Overview

To provide Medical Assistants with the essential knowledge, skills, and tools needed to perform their roles effectively while upholding the high standards of patient care and professionalism at OSSWF.

Understanding Your Role

Customer Service

Being part of the Clinical staff means you will play a large role in creating a safe and welcoming environment for patients, many of whom are in pain.  Our goal is to provide excellent care to our patients and create a positive experience for them.  This section will outline key principles and best practices for delivering excellent service.

Core Principles of Customer Service

1. Professionalism – Always present yourself in a courteous, respectful, and polished manner.

2. Empathy – Understand and acknowledge patients' concerns with compassion.

3. Efficiency – Be organized and proactive in addressing patient needs quickly.

4. Communication – Maintain clear, friendly, and professional interactions.

5. Problem-Solving – Take initiative to resolve issues promptly and effectively.

Interacting with Patients

• Use a friendly, professional tone when talking to patients

• Address patients by name whenever possible to personalize their experience

• Be aware of body language - stand or sit upright and avoid crossing arms.

Handling Difficult Situations

• Dealing with Frustrated Patients:

  • Listen actively and acknowledge their concern

  • Stay calm and professional, even if the patient is upset

  • Apologize for inconveniences when possible and offer a solution or escalate to the appropriate person if needed.

Often times when people are upset, they just want to be heard.  Having empathy and understanding will go a long way turning an angry patient into a pleasant and happy one.

Insurance & Billing Basics

Frequent Terminology

• Coinsurance: Your share of the costs of a covered health care service, calculated as a percentage (for example, 20%) of your allowed amount for the service. You generally pay coinsurance plus any deductibles you owe. (For example, if the health insurance plan's allowed amount for an office visit is $100 and you've met your deductible, your coinsurance payment of 20% would be $20. The health insurance or plan pays the rest of the allowed amount).

• Copayment: A fixed amount (for example, $15) you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service.

• Deductible: The amount you could owe during a coverage period (usually one year) for health care services.  Generally, this must be paid first.  Once paid, your health insurance or plan will begin to pay towards services based on your benefits. For example, if your deductible is $1,000, your plan won't pay anything until you've met your $1,000 deductible for covered health care services subject to the deductible. The deductible may not apply to all services.

• Out of Pocket Max:  This is the amount you are required to pay before your insurance will cover 100% of covered charges and services.  For example, if you have a $2,000 out of pocket, once you meet that (paid for this amount) your insurance will begin paying all covered services in full making your responsibility $0 for the remaining coverage period.

• Durable Medical Equipment (DME): Equipment and supplies ordered by a health care provider for everyday or extended use. DME may include: walking boots, knee braces, splints, etc.

• Excluded Services/Non-Covered: Health care services that your health insurance or plan doesn't pay for or cover. Examples include: PRP, certain other injections, Duplicate or Similar DMEs, etc.  Certain services are non covered across all plan but some are plan specific.

• Network: The facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services.

  • In-network: Health care providers, facilities, and suppliers that have a contract with your health insurance plan to provide services at negotiated (typically lower) rates. Using in-network providers usually results in lower out-of-pocket costs for the patient. 

  • Out-of-network: Health care providers, facilities, and suppliers that do not have a contract with your health insurance plan. This often means higher costs for the patient, as the insurance may cover a smaller portion of the bill or not cover it at all.  If the insurance is HMO they generally won't pay anything for out of network providers.  PPO plans generally will allow a portion to be paid for out of network providers.

• Preauthorization: A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or DME is medically necessary. Sometimes called prior authorization, prior approval or precertification. Your health insurance or plan may require preauthorization for certain services before you receive them, except in an emergency. Preauthorization isn't a promise your health insurance or plan will cover the cost.

• Urgent vs Emergent: Emergent refers to instances where the patient must receive care to prevent loss of life or limb.  Urgent refers to instances where the patient needs a service but it is not life-threatening.  Only Emergent services are allowed with out authorization

• Premium: The amount that must be paid in order to maintain your coverage for your health insurance or plan. You and/or your employer usually pay it monthly, quarterly or yearly.

• Estimate:  All pricing is considered an estimate and must be explained as such to the patient.  The pricing is based on numerous factors such as coverage, benefits given via insurance, and contract amounts.  There is no guarantee that the patient will only owe this amount.

Fracture Care

BILLING FOR NON SURGICAL TREATMENT OF FRACTURES

“FRACTURE CARE”

Thank you for trusting Orthopedic Specialists of SW Florida (OSSWF) with your care. We understand that dealing with a fracture can be challenging, and we are here to support you every step of the way. As part of your treatment, we want to ensure that you have a clear understanding of the billing process for your fracture care.

Fracture care is billed as a global service package at the beginning of your treatment, which is different from how most other services are billed. Here’s what you need to know:

What Does the Global Package Include?

The global package for fracture care includes:

• All normal/uncomplicated office visits related to your fracture during the next 90 days.

• Any necessary follow-up evaluations to monitor healing.

However, additional services provided during the routine fracture care period may result in extra charges. Some of these billable services may include:

• X-rays

• Casts and braces

• Physical and/or occupational therapy

• Injections

• Treatment of complications

Why Is This Charged Like Surgery?

Many insurance companies classify fracture care under surgical procedures, which may appear as a surgical charge on your explanation of benefits (EOB). This classification is determined by your insurer based on national coding standards set by the American Medical Association (AMA).

As a result, the financial responsibility for fracture care may apply to your deductible and can range from $300-$1200, depending on the type of fracture and your specific benefit plan. While this is common in the industry, we understand it can be unexpected. We encourage you to review your insurance benefits closely and reach out to us if you have any questions or need assistance understanding your coverage.

What Should You Expect?

At OSSWF, we are committed to your health and well-being, and we will continue to follow your fracture through the healing process. If you have any questions about your medical care or billing, please feel free to contact us at (239) 461-3652. Our team is here to assist you.

FAQ’s

Q: “I was diagnosed with a fracture before my appointment at OSSWF. Why are you still billing for fracture care?”

A: The global fee for fracture care is not for the initial diagnosis of the fracture, but for the management and follow-up care related to the fracture for the next 90 days.

Q: “I was diagnosed with a fracture, but no treatment was required. Why are you still billing for fracture care?”

A: Even fractures that heal with little intervention still require monitoring and follow-up care. Treatment may include rest, bracing, physical therapy, and medication (e.g., anti-inflammatory drugs). Your physician and care team will continue to follow up on your fracture to ensure proper healing and address any concerns or complications that may arise.