the app

• For contact center agents: you get advanced tools—call dispositions, note-taking, histories, recordings, etc.

Here are some resources for GoTo:

https://support.goto.com/connect/help/explore-the-softphone-in-the-goto-app

https://www.youtube.com/watch?v=VnaCvs2xQl4

INBOUND CALLS

OK TO HANDLE:
-Equipment Troubleshoot (vent alarming, something’s not turning on) utilize T/s chat
-Resupply
-Scheduling (tank refills, requesting rt visit etc.) utilize scheduling chat
-General questions (Resupply updates, reporting issues w/resupply, Fax number confirmation, inquiries on services we do not provide etc.)

DO NOT HANDLE- NEED TO TRANSFER:
-Calls from Referrals (hospital case managers, physicians, nurses, social workers etc.)
-Calls from Insurance (CCS, CCAH care management, Blue Shield UM etc.)
-New Inquiries (self-referrals etc.)
-Miscellaneous calls (employment verification, calls for Nhan etc.)